Understanding and Treating Bipolar Disorder at the Mayo Clinic

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Your evaluation may include the following to determine if you have bipolar disorder:

  • Physical examination Your doctor may perform a physical exam as well as lab tests to rule out any medical issues that could be causing your symptoms.
  • Psychiatric evaluation Your doctor may refer you to a psychiatrist, who will discuss your thoughts, feelings, and behavioral patterns with you. You may also complete a psychological self-evaluation or questionnaire. Family members or close friends may be asked to provide information about your symptoms with your permission.
  • Mood mapping You may be asked to keep a daily journal of your moods, sleep patterns, or other factors that could aid in diagnosis and treatment selection.
  • Bipolar disorder criteria Your psychiatrist may compare your symptoms to the criteria for bipolar and related disorders in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

In children, the diagnosis is

Although children and teenagers with bipolar disorder are diagnosed using the same criteria as adults, symptoms in children and teenagers often have different patterns and may not fit neatly into the diagnostic categories.

Furthermore, children with bipolar disorder are frequently diagnosed with other mental health conditions such as attention deficit/hyperactivity disorder (ADHD) or behavioral issues, which can complicate diagnosis. A referral to a child psychiatrist who has experience with bipolar disorder is advised.

  • Mayo Clinic offers bipolar disorder treatment.
  • Bipolar disorder in children
  • Urinalysis

Treatment

A medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is experienced in treating bipolar and related disorders is best suited to guide treatment. A psychologist, social worker, and psychiatric nurse may be part of your treatment team.

Bipolar disorder is a chronic illness. Treatment focuses on symptom management. Treatment may include the following, depending on your needs:

  • Medications Often, you'll need to start taking medications right away to balance your moods.
  • Treatment should be continued. Bipolar disorder necessitates lifelong medication treatment, even when you are feeling well. People who do not receive maintenance treatment are at a high risk of experiencing a relapse of symptoms or having minor mood changes progress to full-blown mania or depression.
  • Programs for day treatment A day treatment program may be suggested by your doctor. These programs offer the assistance and counseling you require while you work to control your symptoms.
  • Treatment for substance abuse If you have a drinking or drug problem, you will also require substance abuse treatment. Otherwise, dealing with bipolar disorder can be extremely difficult.
  • Hospitalization If you're acting dangerously, feeling suicidal, or becoming detached from reality (psychotic), your doctor may recommend hospitalization. Getting psychiatric care in a hospital can help you stay calm and safe while also stabilizing your mood, whether you're experiencing a manic or major depressive episode.

To control symptoms, the primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy), as well as education and support groups.

Medications

Bipolar disorder is treated with a variety of medications. Medication types and dosages are prescribed based on your specific symptoms.

Among the medications that may be prescribed are:

  • Mood elevators To control manic or hypomanic episodes, mood-stabilizing medication is usually required. Lithobid, valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, and others) are examples of mood stabilizers.
  • Antipsychotics If symptoms of depression or mania persist despite treatment with other medications, an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), or asenapine (Saphris) may be added. Some of these medications may be prescribed by your doctor alone or in combination with a mood stabilizer.
  • Antidepressants To help manage depression, your doctor may prescribe an antidepressant. Because antidepressants can sometimes cause manic episodes, they are usually prescribed in conjunction with a mood stabilizer or antipsychotic.
  • Antidepressant-antipsychotic Symbyax is a medication that combines the antidepressant fluoxetine with the antipsychotic olanzapine. It acts as a mood stabilizer and a depression treatment.
  • Medications for anxiety Benzodiazepines can help with anxiety and improve sleep, but they are typically used only temporarily.

Choosing the Best Medication

Finding the best medication or medications for you will almost certainly require some trial and error. If one does not suit you, there are several others to try.

This procedure necessitates patience, as some medications take weeks to months to fully take effect. Typically, only one medication is changed at a time so that your doctor can determine which medications work best to relieve your symptoms while causing the fewest side effects. Medications may also need to be adjusted as your symptoms change.

Adverse effects

Mild side effects usually go away as you find the right medications and dosages for you and your body adjusts to the medications. If you are experiencing bothersome side effects, consult your doctor or a mental health professional.

Make no changes or discontinue your medications. You may experience withdrawal symptoms if you discontinue your medication, or your symptoms may worsen or return. You may become extremely depressed, suicidal, or experience a manic or hypomanic episode. Call your doctor if you believe you require a change.

Pregnancy and medications

A number of bipolar disorder medications have been linked to birth defects and can be passed on to your baby through breast milk. During pregnancy, certain medications, such as valproic acid and divalproex sodium, should be avoided. Furthermore, birth control pills may lose their effectiveness when combined with certain bipolar disorder medications.

If possible, discuss treatment options with your doctor before becoming pregnant. If you're on medication for bipolar disorder and suspect you're pregnant, contact your doctor right away.

Psychotherapy

Psychotherapy is an essential component of bipolar disorder treatment and can be delivered individually, in families, or in groups. Various types of therapy may be beneficial. These are some examples:

  • IPSRT stands for interpersonal and social rhythm therapy. The goal of IPSRT is to stabilize daily rhythms such as sleeping, waking, and mealtimes. A consistent routine aids in mood management. People with bipolar disorder may benefit from developing a daily routine for sleep, diet, and exercise.
  • CBT stands for cognitive behavioral therapy. The emphasis is on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can assist you in determining what causes your bipolar episodes. You also learn effective stress management and coping strategies.
  • Psychoeducation Psychoeducation about bipolar disorder can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify problems, develop a plan to avoid relapse, and stay on track with treatment.
  • Family-centered therapy Family support and communication can help you stick to your treatment plan and recognize and manage warning signs of mood swings.

Alternative treatment options

Other treatments may be added to your depression therapy depending on your needs.

During electroconvulsive therapy (ECT), electrical currents are passed through the brain, causing a brief seizure. ECT appears to alter brain chemistry, which can reverse symptoms of certain mental illnesses. If you are unable to improve with medications, are unable to take antidepressants due to medical reasons such as pregnancy, or are at high risk of suicide, ECT may be an option for bipolar treatment.

Transcranial magnetic stimulation (TMS) is being researched as a treatment option for people who haven't responded to antidepressants.

Treatment for children and adolescents

Treatments for children and adolescents are generally determined on a case-by-case basis, based on symptoms, medication side effects, and other factors. In general, treatment entails:

  • Medications Children and teenagers with bipolar disorder are frequently prescribed the same medications as adults. Because there has been less research on the safety and efficacy of bipolar medications in children than in adults, treatment decisions are frequently based on adult research.
  • Psychotherapy Initial and long-term treatment can help keep symptoms at bay. Psychotherapy can assist children and adolescents in managing their routines, developing coping skills, addressing learning difficulties, resolving social issues, and strengthening family bonds and communication. Furthermore, if necessary, it can aid in the treatment of substance abuse issues that are common in older children and teens with bipolar disorder.
  • Psychoeducation Psychoeducation can include learning about bipolar disorder symptoms and how they differ from behavior associated with your child's developmental age, the situation, and appropriate cultural behavior. Understanding bipolar disorder can also assist you in supporting your child.
  • Support Working with teachers and school counselors, as well as encouraging support from family and friends, can assist in identifying services and promoting success.
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Clinical studies

Investigate Mayo Clinic studies that are testing new treatments, interventions, and tests to prevent, detect, treat, or manage this condition.

Home remedies and way of life

You'll most likely need to make lifestyle changes to break the cycle of behavior that exacerbates your bipolar disorder. Here are some steps to consider:

  • Stop drinking or using illegal drugs. One of the most serious concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. If you are having difficulty quitting on your own, seek assistance.
  • Create healthy relationships Surround yourself with people who can help you. Friends and family members can offer support and assist you in recognizing warning signs of mood shifts.
  • Establish a healthy routine. A regular sleeping, eating, and physical activity schedule can help you maintain a positive mood. Consult your doctor before beginning any exercise program. Maintain a healthy diet. If you take lithium, consult your doctor about the proper fluid and salt intake. Talk to your doctor or a mental health professional about what you can do if you have trouble sleeping.
  • Before taking any other medications, consult your doctor first. Call your bipolar disorder doctor before taking any medications prescribed by another doctor or any over-the-counter supplements or medications. Other medications can sometimes cause episodes of depression or mania, or they can interfere with the medications you're taking for bipolar disorder.
  • Consider keeping a mood journal. Keeping track of your daily moods, treatments, sleep, activities, and feelings may aid in the identification of triggers, effective treatment options, and when treatment needs to be adjusted.

Medicine that is not conventional

There hasn't been a lot of research done on alternative or complementary medicine, also known as integrative medicine, and bipolar disorder. Because the majority of the studies have been conducted on major depression, it is unclear how these nontraditional approaches work for bipolar disorder.

Take the following precautions before using alternative or complementary medicine in addition to your physician-recommended treatment:

  • Don't stop taking your medications or skip your therapy sessions. When it comes to treating bipolar disorder, alternative or complementary medicine is not a substitute for standard medical care.
  • Communicate openly with your doctors and mental health professionals. Tell them which complementary or alternative treatments you use or would like to try.
  • Keep an eye out for potential hazards. Alternative and complementary products are not regulated in the same way that prescription drugs are. Just because something is natural does not make it safe. Before using alternative or complementary medicine, consult your doctor about the risks, including the possibility of serious drug interactions.

Coping and assistance

Coping with bipolar disorder can be difficult. Here are some strategies that may be useful:

  • Find out more about bipolar disorder. Education about your condition can help you feel empowered and motivated to stick to your treatment plan and recognize mood changes. Help your family and friends understand what you're going through.
  • Maintain your focus on your objectives. It may take some time to learn how to manage bipolar disorder. Maintain your motivation by remembering your goals and reminding yourself that you can work to repair damaged relationships and other issues caused by your mood swings.
  • Join a support group. Support groups for people with bipolar disorder can help you connect with others who are dealing with similar issues and share your experiences.
  • Look for healthy outlets. Investigate healthy outlets for your energy, such as hobbies, exercise, and recreational activities.
  • Learn how to relax and deal with stress. Yoga, tai chi, massage, meditation, and other relaxation techniques can be beneficial.

Preparing for your appointment

You could begin by seeing your primary care physician or a psychiatrist. If possible, bring a family member or a friend to your appointment for support and to help you remember information.

What you are able to do

Make a list of the following items before your appointment:

  • Any symptoms you've experienced, including those that appear unrelated to the reason for the appointment
  • Important personal information, such as major stresses or recent life changes
  • All medications, vitamins, herbs, and other supplements you take, as well as the dosages
  • What to Ask Your Doctor

Some questions you should ask your doctor include:

  • Is it possible that I have bipolar disorder?
  • Is there anything else that could be causing my symptoms?
  • What types of tests will I require?
  • What are the available treatments? Which do you think is best for me?
  • What are the possible side effects of that treatment?
  • What are the alternatives to the primary approach that you propose?
  • I also have the following medical conditions. How can I best manage these conditions together?
  • Is it necessary for me to see a psychiatrist or another mental health professional?
  • Is there a generic equivalent to the medication you're prescribing?
  • Is it possible for me to obtain brochures or other printed materials?
  • What websites do you suggest?

Please do not be afraid to ask additional questions during your appointment.

What to Expect from Your Doctor

Your doctor will almost certainly ask you a series of questions. Be prepared to respond to them and set aside time to go over any points you want to emphasize. Your doctor may inquire:

  • When did you or a loved one first notice your symptoms?
  • How often do your moods shift?
  • Do you ever have suicidal thoughts when you're feeling down?
  • Do your symptoms have an impact on your daily life or relationships?
  • Do you have any relatives who suffer from bipolar disorder or depression?
  • Do you have any other mental or physical health issues?
  • Do you consume alcoholic beverages, smoke cigarettes, or use recreational drugs?
  • How much sleep do you get at night? Does it evolve over time?
  • Do you go through phases where you take risks you wouldn't normally take, such as risky sex or rash financial decisions?
  • What, if anything, appears to alleviate your symptoms?
  • What appears to aggravate your symptoms, if anything?

Mayo Clinic offers bipolar disorder treatment.

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a href="MY_REDIRECT_PREFIXhttps://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955" target="_blank">span>Symptoms & causes/span>/a
  1. NA Reilly-Harrington and colleagues The Concise Health Risk Tracking Self-Report is a tool for predicting suicidal ideation and behavior in bipolar disorder. Affective Disorders Journal 2016;192:212
  2. Bipolar disorder and related conditions In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed Arlington, Virginia 2013; American Psychiatric Association http://www psychiatryonline org Accessed in December 2, 2016
  3. Bipolar illness The National Institute of Mental Health (NIMH) https://www nimh nih gov/health/topics/bipolar-disorder/index shtml Accessed in December 2, 2016
  4. Bipolar illness The National Institute of Mental Health (NIMH) https://www nimh nih gov/health/publications/bipolar-disorder-tr-15-3679/index shtml Date accessed: December 2, 2016
  5. Children and teenagers with bipolar disorder The National Institute of Mental Health (NIMH) is a government-funded organization that https://www nimh nih gov/health/publications/bipolar-disorder-in-children-and-teens-qf-15-6380/index shtml Accessed in December 2, 2016
  6. Bipolar disorder The National Alliance on Mental Illness (NAMI) https://www nami org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder Accessed in December 2, 2016
  7. AskMayoExpert Bipolar illness Rochester, Minnesota 2016; Mayo Foundation for Medical Education and Research Date accessed: December 2, 2016
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  9. D Axelson et al. Pediatric bipolar disorder: Treatment Options http://www uptodate com/home Accessed in December 2, 2016
  10. Birmaher B Epidemiology, pathogenesis, clinical manifestations, and course of pediatric bipolar disorder http://www uptodate com/home Accessed Dec 2, 2016
  11. A. Picardi et al. Treatment of mood disorders through psychotherapy Mental Health Clinical Practice and Epidemiology 2014;10:140
  12. KN Fountoulakis and colleagues The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for adults with bipolar disorder (CINP-BP-2017), part 2: review, evidence grading, and a precise algorithm International Journal of Neuropsychopharmacology In press http://ijnp oxfordjournals org/content/early/2016/11/05/ijnp pyw100 long Accessed in December 6, 2016
  13. JL Beyer and colleagues Bipolar depression and nutrition North American Psychiatric Clinics 2016;39:75
  14. NA Qureshi and colleagues A review of the literature on mood disorders and complementary and alternative medicine. Neuropsychiatric Disorders and Their Treatment 2013;9:639
  15. RA Sansone and colleagues N-acetyl-cysteine (NAC) Clinical Neuroscience Advances 2011;8:10
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  17. DK for Hall-Flavin (expert opinion) Rochester, Minnesota's Mayo Clinic Dec 27, 2016
  18. CA Krieger (expert opinion) Rochester, Minnesota's Mayo Clinic Jan 4, 2017
  19. Post RM Adults with bipolar disorder: Choosing a Maintenance Treatment http://www uptodate com/home Retrieved in January 4, 2016
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  21. Stovall J Adults with bipolar disorder: Pharmacotherapy for acute mania and hypomania http://www uptodate com/home Accessed in January 4, 2017
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