As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.
Bipolar disorder can be a debilitating condition that is most known for its cyclical nature. Estimates suggest that as many as 60 million people worldwide live with some version of Bipolar Disorder.
There are two types to Bipolar Disorder (Bipolar I Disorder and Bipolar II Disorder), each with their own features. Bipolar disorder is generally thought of as a cyclical condition with periods of euphoria or mania and depressed mood and lethargy, however, that is not always the case. Bipolar II Disorder, by contrast, manifests through cycles of depression and less extreme periods of heightened, manic moods (known as hypomania).
It can be difficult to diagnose Bipolar Disorder due to its unstable nature. Individuals who live with some version of Bipolar Disorder may also experience other mental health conditions, further complicating diagnosis. It is estimated that individuals with Bipolar Disorder may have met the criteria for other mental health conditions over the course of their lives as much as 95% of the time.
Due to the highly individual nature and course of Bipolar Disorders it can be frustrating for both the individuals and their treatment teams who seek to find the best course of treatment. Often, a variety of medications or treatments may be explored before finding the correct regimen for stabilization and increased functioning.
Bipolar Disorder I
Individuals with Bipolar Disorder I may experience persistent depressive symptoms with intermittent periods of extreme euphoria and invincibility, also known as mania. That is, Bipolar Disorder I is characterized by extremely high highs and very low lows.
People with Bipolar I Disorder most often experience episodes of major depression and periods of mania (also known as manic episodes). During a depressive episode, people with Bipolar I may experience any of the following:
- Depressed mood on most days
- Loss of interest or pleasure in previously enjoyable activities
- Significant changes in weight such as loss or gain without trying
- Loss of energy or feeling fatigued
- Difficulty concentrating or focusing on tasks
- Feeling unworthy or having extreme amounts of guilt
- Thoughts of death, dying or suicide
These periods of depression are experienced in cycles with periods of extreme euphoria or mania, also known as manic episodes. Manic episodes may include the following symptoms:
- Abnormally increased energy
- Feelings of invincibility
- Decreased need for rest of sleep (some people may not sleep for days on end)
- Dramatically increased sense of self or confidence
- Especially prone to distraction
- Difficulty staying on topic
- Racing thoughts
- More talkative than usual & quick speech
- Dramatic increase in goal-directed activity or purposeless activity
- Engagement in high-risk activities that may have significant negative consequences, such as shopping sprees, risky sexual behavior, driving recklessly, etc.
Bipolar Disorder II
Those with Bipolar II Disorder may experience the same depressive periods, but instead may not experience full manic episode cycles. Instead, they may experience a low grade of mania, known as hypomania.
Individuals with Bipolar II may experience hypomanic episodes for several consecutive days, but may never experience a full manic episode, unlike Bipolar I Disorder. Much like Bipolar I, those with Bipolar II Disorder often experience periods of major depression. Other symptoms include pressured speech (a tendency to speak rapidly and with urgency, speech that is often difficult to interrupt), irritability, and defensiveness.
Treatment for Bipolar Disorder
Pharmacotherapy (Medication)
Medication is the most valuable tool for those who live with Bipolar Disorder. Psychiatrists often prescribe medication that is designed to even out the client’s mood so that a more balanced, day-to-day existence is possible. Categories of medications considered for the treatment of Bipolar Disorder include mood stabilizers, antidepressants, and atypical antipsychotics.
Therapy
When combined with medication, therapy can be an extremely useful tool for those who live with Bipolar Disorder. Psychoeducation, or education about mental health issues and Bipolar Disorder conditions, is often a big part of talk therapy due to the mysterious and ever-changing nature of the condition.
Treatment for Bipolar Disorder may also include focus on cognitive and behavioral techniques to improve daily functioning, avoid behaviors with negative consequences, and address disruptive thought patterns. During sessions with a therapist, you might talk through ongoing patterns of self-criticism that may be more present during depressive episodes. By working on consistent ways of addressing problematic thinking, a therapist can help you reduce stigma and internalized shame that you may experience with the condition. Additionally, a mental health professional might assist you in crafting daily structure and routine that will help more aggressively moderate the conditions depressive symptoms.
By contrast, a therapist will also support you as you cope with the symptoms of mania or hypomania. Due to the risky nature of mania, a therapist will work with you to limit personal risks and help you put safety measures in place for an upcoming manic or hypomanic episode. This may include creating a concrete plan for engagement during those times as well as enlisting support from other people in your life for ongoing support and accountability throughout treatment.
Due to the nature of Bipolar Disorder, individuals with the condition are at high risk for abusing substances as a way to cope with changing moods and instability. As you might imagine, this can be particularly dangerous for individuals with very strong variations in mood. Depressive episodes may be exacerbated by “crashing” after intoxication, and manic episodes may be even more dangerous when using illicit substances that also limit inhibitions and increase risk taking. For individuals who use substances in an effort to manage their moods, substance abuse counseling and support groups can be helpful additions to individual therapy.
Interpersonal and Family Therapy
In addition, family focused or interpersonal (relational) focused therapy are often very helpful for individuals who live with Bipolar Disorders. In individual sessions, a therapist may help a client explore and resolve interpersonal difficulties that may have arisen due to their condition and presentation. Often times, clients may not be aware of how their condition may be impacting their daily interactions with others. By using interpersonal focused therapy and feedback, a mental health professional can help prepare you to restore relationships, build new one and learn to maintain those connections effectively.
In addition, family focused therapy can help both the individual and the family learn more effective communication skills to better address family issues and better support those living with Bipolar Disorder.
Therapeutic Note
Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.
Questions You Might Have For Your Talkspace Therapist
- How do I know if I have BP I or II?
- What if I don’t want to take medication?
- What is hypomania?
- Does Bipolar disorder run in families?
- I like how I feel when I’m manic and not depressed, why does everyone say it’s not OK?
Sources
Association, A.P.. "Bipolar and Related Disorders." Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 65-92.
National Institute of Mental Health (2016). Bipolar Disorder. Retrieved April 11, 2017
World Health Organization (2017). Mental disorders. Retrieved April 11, 2017