Department of Psychiatry

• Either elevated, euphoric, or irritable, angry mood
• Racing thoughts and flight of ideas
• Increased activity Inflated self-esteem or grandiosity
• Decreased need for sleep
• Being more talkative than usual
• Distractibility
• Engaging in risky behavior

• Loss of interest in things you used to do
• Feeling sad, blue, or down in the dumps
• Feeling slowed down or restless and unable to sit still
• Increase or decrease in appetite or weight
• Thoughts of death or suicide
• Problems concentrating, thinking, remembering, or making decisions
• Trouble sleeping, or sleeping too much
• Loss of energy or feeling tired all of the time
• Feeling guilty or a sense of worthlessness

The classic form of bipolar disorder is called bipolar I disorder. It is characterized by a person having one or more manic episodes. Most people also experience depressive episodes in addition to manic episodes. Severe episodes of bipolar disorder may lead to periods of psychosis, which may include hallucinations (seeing or hearing things that aren’t there), or delusions (false but strongly held beliefs.

Bipolar II is a type of bipolar disorder in which people have had at least one hypomanic episode in addition to a depressive episode. A hypomanic episode is a period of elevated, expansive, or irritable mood that lasts for a shorter period of time and causes fewer problems in functioning than a manic episode.

Cyclothymia is a chronic, fluctuating mood disturbance characterized by periods of hypomania and periods of depression. Although the person experiences some of the symptoms of depression, the depressive symptoms are not fully characteristic of a major depressive episode.

Some people with Bipolar I or II disorders have rapid cycling. Rapid cycling is currently defined as having 4 or more mood episodes within 12 months. The person might cycle rapidly through different mood states, such as depression, mania, mixed or hypomania.

A mixed episode is characterized by a period of time lasting at least one week, in which symptoms of mania and depression occur at the same time.

Medications are considered an essential part of treatment of bipolar disorder. Medications allow people with bipolar disorder to remain well longer, have fewer recurrences of their illness and remain more in control of their lives. Most often, bipolar medications include mood stabilizing agents and antipsychotic agents. Working with your doctor to learn about a medication’s benefits and side effects is also an essential part of medication treatment. A collaborative working relationship between a patient and his or her psychiatrist is necessary to find the medication or combination of medications that work best. Mood stabilizers are used to reduce the highs and lows of bipolar disorder. The main mood stabilizers in use today include lithium carbonate (Lithonate, Eskalith CR, among others), divalproex sodium (Depakote, Depakote ER, Depakene, valproic acid), lamotrigine (Lamictal) and carbamazepine (Tegretol, Carbetrol).

Atypical antipsychotics have been found to be very useful in the treatment of bipolar disorder, even if a person does not experience psychosis. All of the atypical antipsychotic agents are useful in treating mania, and include risperdone (Risperidal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and aripiprazole (Abilify). In addition, two of the atypicals have been approved to treat bipolar depression: quetiapine and olanzapine/fluoxetine (Symbyax).

The use of antidepressants in treating bipolar disorder is controversial, as there is little medical evidence that they provide benefits in bipolar depression and may worsen the course of the illness over time. While many patients with bipolar disorder still take antidepressants, speaking to one’s doctor about their use, risks, and potential benefits is the best way to proceed.

For a long time, mental health professionals believed that medication was the only effective treatment for bipolar disorder. However, recent research has demonstrated the value of psychotherapy as an addition to medications. People with bipolar disorder may be particularly vulnerable to stress, changes in schedule, sleep patterns, interpersonal difficulties, and negative thinking. These vulnerabilities may lead to changes in mood, such as a manias or depressions. Psychotherapy helps the person and their family to understand the disorder, identify triggers that are associated with mood changes, make changes to their daily structure and schedule, and thinking patterns that may help shorten mood episodes or prevent mood episodes. In addition, psychotherapies can help patients and their families and friends develop effective ways of communicating during a mood episode that can help minimize symptoms. The psychotherapies that have been studied and found effective for bipolar disorder include Cognitive-Behavioral Therapy (CBT), Family Focused Therapy (FFT), and Interpersonal and Social Rhythm Therapy (IPSRT). Psychotherapy also provides people with a safe, understanding environment where they can explore their feelings about being bipolar, and work toward acceptance and effective management of the disorder.

Developed by Aaron Beck, MD, CBT is a structured, goal-oriented form of psychotherapy that aims to help a person recognize negative thoughts and behavioral patterns and to modify them. The CBT model for bipolar disorder proposes that people with this condition often hold problematic beliefs about themselves (e.g. “I must be flawed, guilty or a failure”) which, when activated by life stressors, can trigger symptoms of bipolar disorder. Cognitive-behavioral therapy typically includes helping the person with bipolar disorder to: (1) identify and change strong thoughts or beliefs about themselves or others that may trigger mood shifts, like elation or depression, (2) identify early signs of mania or depression so that prompt action can be taken to prevent a full manic or depressive episode from occurring, (3) monitor and grade mood, physical activity and sleep, and (4) learn problem solving strategies for handling interpersonal problems and stressors.

Family focused therapy (FFT) was developed by David Miklowitz, Ph.D. and Michael Goldstein, Ph.D. at the University of Colorado and UCLA. FFT was developed to help patients and their families to identify stressors that might precipitate a bipolar episode. The goals of FFT are (1) to provide psychoeducation to the patient and their family about bipolar disorder, (2) to enhance communication within the family, and (2) to develop problem solving skills for life stressors, such as relationship or work problems.

Interpersonal and Social Rhythm Therapy (IPSRT), developed by Ellen Frank, Ph.D., is based on the observation that bipolar disorder is in part a problem of altered body rhythms (e.g. sleep patterns, seasonal rhythms, eating, and exercise rhythms), that are often disrupted by interpersonal changes or stressors. Interpersonal problems (e.g., family disputes) and disruptions in daily routines or social rhythms may make people with bipolar disorder more susceptible to new manic or depressive episodes. IPSRT focuses on minimizing these potential triggers. Body rhythm disturbances such as sleep disturbances, can be managed by helping patients to set up and stick to healthy routines. For example, establishing set bedtime and wake times can help stabilize mood and reduce relapses of the illness.