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Understanding Bipolar I and II

Mary-Lauren O’Crowley, LPC, NCC 

Every now and then, everyone will have a “bad day”. We may cry, feel depressed, overwhelmed and tired. We also will have other days where we are energetic, full of life and happy. A certain population, however, experiences unusual mood disorders which amplify more common mood swings. In fact, this population often battles chronic depression interchanged with extreme mania – severely enough to cause significant damage to relationships, careers and personal stability.

What Are the Symptoms, Risk Factors, and Treatment Options?

Bipolar Disorder affects 2.8% of the U.S adult population. Patients with untreated bipolar disorder often find themselves suffering from manic episodes characterized by a flight of ideas, extreme energy, talkativeness, restlessness, agitation, decreased need for sleep, and inflated self-image. Increased self-confidence often accompanies a manic episode, with the patient often believing he or she can accomplish substantial feats. States of Mania are usually followed by episodes of depression, wherein the patient experiences feelings of hopelessness, suicidal thoughts or urges, lack of pleasure or interest in activities, social withdrawal, and diminished mood. Mania sometimes involves psychotic symptoms such as hallucinations (seeing or hearing things that are not there) and delusions (false beliefs). Milder symptoms of mania are known as hypo-mania and do not typically affect one’s day to day life. 

Currently, clinicians have distinguished between two categories of Bipolar Disorder: Bipolar I and Bipolar II. Bipolar I disorder is distinguished by severe episodes of mania, followed by a period of depression. Bipolar II disorder is distinguished by less severe manic episodes (racing thoughts, distractibility, talkativeness). The average age of onset of Bipolar Disorder is 25 years of age; However, an onset of bipolar disorder during the late teens to early twenties is not uncommon. 

Risk factors for developing bipolar disorder are often said to be either biological or environmental. Biological risk factors include a family history of mental illness or having a parent or sibling diagnosed as having Bipolar Disorder. Environmental risk factors include child maltreatment or child emotional abuse and neglect. Additionally, patients who have already been diagnosed as bipolar have risk factors for developing a relapse. These include stressful life events such as divorce, parental loss, birth of a child, moving and others. Postpartum depression especially affects patients with bipolar disorder and often escalates to post-partum psychosis.

With treatment, living a normal life with bipolar disorder is possible. Treatment includes medication and psychotherapy. At the onset of a bipolar diagnosis, patients are often referred to a psychiatric hospital where medication will be prescribed and admission made. Upon admission, observation will begin to monitor for stabilization as well as reaction to the medication. A variety of classes of medication have been found effective for treating bipolar disorder. They include mood stabilizers such as lithium, valproate, lamotrigine and carbamazepine, Antipsychotics such as lurasidone, olanzapine, quetiapine and cariprazine, and benzodiazepines.

Psychotherapy or counseling has also been effective in managing or treating bipolar disorder. Counseling can be used to inform family members of triggers which can lead to an onset of an episode, how to manage current episodes as well as how to plan for and prepare for possible episodes surrounding an upcoming life event. Counseling can also be used to help the patient make sense of his or her diagnosis and trauma that may have contributed to the diagnosis. Psychotherapy is not a one-time event, but rather a continuous process of learning, growing and mediating within the life of the patient.

The outcome for patients who are bipolar are often positive as long as medication guidelines are adhered to. Relapses often occur as patients try to forgo medication, leading to an episode of greater severity. Maintaining a healthy diet, getting proper sleep and exercise, managing stress, learning to recognize mood swings and identify triggers, getting support from friends and family, avoiding drugs and alcohol, and taking medication can ensure a healthy, positive prognosis for bipolar patients.

If you or someone you know is struggling with mood swings or possible Bipolar Disorder, please reach out to the intake specialists at Symmetry Counseling today to begin your mental health care journey!


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