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PrintDiagnosing bipolar disorder
Because the diagnosis of bipolar disorder can be tricky even for trained professionals, it is best to see a psychiatrist rather than a family doctor. A psychiatrist specializes in mental health, and is more likely to know about the latest research and treatment options.
The Diagnostic Exam
A diagnostic exam for bipolar disorder generally consists of the following:
- Psychiatric History – Your doctor or specialist will conduct a complete psychiatric history. You will answer questions about your symptoms, the history of the problem, any treatment you’ve previously received, and your family history of mood disorders.
- Medical History and Physical – There are no lab tests for identifying bipolar disorder. But your doctor may conduct a medical history and physical exam in order to rule out illnesses or medications which might be causing your symptoms. Screening for thyroid disorders is particularly important, as they can cause mood swings that mimic bipolar disorder.
| Medical Conditions That Can Cause Bipolar Symptoms | |
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In addition to the psychiatric and medical history, your doctor
may talk to family members and friends about your moods and
behaviors. Often, those close to you can give a more accurate
and objective picture of your symptoms.
If your doctor determines that you have bipolar disorder, he
or she will explain your treatment options and possibly prescribe
medication for you to take. You may also be referred to another
mental health professional, such as a psychologist, counselor,
or a bipolar disorder specialist. Together, you will work with
your healthcare providers to develop a personalized treatment
plan.
Difficulties of diagnosis
According to the Depression
and Bipolar Support Alliance, approximately 7 out of
10 people with bipolar disorder are misdiagnosed at least
once, with the average length of time from a person’s
first bipolar symptoms to a correct diagnosis and treatment
of 10 years.
While bipolar disorder can be tricky to diagnose correctly,
the primary reason behind this delay is that people in the
manic stage of the illness don’t think they have a problem
and are unlikely to see a mental health professional voluntarily.
On the other hand, while people in the depressive stage may
seek help, they are often misdiagnosed with clinical
depression.
Is it Bipolar Disorder or Depression?
The following factors may indicate that your depression is really bipolar disorder:
- You’ve experienced repeated episodes of major depression.
- You had your first episode of major depression before age 25.
- You have a first-degree relative with bipolar disorder.
- When you’re not depressed, your mood and energy levels are higher than most people’s.
- When you’re depressed, you oversleep and overeat.
- Your episodes of major depression are short (less than 3 months)
- You’ve lost contact with reality while depressed.
- You’ve had postpartum depression before.
- You’ve developed mania or hypomania while taking an antidepressant.
- Your antidepressant stopped working after several months.
- You’ve tried 3 or more antidepressants without success.
Source: PsychEducation.org
Other conditions which are sometimes confused with bipolar
disorder are schizophrenia, ADHD, borderline personality
disorder, and panic disorder. Additionally, people with bipolar
disorder often suffer from co-existing conditions such as
substance abuse, anxiety disorders, and personality disorders,
further complicating the diagnostic picture.
Treating bipolar disorder
With treatment, the vast majority of people with bipolar disorder are able to achieve substantial relief from their symptoms. However, because the mood cycles of bipolar disorder are recurrent, treatment must focus not just on the acute crisis of mania or depression, but on long-term preventive care.
A comprehensive treatment plan for bipolar disorder aims to alleviate current symptoms, prevent future mood episodes, and address any relationship or occupational problems caused by the illness. A treatment plan that combines psychotherapy with medication is often the best strategy for meeting these goals.
Acute Phase of Treatment
In the acute phase of bipolar disorder, the treatment goal is to end the current manic, depressive, hypomanic, or mixed episode.
- Medication – Mood-stabilizing medications are the primary treatment during the acute phase of bipolar disorder. For acute mania, drug choices include traditional mood stabilizers and atypical antipsychotics. Sedatives may also be used for short-term relief of anxiety and insomnia. For acute depression, antidepressants are prescribed in combination with a mood stabilizer.
- Electroconvulsive Therapy (ECT) – For severe episodes of mania and depression, electroconvulsive therapy (ECT) can produce significant improvement. In fact, it is a life-saving option for bipolar patients at a high risk of suicide, including people with psychotic symptoms such as delusions or hallucinations. ECT is also an option for people who haven’t responded to medication or can’t take it because of pregnancy or a medical condition.
- Hospitalization – If you are a danger to yourself or to others, hospitalization should be considered. The hospital is a safe environment where you can get round-the-clock care until your mood is stabilized. Because mania and depression affect your judgment and insight, you may not realize you need help and be hospitalized against your will. To learn more, see the Depression and Bipolar Support Alliance’s Guide to Psychiatric Hospitalizations. It includes help for patients, advice for family members, and information about preparing an advanced directive, a legal document that outlines your treatment preferences and who you’d like to make your healthcare decisions if you are unable to make them for yourself.
- Psychotherapy – During an acute manic episode, psychotherapy is usually of little benefit. If you’re in a manic state, your ability to sit through a session and listen to what the therapist has to say is limited. However, a person in the depressive phase of bipolar disorder can receive a great deal of help from therapy.
Preventive or Maintenance Phase of Treatment
In the preventive or maintenance phase of bipolar disorder treatment, the focus is on maintaining a stable mood and preventing future episodes of mania or depression.
In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
Source: NIMH
- Medication – Mood-stabilizing medications are almost always continued even when the symptoms of mania or depression are under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and even prevent them entirely. If you’ve had two or more manic or depressive episodes, it is recommended that you stay on mood stabilizers indefinitely.
- Psychotherapy – Therapy during the maintenance phase of treatment is essential for dealing with your disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
- Education – Managing symptoms and preventing complications begins with a thorough knowledge of your illness. Education is a key component of treatment. The more you and your loved ones know about bipolar disorder, the more effective you’ll be at avoiding problems and dealing with setbacks.
- Support – Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group gives you the opportunity to share your experiences and learn from others who know what you’re going through.
For self-help tips on managing bipolar disorder in your daily life, see Taking Charge of Bipolar Disorder.
Medications for bipolar disorder
Mood stabilizers, antidepressants, and antipsychotics are the three major types of medications that are used to control bipolar disorder.
You and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, it may take some time for you and your doctor to find the right drug treatment plan. You may have to try several different medications before you find one that relieves your specific symptoms. The course of bipolar disorder is also unpredictable. Your symptoms may change over time, necessitating a medication switch down the road.
To learn about medication for manic depression, see How to Find the Right Bipolar Disorder Drug and Take it Safely.
Therapy for bipolar disorder
Psychotherapy, or talk therapy, is essential for dealing with the impact of bipolar disorder. It is an integral part of preventive or maintenance treatment. In psychotherapy you can learn how to deal with problems your manic or depressive episodes are causing, improve your relationships, and overcome self-esteem issues. Your therapist can also help you address other problems you may be suffering from, such as substance abuse or anxiety.
Intensive Therapy Improves Your Chances for Getting and Staying Well
According to a study published in the April 2007 issue of
the Archives of General Psychiatry, people who take medications
for bipolar disorder are more likely to get well faster and
stay well if they also receive intensive psychotherapy.
Three types of psychotherapy are especially helpful in bipolar disorder treatment: cognitive-behavioral therapy, interpersonal and social rhythm therapy, and family-focused therapy.
Cognitive-behavioral therapy (CBT)
In CBT, you examine how your thoughts affect your emotions. You also learn how to change negative thinking patterns and behaviors into more positive ways of responding. For bipolar disorder, the focus is on managing symptoms, avoiding triggers for relapse, and problem-solving. According to the National Alliance for the Mentally Ill, patients who receive CBT in addition to treatment with medication have better outcomes than patients on medication alone.
Interpersonal and social rhythm therapy
Interpersonal therapy focuses on current relationship issues and helps you improve the way you relate to the important people in your life. By addressing and solving interpersonal problems, this type of therapy reduces stress in your life. Since stress is a trigger for bipolar disorder, this relationship-oriented approach can help reduce mood cycling.
For bipolar disorder, interpersonal therapy is often combined with social rhythm therapy. People with bipolar disorder are believed to have overly sensitive biological clocks, the internal timekeepers that regulate circadian rhythms. This clock is easily thrown off by disruptions in your daily pattern of activity, also known as your “social rhythms.” Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, and exercising. When these rhythms are stable, the biological rhythms that regulate mood remain stable as well.
Family-focused therapy
Living with a bipolar person can be difficult, causing strain in family and marital relationships. Family-focused therapy addresses these issues and works to restore a healthy and supportive home environment. Educating family members about the disease and how to cope with it is a major component of treatment. Working through problems in the home and improving communication is also a focus of treatment.
Alternative and complementary treatments
Most alternative treatments for bipolar disorder are really complementary treatments, meaning they should be used in conjunction with medications and talk therapy. Here are a few of the options that are showing promise:
- Light and dark therapy – Like social rhythm therapy, light and dark therapy focuses on the sensitive biological clock in people with bipolar disorder. This easily disrupted clock throws off sleep-wake cycles, a disturbance that can trigger symptoms of mania and depression. Light and dark therapy for bipolar disorder regulates these biological rhythms—and thus reduces mood cycling— by carefully managing your exposure to light. The major component of this therapy involves creating an environment of regular darkness by restricting artificial light for ten hours every night.
- Mindfulness Meditation – Research has shown that mindfulness-based cognitive therapy and meditation help fight and prevent depression, anger, agitation, and anxiety. The mindfulness approach uses meditation, yoga, and breathing exercises to focus awareness on the present moment and break negative thinking patterns.
- Acupuncture – Acupuncture is currently being studied as a complementary treatment for bipolar disorder. Some researchers believe that it may help people with bipolar disorder by modulating their stress response. Studies on acupuncture for depression have shown a reduction in symptoms, and there is increasing evidence that acupuncture may relieve symptoms of mania also.
To Learn More...
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Related links for bipolar disorder diagnosis and treatment
Bipolar disorder diagnosis
How Is Bipolar Disorder Diagnosed? – Learn about the diagnosis of manic depression, including other conditions that should be ruled out. (University of Maryland Medical Center)
You've Just Been Diagnosed... – Describes what to expect after you’re diagnosed with a mood disorder. Includes treatment information and questions to ask your doctor. (Depression and Bipolar Support Alliance)
Bipolar Diagnosis Gives Patients New Lease On Life – Article on the diagnosis of Bipolar II disorder. (Columbia News Service)
Bipolar disorder treatment
Treatment of Bipolar Disorder: A Guide for Patients and Families – Learn about the diagnosis and treatment of bipolar disorder. Includes a thorough discussion of treatment options for both the acute and preventive phase of the illness. (Postgraduate Medicine Special Report)
Finding Peace of Mind: Treatment Strategies for Depression and Bipolar Disorder – Overview of treatment options for bipolar disorder, including medication, support, and therapy. (Depression and Bipolar Support Alliance)
Wrestling with Bipolar Disorder – Article on the treatment of bipolar disorder, including new medication guidelines and the place of psychotherapy. (Psychology Today)
Psychotherapy: How it Works and How it Can Help – Covers goals of psychotherapy for bipolar disorder, how to find a therapist, what to expect at an appointment, and how to evaluate your therapy sessions. (Depression and Bipolar Support Alliance)
Finding a treatment provider
Find A Mental Health Professional – Features resources and advice for finding the right bipolar disorder treatment provider. Includes a Personal Guide to finding the right doctor or therapist, External Referral Services, and Patient-to-Patient Recommendations. (Depression and Bipolar Support Alliance)
Referral Database: Finding a Bipolar Specialist – Free referral source for patients and their families includes a searchable database of bipolar specialists across the United States. (Massachusetts General Hospital Bipolar Clinic and Research Program)
Finding a Mental Health Specialist: What to Look For and Questions to Ask – Advice for people with bipolar disorder on picking a therapist or psychiatrist. (PsychEducation.org)
Hospitalization for bipolar disorder
Guide to Psychiatric Hospitalizations – Learn why hospitalization for bipolar disorder may be necessary and find recommended treatment facilities. Helpful articles includes Understanding Hospitalization for Mental Health and A Family Guide to Psychiatric Hospitalization. (Depression and Bipolar Support Alliance)
State-by-State Information on Psychiatric Advance Directives – Find information on preparing an advanced directive that is legally binding in your state. Advanced directives specify your treatment preferences ahead of time for cases where you are incapacitated by mania or depression. (The National Resource Center on Psychiatric Advance Directives)
Delving deeper into bipolar disorder diagnosis and treatment
Psychosocial Interventions for Bipolar Spectrum Disorder – Manual takes an in-depth look at diagnosing and treating bipolar disorder. Includes information on treatment planning, relapse prevention strategies, and medication education. (Behavioral Health Care)
Cognitive Therapy for Bipolar Disorder – Excerpt from a book on cognitive-behavioral therapy for bipolar disorder. (National Association for Continuing Education)
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