Treating Bipolar Disorder

While the term “manic depression” is still often used in everyday language, it was replaced in formal psychiatric classification with Bipolar Disorder in 1980.  Bipolar Disorder has degrees of severity and is not always experienced in the same way by those individuals who suffer from it. This is recognised by the diagnostic manual  DSM-5, which subdivides Bipolar Disorder principally, but not solely, into Bipolar Disorder I, Bipolar Disorder II, Cyclothymic Disorder (often referred to as Bipolar III) and Bipolar Disorder Not Otherwise Specified.

Highs and Lows: Types of mania and depression

Mania is a defining phase in Bipolar Disorder I, during which the person experiences periods of intensely heightened mood.   Bipolar mania can last several months or just a few days. This may include irritability, racing thoughts, unusually intense energy or extreme manifestations of various behaviours. This may be interspersed with periods of depression featuring symptoms such as low mood, much reduced morale and motivation, feelings of hopelessness and physical inertia.

Hypomania is a somewhat less intense version of mania. Hypomanic episodes feature in a diagnosis of Bipolar II Disorder along with alternating episodes of depression.  Hypomania can sometimes morph into mania.

Cyclothymic Disorder is the least severe Bipolar condition and a diagnosis requires that for at least two years the person has frequently experienced symptoms of hypomania and depression. These have to be insufficiently severe to be classed as either a hypomanic episode or a major depressive episode.  Cyclothymic Disorder tends not to be incapacitating or particularly debilitating.  However, it can become more serious if not recognised and responded to.

From understanding how the disorder works to practical steps to restore stability

Understanding the condition from which you suffer helps to reduce anxiety and provides a basis from which to take action to restore wellbeing. Examination of the way the person lives their life may shed light on things that threaten stability of mood. Psychotherapy or counselling can help them recognise patterns and particularly the warning signs that mood is heading one way or the other and develop preventative or coping strategies. Medication is often an essential component of any treatment plan to avoid the disruption caused by dramatic and intense swings from one extreme to the other. Practical steps to ensure that medication is taken consistently as prescribed is advisable, such as saving a reminder into a mobile phone.

Combining therapies and ensuring the availability of support

The aim of therapy is to acquire as much stability as possible in mood as well as in related thoughts, behaviours and sensory sensitivity. This may be achieved through a combination of health education, lifestyle changes, psychotherapy and prescribed medication.  As with many health conditions, isolation and social disconnection are to be avoided.  A good support system is vital.  Other people sometimes see signs of an impending episode of hypomania, mania or depression before the person themselves.  Well-informed family and friends can help provide a safety net and resources for recovery should this occur.

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Clinically Reviewed By

Dr. Victor Leroy

Dr. Victor Leroy, a psychiatrist with specialised training in addiction psychiatry from Lausanne University Hospital, combines medical expertise with a passion for systemic psychotherapy. He has worked at length in both the public and private sector, utilising a combination of patient-centered approaches to support them and their loved ones in recovery. A member of AVMCA and COROMA, he consults in French, English, German, and Italian, focusing on integrated care for addiction medicine.

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