Bipolar 101 What to do after diagnosis

You hear it all the time, a person is given a diagnosis of bipolar disorder, the doctor writes a prescription, tells them to book a follow up appointment and that person leaves the doctors office with a lot of unanswered questions. Often their first reaction is denial, confusion, frustration and for some possibly relief that they’re not crazy.

Bipolar is an illness were those diagnosed and the people caring for them will both need understanding and emotional support. The best place to fulfill these needs is through education. When you take time to learn about the disorder you begin to find a much needed balance. Gaining knowledge empowers you to move forward and puts you on a path towards “recovery.”

In this article I’ll be covering basic information to get you started. To begin you should know it is possible for someone to go years before being diagnosed. Statistically nearly 7 out of 10 people with bipolar are misdiagnosed as least once, and that average length or time from the first symptoms to correct diagnosis is 10 years. Therefore it’s completely understandable why denial, confusion or frustrations are all common reactions to the diagnosis.

Current beliefs/findings are that bipolar disorder is primarily brought about by abnormal biological changes in brain chemistry. These changes involve mood swings from mania to depression. There are symptoms in addition to mania and depression but in general all forms of bipolar include obvious changes in moods. It’s important to note with bipolar these mood changes are episodic, meaning they’re not continuous but come in separate and distinct bouts.

Researchers are looking into a possible gene as a contributing factor, but so far no gene has been linked to bipolar disorder. Although studies are showing that bipolar tends to run in families. Statistically a child whose parent has bipolar is15-30 % more likely to develop the illness and when both parents have the disorder that number rockets to 50-75%.

To help you get a better picture of the illness the following categories are used to describe bipolar disorder. These include bipolar I, bipolar II, Cyclothymia, Rapid Cycling and NOS.

Bipolar I; Is diagnosed when a person experiences severe depressive and full-blown manic episodes. It is estimated that about 1% of the general populations has bipolar I

Bipolar II; Is diagnosed when a person has frequent major depressive episodes and more episodes of hypomania instead of full blown mania. Bipolar II is the more common form to be diagnosed.

Cyclothymia; A person diagnosed with cyclothymia is usually perceived as extremely moody and very emotionally reactive. This is considered to be a milder version of bipolar II. Still if left untreated cyclothymia usually will develop into bipolar I or II.

Rapid Cycling; You’ll hear this term to describe when a person has more than four manic / depressive episodes within a twelve month period. Statistically 10-20% of people with bipolar will develop rapid cycling. Rapid cycling is also more common in women and those diagnosed with bipolar II.

Not Otherwise Specified (NOS); basically this term describes a variation of bipolar disorder that doesn’t follow any particular pattern.

As I mention there are shared symptoms aside from the depression and mania. These may include delusions, hallucinations, paranoia, intense anger or irritability, anxiety, feeling overwhelmed, lack of focus, suicidal thoughts or impulses, self-harm and also hypochondria. It is the combination, length and severity of the symptoms that can lead to a proper diagnosis.

Once you receive a bipolar diagnosis it becomes important to track your moods, medications, and life style choices (food, exercise & environments). By doing this you learn to spot warning signs, see patterns, or possibly avoid triggers. To put this in perspective I’ve listed some common symptoms of depression, signs of mania and possible triggers.

Starting with depression the obvious signs include prolonged sadness, feeling of hopelessness or suicide. But restlessness, irritability, increased worry, anxiety and inability to concentrate or make decisions can be signs. Also when tracking your moods pay attention to changes in your appetite (eating more or less), changes in your sleep (sleeping more or less) and if you notice you’re less interested in activities that you normally would enjoy make note of this. These are all signs of depression.

The other side of bipolar is manic or hypomania. Both are evident when your mood is abnormally energetic or irritable. Noticing hypomania can sometimes be difficult because a person feels good, continues to be productive and is functionally well but unlike a full blown manic episode hypomania shouldn’t require emergency care. What you’re looking to spot is when those abnormally increased energy levels last more than a week.

Although bipolar symptoms are a result of biological changes in brain chemistry it is possible triggers can ignite bipolar episodes. Obviously all trigger may not be avoided yet it’s still important to know what they are. Some common triggers involve stressors such as arguments, certain social or family events and alcohol or drug abuse. Simple everyday tasks like poor sleep habits, unhealthy eating choices, relationship issues or anything that disrupts your balance can trigger an episode.

Taking the time to track your symptoms and triggers helps to make educated decisions on the medications you may be prescribed. Unfortunately not everyone responds to these medications in the same way. Be prepared to try several different combination's and dosages before you find one that works for you. The other problem with bipolar medications is the amount of time that may pass before you see any affects. Because of these extended time periods finding the best combination could reasonably take a month or even over a year. This fact makes it easy to understand the frustration many people feel when seeking medication treatment for bipolar disorder.

Usually, bipolar medications are prescribed by a psychiatrist. But in some cases clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. With mood stabilizers, antipsychotics and antidepressants there are numerous medications available, leaving open an infant number of combinations. When you’re given these prescriptions take a moment to learn the names, what category they fall under and what they are used for. Ask what side affects you should be looking out for, what is normal and what needs immediate attention. From the beginning and as you continue on chart all your medications including the dosages and side affects, this will help determine what combination works best for you over a period of ime.

Starting with Mood Stabilizing medications, these are usually the first choice to treat bipolar disorder. Their function is to help even out the highs and lows. Mood stabilizers (or anticonvulsants) are generally used in the long term treatment of bipolar disorder. With mood stabilizers you may notice a variety of side affects including, restlessness, dry mouth, bloating, indigestion, heartburn, acne, drowsiness, dizziness, discomfort to cold temperature, joint or muscle pain, headache, diarrhea, constipation, brittle hair and nails or even mood swings.

To treat the symptoms of mania you may be prescribed an atypical antipsychotic medication. With most atypical antipsychotics the side effects go away after a few days and often can be managed successfully. These include dizziness when changing positions, blurred vision, rapid heartbeat, sensitivity to the sun, skin rashes, menstrual problems, major weight gain and a change in metabolism.

Antidepressants are used to help lift the depressive symptoms of bipolar disorders. People with bipolar disorder who take an antidepressant are often prescribed a mood stabilizer. The reason for taking both is if you’re only on an antidepressant you can increase your risk of developing rapid cycling and hypomania or mania. With antidepressants the side affects do subside after a few days, but it is possible for them to remain consistent. You may notice headaches, nausea, sleeplessness, drowsiness or feeling jittery. And both men and women could experience sexual problems.

When it comes to your meds don’t take anything for granted we know certain medication and supplement combination's may cause unwanted or even dangerous side affects. Tell your doctor about all prescription drugs, over-the-counter medications or supplements you’re using.

Medications are just one part of managing your bipolar disorder. The second treatment includes therapy. A licensed psychiatrist, psychologist, social worker, or counselor can provide therapy for bipolar disorder. Remember you’re looking for a long term partnership. The doctor you choose will be assisting you to put in place your personal treatment plan. Find a doctor, who makes you feel comfortable, listens and understands bipolar disorder. If you don’t feel your needs are being met it’s perfectly OK to switch doctors.

Most therapists use a combination of approaches including cognitive and interpersonal therapies to help manage bipolar symptoms. The purpose of these behavioral therapies is for you to begin changing and gaining control over any unwanted behaviors. For example cognitive behavioral therapy or CBT helps people with bipolar learn to change harmful of negative thought patterns and behaviors into positive thoughts and actions. A method of therapy that works towards managing your daily routine and to improve your relationships is known as interpersonal and social rhythm therapy. And at some point you may work with family-focused therapy. This process is used to enhance family coping strategies. Examples would include recognizing new manic or depression episodes, learning how to avoid triggers, working on improving communication and also become skilled at problem solving.

Other terms you may hear include psycho education which is a therapy group where participants learn to recognize signs of relapse making it easier to get treatment early on. And the other is electroconvulsive therapy (ECT) also known as shock treatment. ETC is controversial but still used to help people who have tried medications and psychotherapy and they don’t work.

With bipolar disorder maintaining stability requires a good strategy incorporating, staying educated, healthy eating, exercise, avoiding stress, therapy, medications, a sleep routine, coping skills, having an emergency plan in place, making sure to surround yourself with positive people and eliminate toxic relationships. The road to “recovery” begins with balance.

You now have a basic educational foundation to begin moving forward. As you can see bipolar disorder is an illness that is as individual as the person diagnosed with it. Some sufferers will experience episodes of depression and mania over many years and others become symptom free. Therefore when is comes to the meaning of recovery it’s up to you to determine what “recovery” will look like.

Start by finding out which category of bipolar you’ve been diagnosed with. Then put together a complete charting system. By efficiently tracking your signs, symptoms, medications etc. you make it possible to work with your doctors more effectively putting together your personal treatment plan.

Next month I’ll be addressing bipolar and relationships. With so many dynamics between the people diagnosed with bipolar, those that loving care for them and a variety other outside influences it’s a topic with many perspectives.