Breaking Down the Bipolar Spectrum: Tailored Treatment Approaches
Many of us are familiar with the term ‘bipolar’. We commonly associate it with moodiness, but bipolar disorder or bipolar spectrum is much more than that. Bipolar disorder is a mood disorder and is prevalent in 0.5% to 5% of the population. Like many psychological conditions, it can be managed with proper and timely treatment. Before we delve into the treatment of bipolar disorder, let’s take a quick look at what it is.
What is Bipolar Disorder?
Bipolar disorder is characterised by an individual cycling between two or more mood states, or highs and lows. Mood states include:
- Depression
- Mania
- hypomania (a milder form of mania)
- and a mixed state where the individual may show signs of both depression and mania.
Bipolar disorders are classified into four types:
- Bipolar I - Manic or mixed episodes, with or without depressive episodes
- Bipolar II - Episodes of hypomania and depression, without a history of manic episodes
- Cyclothymia - Cycling between hypomania and depression
- Other specified bipolar and related disorders - Manic symptoms that do not fit into other diagnostic criteria
How is Bipolar Disorder diagnosed?
Because of its complexity, it takes time to accurately diagnose bipolar disorder. A diagnostic valuation includes:
- Mental health history and evaluation
- Charting mood
- Medical history and tests
- Psychiatric assessment tests
Treatment of bipolar disorder
Bipolar treatment usually involves a combination of medication and psychotherapy. The exact permutation and the type of medication and psychotherapy are tailored to suit the individual. For example, if one is currently in the middle of an episode, the treatment may be different from what is appropriate for someone who is currently ‘euthymic’ - or, in a normative mood state. Family therapy is also found to be useful in the management of bipolar disorder considering that the fluctuations in mood states impact the family system, too. Lifestyle changes like including daily movement are also helpful in managing one’s mood.
Let’s look at these in a bit more detail.
- Medication
Three main types of medications are used for the treatment of bipolar disorder: mood stabilizers and./or antipsychotics, and antidepressants. Lithium is a popular mood stabilizer that is commonly associated with the treatment of Bipolar Disorder.
- Psychotherapy
Long-term, ongoing psychotherapy is recommended in cases of bipolar disorder. Psychotherapy can equip the individual with strategies to manage symptoms, chart moods, and manage the discomfort and anxiety that may come with living with bipolar. Psychotherapy is also an avenue to gain some valuable education and information about the illness.
There are specific psychotherapies that are found to be particularly helpful for the management of bipolar disorder. These are listed below:
- Cognitive Behavioural Therapy: Cognitive Behavioural Therapy or CBT is helpful is the management of depression. Bipolar disorder can also come with difficulties in the sleep cycle. CBT for insomnia is a line of treatment that can help improve one’s sleep. CBT can also help reframe how one views bipolar disorder, easing the negative feelings or thoughts associated with it.
- Interpersonal and Social Rhythm Therapy: Considering that bipolar disorder can disrupt one’s routine and rhythm, this form of therapy can help maintain a sense of stability through the highs and lows of living with the illness. ISRT is focused on regulating one’s circadian rhythm by stabilizing the individual’s routine. Working on interpersonal relationships is also an important part of this line of treatment.
- Family-focused therapy
Someone I know lives with bipolar disorder. During the depressive episodes, she would be unable to get out of bed, and all she wanted to do was - nothing. Her mother would leave her bedroom door open, head to the kitchen, and make her daughter’s favourite meals. The aroma would stir up some appetite in her, and give her a reason to get out of bed. This intervention from the mother is so powerful because it’s silent, not imposing at all, and full of love and assurance.
Families play an important role in the management of bipolar disorder. This is where family-focused therapy can help. By offering psychoeducation to the caregivers, it can help the family better manage symptoms and episodes as and when they arise.
- Lifestyle changes
There’s a growing body of research which shows that our lifestyle habits impact our mental health. Making appropriate changes in diet and incorporating regular exercise are two lifestyle-related changes that have been shown to help with the management of bipolar symptoms. Exercise is particularly helpful for the management of depressive symptoms. However, remember that it’s important to consult with your healthcare providers - psychiatrists, psychotherapists and nutritionists - before making any lifestyle changes.
Bipolar disorder can be an overwhelming condition to live with. But, with the right combination of treatments, it can be managed.
Kay Redfield Jamison is an American psychologist, working as a clinician and an academic. She is also bipolar. Yes, you read it right. She is the healer and the healed, with a prolific career as a psychotherapist and a writer. She points out, “Because I teach and write about bipolar illness, I’m often asked what is the most important factor in treating bipolar disorder. My answer is competence. Empathy is important, but competence is essential”.
In her memoir, The Unquiet Mind, Jamison offers a unique, dual perspective on living with bipolar - as a patient, and a clinician. It’s a must-read, and I recommend it to anyone who is living with or has a loved one who is living with bipolar. Through her candour and academic brilliance, Jamison shows us that bipolar, while debilitating, can be managed.
I find Jamison’s story extremely inspiring. Despite severe episodes, she has built a career and a life for herself, showing us that while living with bipolar may come with its challenges, one can still find valuable and meaningful pursuits in life.
References:
Apa (2024).org. https://www.apa.org/monitor/2022/01/ce-bipolar-spectrum#:~:text=Bipolar%20disorder%20is%20an%20episodic
Bauer, I. E., Gálvez, J. F., Hamilton, J. E., Balanzá-Martínez, V., Zunta-Soares, G. B., Soares, J. C., & Meyer, T. D. (2016). Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. Journal of Psychiatric Research, 74(74), 1–7. https://doi.org/10.1016/j.jpsychires.2015.12.006
Bhandari, S. (2022, October 31). Treatment of Bipolar Disorder. WebMD. https://www.webmd.com/bipolar-disorder/understanding-bipolar-disorder-treatment
Clemente, A. S., Diniz, B. S., Nicolato, R., Kapczinski, F. P., Soares, J. C., Firmo, J. O., Castro-Costa, É., Clemente, A. S., Diniz, B. S., Nicolato, R., Kapczinski, F. P., Soares, J. C., Firmo, J. O., & Castro-Costa, É. (2015). Bipolar disorder prevalence: a systematic review and meta-analysis of the literature. Brazilian Journal of Psychiatry, 37(2), 155–161. https://doi.org/10.1590/1516-4446-2012-1693
Frank, E., Swartz, H. A., & Boland, E. (2007). Interpersonal and social rhythm therapy: an intervention addressing rhythm dysregulation in bipolar disorder. Dialogues in Clinical Neuroscience, 9(3), 325–332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202498/
Mayo Clinic. (2021, February 16). Bipolar disorder - Diagnosis and treatment. Mayoclinic.org. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961
National Institute of Mental Health. (2023, February). Bipolar Disorder. National Institute of Mental Health; National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder
NHS. (2021, February 11). Treatment - Bipolar Disorder. Nhs.uk; Crown. https://www.nhs.uk/mental-health/conditions/bipolar-disorder/treatment/
Sylvia, L. G., Pegg, S. L., Dufour, S. C., Janos, J. A., Bernstein, E. E., Chang, W. C., Hall, N. E., Ellard, K. K., Nierenberg, A. A., & Deckersbach, T. (2019). Pilot study of a lifestyle intervention for bipolar disorder: Nutrition exercise wellness treatment (NEW Tx). Journal of Affective Disorders, 250, 278–283. https://doi.org/10.1016/j.jad.2019.03.033