Bipolar Disorder (cont'd)

The Course of Bipolar Disorder

Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third find that some linger. A small percentage experience chronic unremitting symptoms despite treatment.

Bipolar I disorder is the classic form of the illness, which involves recurrent episodes of mania and depression. People with bipolar II disorder never develop severe mania; instead they experience episodes of hypomania that alternate with depression.

When four or more episodes of illness occur within a twelve-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

Most people with bipolar disorder can lead healthy and productive lives when the illness is properly treated. Without treatment, however, the disorder tends to worsen. Over time a person may suffer more frequent and more severe manic and depressive episodes than when the illness first appeared.

Some people with bipolar disorder become suicidal. Risk for suicide appears to be greater earlier in the course of the illness. A person with bipolar disorder, or anyone thinking about committing suicide, needs immediate attention from a mental health professional or a physician.

Treatment

To achieve wellness, it is essential that people receive treatment for a co-occurring anxiety disorder and bipolar disorder. Treatment for both, however, is more complex than treatment for one.

Carefully consider all treatment options with your doctor or mental health provider: medication, therapy, or a combination. With proper treatment, anxiety disorders and bipolar disorder can be overcome.

Medications
When treating a co-occurring anxiety and bipolar disorder with medication [1], most doctors first prescribe a mood stabilizer to address the bipolar disorder.

Starting an antidepressant (a common medication approach for anxiety disorders) before mood stabilization is achieved may worsen the bipolar disorder symptoms. However, an antidepressant can trigger manic episodes, even while taking a mood stabilizer.

For this reason, doctors sometimes avoid prescribing antidepressants or prescribe them at a low dose for patients with co-occurring disorders, and they monitor carefully any patients who are taking a mood stabilizer and an antidepressant.

Because benzodiazepines (a class of drugs often used to treat anxiety disorders) do not appear to have negative effects on bipolar disorder, they may be used for anxiety in patients with co-occurring bipolar disorder. However, they may cause side effects, including physical dependence and tolerance (a need for more medication over time), and there is some risk of abuse among people suffering from bipolar disorder, particularly those who have experienced alcohol or substance abuse.

People may need to try a few different combinations to find the most effective medications.

Types of Therapy
People with bipolar disorder should receive medication for mood stabilization. But therapy also plays an important role.

Using cognitive-behavioral therapy (CBT) or another evidence-based psychotherapy instead of medication for an anxiety disorder addresses concerns about side effects from taking mood stabilizers with anti-anxiety medications.

Below are forms of therapy with varying levels of research evidence for anxiety disorders:

• Cognitive-Behavioral Therapy. Many therapists use cognitive and behavior therapies, often referred to as CBT, which is a short-term form of psychotherapy. Learn more about CBT [2].
• Family Therapy. This form of therapy uses strategies to reduce the level of distress within a family that may either contribute to an ill person’s symptoms or result from them.
• Relaxation Techniques. These techniques may help people develop the ability to cope more effectively with the stresses that contribute to anxiety and mood, as well as with any associated physical symptoms. Breathing re-training, progressive muscle relaxation, and exercise are among the techniques.
• Interpersonal and Social Rhythm Therapy. Effective for bipolar disorder, this treatment program stresses maintaining a regular schedule of daily activities and stability in personal relationships. Patients record the timing of their activities, moods, and levels of social stimulation. As treatment progresses, they work to keep stable social rhythms (when to sleep, exercise, eat, etc.), anticipate events that could disrupt rhythms, and develop plans for continued mood and social rhythm stability.

Getting Help

Find a therapist who treats anxiety disorders [3].

Consider asking the following questions during your initial consultation:

• What training and experience do you have in treating anxiety disorders and bipolar disorder?
• What is your basic approach to treatment?
• Do you recommend treating the anxiety first or the bipolar disorder?
• How do you manage treatment if I am seeing another doctor/therapist for treatment as well?
• Can you prescribe medication or refer me to someone who can?
• How long is the course of treatment?
• How frequent are treatment sessions and how long do they last?
• Do you include family members in therapy?
• Will it be possible to reach you after hours in the event of an emergency or crisis?
• What is your fee schedule, and do you have a sliding scale for varying financial circumstances?
• What kinds of health insurance do you accept?

More Steps to Reduce Anxiety and Regulate Mood

Join a support group. Search for one here [4]. Learn about other self-help groups at the Depression and Bipolar Support Alliance (DBSA) [5] website.

Exercise regularly. Exercise can have a beneficial effect on anxiety, bipolar disorder, and depression because chemicals released during exercise have a stabilizing effect on mood. Set a goal of 30 minutes of activity three to five times a week: Jog, walk, bike, or dance.

Get a good night’s sleep. Sleep deprivation is never beneficial. As noted above, insomnia can be a trigger for manic episodes. Learn more about anxiety and sleep disorders[LINK to new page].

Avoid alcohol and drugs. Alcohol and drugs that have not been prescribed can aggravate anxiety, trigger panic attacks, and worsen episodes of mood disorders. Find out more about anxiety disorders and substance abuse [6].

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