Bipolar Disorder For Dummies Cheat Sheet

What is bipolar disorder?

Bipolar disorder is a physical illness that affects the brain. A bipolar diagnosis requires at least one episode of mania (often characterized by high energy, racing thoughts, irritability, and rapid speech that negatively affect one’s ability to function) or hypomania (a less severe form of mania.)

Also, the disorder typically includes episodes of depression that alternate with the mania or hypomania. Your specific diagnosis depends on your symptoms.

Bipolar disorder diagnostic categories

In the U.S., doctors refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM), which provides several different categories for bipolar disorder:

• Bipolar I: The classic form of bipolar disorder is diagnosed when someone experiences at least one manic episode. Most people with Bipolar I also experience periods of major depression, and these are referred to as bipolar depressive episodes.
• Bipolar II: People with bipolar II experience hypomanic episodes and recurrent major depressive episodes. If mania enters the picture, the diagnosis changes to bipolar I.

• Cyclothymic disorder: This is a chronic cycling mood disorder characterized by numerous periods with hypomanic symptoms that aren’t enough to qualify as hypomanic episodes and numerous periods with depressive symptoms that aren’t enough to qualify as depressive episodes.

  Symptoms must last at least two years in adults and one year in children and adolescents. These symptoms must be present at least half the time with no symptom-free period lasting longer than two months.

  Additionally, for a diagnosis of Bipolar I or II or cyclothymic disorder, symptoms must not be caused by substances or a medical condition, cannot be attributed to schizoaffective disorder, and the pattern of shifting mood states must cause significant distress or impairment in important areas of function.

• Substance/medication-induced bipolar disorder: Bipolar symptoms can be attributed to intoxication or withdrawal from drugs or alcohol or medication side effects.
• Bipolar and related disorder due to another medical condition: Bipolar symptoms can be attributed to another medical condition, such as hyperthyroidism (overactive thyroid).
• Other specified bipolar and related disorder: Introduced in DSM-5, this category enables doctors to diagnose bipolar disorder when symptoms characteristic of bipolar disorder significantly impair normal function or cause considerable distress but don’t quite meet the full diagnostic criteria for the other bipolar diagnostic classes.

• Unspecified bipolar disorder: This form of bipolar involves variations of cycling moods that resemble manic or depressive episodes and interfere with daily routines but don’t fulfill the complete diagnostic requirements for the other classifications of bipolar disorder in this list.

  This diagnosis is used instead of other specified bipolar and related disorder when a doctor, for whatever reason, doesn’t want to go into detail about why the criteria for a specific bipolar diagnosis hasn’t been met; for example, in emergency room settings.

Bipolar disorder specifiers

The DSM provides specifiers that enable doctors to more fully describe the person’s condition:

• Current or most recent episode: Manic, hypomanic, or depressed
• Severity of illness: Mild, moderate, or severe
• Presence or absence of psychosis: Delusional thinking, paranoia, or hallucinations that may accompany depression or mania
• Course of illness: Active (with or without psychosis), in partial remission, or in full remission
• With anxious distress: If symptoms include significant anxiety symptoms
• With mixed features: For example, mania with symptoms of depression, such as guilt, hopelessness, or suicidal thoughts; or depression with symptoms of mania, such as physical agitation and racing thoughts
• With rapid cycling: Characterized by four or more mood episodes in a 12-month period
• With melancholic features: Extreme depression with very low mood and energy
• With atypical features: Symptoms that used to be considered less typical of depression but are now recognized as frequent features of depression (for example, sleeping too much)
• With catatonia: A state of minimal responsiveness to the environment and abnormal movement
• With peripartum onset: The bipolar mood episode occurs any time during pregnancy or in the four weeks after delivery
• With seasonal pattern: Mood episodes follow a pattern corresponding to the seasons or specific times of year

If left untreated, bipolar disorder (and other mental health disorders) could become so severe that a person suffering from them might experience thoughts of self-harm. If this is happening to you or a loved one, call the National Suicide Prevention Lifeline at (800) 273-8255, or your local suicide prevention hotline.

Treating the brain: Medications

The primary treatment for bipolar disorder is medication with the goal of restoring normal brain function. Medications can be categorized by the conditions they’re commonly used to treat. See below.

Medications for treating mania

Medications that target mania include lithium; certain anticonvulsants, such as valproate (Depakote); second generation antipsychotics, such as olanzapine (Zyprexa) and aripiprazole (Abilify); and the first-generation antipsychotic haloperidol (Haldol). Acute mania is a medical emergency, and doctors often layer antimanic agents to help resolve symptoms quickly.

Medications for treating bipolar depression

Bipolar depression doesn’t respond to medications the same way that unipolar depression does. Medications that specifically treat bipolar depression include quetiapine (Seroquel), lurasidone (Latuda), and a combination of fluoxetine (Prozac) and olanzapine (Zyprexa) called Symbyax.

However, treating bipolar depression is challenging and treatments can expand to include other medications, such as lithium; the anticonvulsant lamotrigine (Lamictal); valproate (Depakote); and newer second-generation antipsychotics including caripraszine (Vraylar) and lumateperone (Caplyta).

Antidepressants can be less effective in bipolar depression and can trigger manic symptoms, but they are still used in many situations. These include the selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), and citalopram (Celexa); and the serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq).

Bupropion (Wellbutrin) is another antidepressant that is sometimes used to treat bipolar depression.

Antipsychotics

Antipsychotics were originally developed to help treat schizophrenia, but they’re often also useful in treating psychosis that sometimes accompanies acute mania or depression.

Some medications in this category also have antidepressant effects. This group includes the first-generation antipsychotic haloperidol (Haldol) and second-generation antipsychotics, including aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal).

Others include asenapine (Saphris), ziprasidone (Geodon), paliperidone (Invega), cariprazine (Vraylar), and lumateperone (Caplyta).

Maintenance/prevention medications

These are medications that are continued after an acute mood episode to reduce the likelihood that another mood cycle will occur. Usually, the doctor will continue whatever medication(s) that helped to reduce the mania and/or depression, such as lithium and valproate (Depakote), often with an antipsychotic.

One of the goals in preventive management is to reduce medications when possible, and sometimes the antipsychotics can be removed at some point.

The anti-convulsant lamotrigine (Lamictal) is an effective maintenance medication for some people, but it doesn’t treat acute mania.

Antianxiety medications

Antianxiety medications (sometimes called anxiolytics, pronounced ang-zy-oh-lit-ics) include alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin).

Antianxiety medications aren’t used to treat the bipolar disorder itself but to help with the commonly co-occurring symptoms of anxiety or agitation.

Sleep aids

Because sleeplessness often accompanies mania or depression and may exacerbate it, doctors may prescribe sedative/hypnotics, such as zolpidem (Ambien), eszopiclone (Lunesta), and zaleplon (Sonata). They may also prescribe melatonin or the melatonin receptor antagonist ramelteon (Rozerem); or a newer class of sleep medications called dual orexin receptor antagonists, such as suvorexant (Belsomra).

Sometimes, doctors prescribe other medications to use their sedating side effects, such as the older antidepressants trazodone (Desyrel) and mirtazapine (Remeron); or the anticonvulsant gabapentin (Neurontin). These aren’t used to treat bipolar symptoms, but rather to help manage sleep issues that often affect people with bipolar and that can complicate the illness.

Note: Other treatments target the biology of the brain, including light therapy, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS).

These therapies, like medication, are designed to treat bipolar from the inside out via the brain. Other therapies and self-help strategies, including interpersonal and social rhythm therapy (IPSRT), mindfulness training, and dialectical behavioral therapy (DBT), help manage bipolar from the outside in.

Maintaining mood stability

The overall treatment plan for helping a person with bipolar disorder achieve and maintain mood stability is fairly straightforward:

• Take your medications as prescribed, even when you’re feeling well, and consult your doctor before making any medication changes.
• Establish routines that ensure a regular sleep-wake schedule. Lack of quality sleep is related to mood instability and is often a warning sign of an impending mood episode.
• Ingest more of the stuff that nourishes and supports you and less of the stuff that increase the risks of mood episodes. Heavy use of cannabis and alcohol are particularly high risk when managing bipolar disorder.
• Exercise. Try to remain physically active. Even a relaxing 30-minute walk or 1 to 5 minutes of intensive exercise a few times a week can help health and mood.
• Monitor your moods and seek help sooner rather than later. Early intervention can prevent major mood meltdowns.

10 ways to help a loved-one with bipolar disorder

If a loved one has bipolar disorder, you’re probably wondering what you can do to help. Although your loved one ultimately decides what your level of involvement will be, the two of you may want to consider the following ways you can help:

• Get educated. Knowing what your loved one is dealing with leads to understanding and empathy, which are essential to becoming an effective support person.
• Establish a structured schedule. Daily routines, especially consistent sleep-wake cycles, are important for mood stability and are much easier for your loved one to maintain in a supportive, structured household.
• Tone down the volume and emotions. Intense emotional reactions, in particular criticism and hostility may contribute to mood instability, so try to maintain a relatively calm atmosphere.
• Avoid the four big communication no-nos. Criticism, blame, judgment, and demand are likely to drive a wedge between you and your loved one. Ban them from your interactions.
• Hone your communication skills. How you say something is often as important as what you say when talking with others. Establish a receptive forum by using effective communication techniques.
• Establish boundaries and respect autonomy. Loved ones with bipolar disorder maintain their autonomy to make decisions, except in extreme circumstances — when their symptoms create a risk of harm to themselves or others. Bipolar often limits insight into the illness, and your loved one’s decisions may frustrate you. Try to stay connected without trying to control them. The long-term picture is best served by respecting their humanity and sitting with their struggle rather than taking a win/lose approach.
• Become a problem solver. When conflict arises, approach the issue as a mutual problem to be solved together instead of as a disagreement in which one person is right and the other is wrong. Work together to find ways to meet everyone’s needs.
• Reschedule when discussion becomes unproductive. Take a timeout when discussion begins to heat up and then return to the negotiating table when emotions have cooled.
• Take care of yourself. One of the burdens that your loved one with bipolar carries is seeing how miserable it makes you. Feeling sorry for yourself is natural and understandable, but try as much as possible to focus on more pleasant aspects of your life, such as friends, hobbies, and managing your own well-being.
• Have fun together. At times, bipolar disorder may be your life, but it doesn’t always have to be. When symptoms subside, make enjoyable times together a priority.

Ask your loved one for specific ways you can help, such as attending doctor visits, assuming management of the family finances, or even cooking or doing the laundry. You don’t want to do everything for your loved one — daily chores provide routine and a sense of accomplishment — but try to ease the burden, especially during times of mood instability.