Although I have a general practice and see clients with a variety of problems, Bipolar disorder has become a primary specialty for me. I've had many bipolar clients and found that, although it can be a very debilitating condition, it is quite treatable . I've seen clients learn to understand and manage their moods, using medication and learning new coping strategies that become a routine part of life. For most people with bipolar disorder much improved functioning is possible and many life goals can be realized. Patience and persistence can lead you further than you may believe possible if you are struggling with untreated bipolar disorder now.
What is Bipolar Disorder?
Bipolar Disorders (Bipolar I, Bipolar II and Cyclothymia are included in this discussion) are disorders of mood. Bipolar I and II include major depressive episodes (see depression page). Bipolar I includes at least one manic episode lasting at least one week. Bipolar II includes a hypomanic episode of at least 4 consecutive days. Cyclothymia includes mood swings also, with features of depression and mania, but not enough symptoms to meet the criteria for Bipolar I or II or major depression.
Features of Mania and Hypomania include a period of abnormally expansive, elevated or irritable mood and at least 3 (if mood is elevated) or 4(if mood is irritable) of the following features:
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech (talking fast without stopping to listen)
Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation (not being able to keep still)
Excessive involvement in activities that have a high potential for painful consequences such as over-spending, risky sexual behavior, plunging ahead with plans for business or recreational activities without regard for possible loss or injury.
You may hear or see depicted descriptions of bipolar disorder that vary widely and include an array of behaviors and symptoms. This is because these disorders can vary greatly in the severity of symptoms, length of episodes and combination of features that a particular individual may exhibit. So you may know someone with a bipolar diagnosis who is sometimes very depressed and withdrawn and at other times agitated, impatient and volatile. Another individual with bipolar disorder may at times have delusional beliefs such as believing they possess super powers or that they are about to make millions of dollars on an invention that exists only in their imagination. Some people with Bipolar I experience hallucinations, seeing or hearing things that aren't there. These more severe symptoms are not always present, but surface for limited periods during manic episodes.
If you or someone you care about exhibits these behaviors and symptoms when they are not under the influence of drugs or alcohol, they may have one of these disorders. Some people function fairly well with cyclothymia and milder bouts of depression or mania. They still may be able to benefit from some of the suggestions below about coping with these disorders. Whether the condition seems strong or mild, an assessment by a qualified mental health professional can be useful. These disorders can seriously impair academic, occupational, social and relational functioning. There is real risk of self harm during mania or depression. Establishing a relationship with a mental health professional who sees you in all your moods can be very helpful in developing healthy coping strategies and creating a safety net for individuals with bipolar disorders.
Treatment with medication is often required to stabilize moods. It is important to get the diagnosis clear. Often people with bipolar are diagnosed as having major depression only. This could happen because manic symptoms are not apparent during the assessment and are not reported by the patient. Often Bipolar begins with a major depressive episode and when the patient is first seen there has not yet been a manic episode. Antidepressant medication can sometimes make manic symptoms worse. It's important to report experiences that could be evidence of a manic episode to your treating physician in order to get an accurate diagnosis. Bipolar patients are usually prescribed "mood stabilizers." Often other meds will be added to address depression, anxiety or psychotic features if they are present. This is usually done by a psychiatrist (an MD specializing in mental health problems.) Sometimes a primary care physician will prescribe these medications.
Psychotherapy, in addition to medication, is recommended for newly diagnosed individuals and on an ongoing basis even after symptoms are more controlled in order to help the client monitor moods and learn and continue to improve coping behaviors.
Often the first goals of therapy include learning more about what it means to be bipolar and deciding whether to accept that this diagnosis is accurate for you. If you are bipolar and your symptoms sometimes interfere with your ability to keep a job, maintain friendships, stay in a healthy intimate relationship or make good choices for yourself, this is a situation that is not going to disappear. Once you accept that it is real and decide to learn what you can do to live successfully with bipolar, you have passed what I consider the biggest roadblock to recovery.
We will talk about how you feel about taking medication and address your concerns if you have them. Most people with bipolar do much better when they are on the right medication and stick with it. It can be hard to accept that you will probably be taking meds on a long term basis. Compliance with the medication regime that you and your physician have developed is a very important component of maintaining good functioning with Bipolar. I work with clients to help them stay on their meds and help them address concerns with the prescribing medical professional. I often communicate directly with the Doctor.
With my clients I work on recognizing internal cues that signal oncoming changes in mood. We develop a personalized list of coping responses. These may include mindfulness practices; enlisting a support person; physical coping strategies such as relaxation breathing, stretching, walking, singing; cognitive strategies such as recognizing irrational thoughts and developing a repertoire of rational responses and positive "self-talk"; improving communication skills to deal with conflict and fallout from past episodes of erratic, angry or odd behavior; improving anger management.
In particular, most bipolar individuals need to learn to develop realistic goals and manage time effectively. During periods of expansiveness, individuals may bite off more than they can chew and end up overloaded with commitments. This often leads to a "crash" which precipitates a depressed episode. It is sometimes challenging for individuals who love the exhilaration of the creative stages of a project to tolerate the routine and sometimes unexciting phase of follow thru with a plan. It is possible to learn to be more of a tortoise who succeeds through "slow and steady" effort. It is also possible to learn to successfully harness your enthusiasm during more energized periods without spinning too fast. Learning to prioritize and stick to a plan and a schedule can be an important key to successful functioning with Bipolar.
Bipolar often affects cognitive functioning and memory. Some of these problems can be ameliorated by learning to focus attention, write things down and develop other organizational skills.
Often we will focus on specific issues of impulse control and addictive behaviors that may include, substance abuse, spending, gambling, eating problems, sexual activity, self-harming, and others.
Besides the special issues of bipolar disorder, my clients present the same range of additional issues that other clients present. We may also address anxiety, relationship problems, substance abuse and addiction, grief and loss, recovery from trauma or abuse, self-acceptance and identity issues, phase of life issues, and others. Please see the Home Page for a list of various therapy approaches in which I am trained and experienced.
I LOOK FORWARD TO MEETING YOU AND ANSWERING ANY QUESTIONS YOU MAY HAVE ABOUT THERAPY