Bipolar disorder - diagnosis and treatment (2023)

Diagnose

To determine if you have bipolar disorder, your evaluation may include:

• Physical examination.Your doctor can perform a physical exam and laboratory tests to identify medical problems that could be causing your symptoms.
• Psychiatric Evaluation.Your doctor may refer you to a psychiatrist who will talk to you about your thoughts, feelings, and behavioral patterns. You can also fill out a self-assessment or psychological questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
• mood graphic.You may be asked to keep a daily log of your mood, sleep pattern, or other factors that may aid in diagnosis and finding the right treatment.
• Criteria for Bipolar Disorder.Your psychiatrist can compare your symptoms to the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association.

diagnosis in children

Although diagnosing children and adolescents with bipolar disorder involves the same criteria as adults, symptoms in children and adolescents often show different patterns and may not fit neatly into diagnostic categories.

In addition, children with bipolar disorder are also often diagnosed with other mental illnesses, such as attention-deficit hyperactivity disorder (ADHD) or behavioral problems, which can complicate the diagnosis. Referral to a child psychiatrist experienced with bipolar disorder is recommended.

Treatment

Treatment is best directed by a doctor who specializes in the diagnosis and treatment of mental health problems (psychiatrist) and specializes in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, a social worker, and a psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment aims to control symptoms. Depending on your needs, treatment may include:

• medication.You often need to start taking medication right away to balance your mood.
• continued treatment.Bipolar disorder requires lifelong drug treatment, even during periods when you are feeling better. People who skip maintenance therapy are at high risk of symptom recurrence or minor mood swings progressing to mania or depression.
• Day Treatment Programs.Your doctor can recommend a daily treatment plan for you. These programs provide the support and guidance you need while managing your symptoms.
• Substance Abuse Treatment.If you have a problem with alcohol or drugs, you also need substance abuse treatment. Otherwise, it can be very difficult to control bipolar disorder.
• hospitalization.Your doctor may recommend hospitalization if you are behaving dangerously, have suicidal thoughts, or are withdrawing from reality (psychotic). Psychiatric treatment in a hospital can help you stay calm, confident and stabilize your mood, whether you are having a manic or major depressive episode.

Primary treatments for bipolar disorder include medication and psychological counseling (psychotherapy) to control symptoms, and may also include education and support groups.

medication

Various medications are used to treat bipolar disorder. The types and doses of medication prescribed will depend on your specific symptoms.

Medications may include:

• mood stabilizers.You usually need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others), and lamotrigine (Lamictal).
• Antipsychotics.If symptoms of depression or mania persist despite treatment with other medications, add an antipsychotic such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), or Adding asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
• Antidepressants.Your doctor may add an antidepressant to help control depression. Because an antidepressant can sometimes trigger a manic episode, it is often prescribed in conjunction with a mood stabilizer or antipsychotic.
• Antidepressant-Antipsychotic.The drug Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It acts as a treatment for depression and as a mood stabilizer.
• anti-anxiety medications.Benzodiazepines can help with anxiety and improve sleep, but they're usually used short-term.

Find the right drug

Finding the right medication or medications for you will likely involve some trial and error. If one doesn't work well for you, there are several others you can try.

This process requires patience, as some medications take weeks or months to take full effect. Typically, only one drug is switched at a time so your doctor can determine which drugs work to relieve your symptoms with the least bothersome side effects. Medications may also need to be adjusted as your symptoms change.

collateral damage

Mild side effects usually get better once you find the right medication and adjust the dosages that work for you and your body to the medication. Talk to your doctor or psychologist if you notice any bothersome side effects.

Do not make any changes or stop taking your medicines. If you stop taking the medicine, you may experience withdrawal symptoms, or your symptoms may worsen or come back. They may become very depressed, have suicidal thoughts, or have a manic or hypomanic episode. If you think you need to change anything, consult your doctor.

medication and pregnancy.

Several medications for bipolar disorder can be linked to birth defects and can be passed to the baby through breast milk. Certain medications such as valproic acid and divalproex sodium should not be used during pregnancy. Birth control medications may also not work as well when taken with certain medications for bipolar disorder.

Discuss treatment options with your doctor before you become pregnant, if possible. If you are taking medicines to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away.

psychotherapy

Psychotherapy is an essential part of treating bipolar disorder and can be conducted in individual, family, or group settings. Various forms of therapy can be helpful. These include:

• Interpersonal and Social Rhythm Therapy (IPSRT).IPSRT focuses on stabilizing circadian rhythms such as sleeping, waking, and eating. A consistent routine allows for better mood management. People with bipolar disorder can benefit from establishing a daily routine of sleep, diet, and exercise.
• Cognitive behavioral therapy (CBT).The focus is on identifying negative and unhealthy beliefs and behaviors and replacing them with healthy and positive ones. CBT can help identify what is triggering your bipolar episodes. You will also learn effective strategies for managing stress and dealing with stressful situations.
• PsychoedukationLearning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify problems, create a plan to prevent recurrence, and continue treatment.
• Family Centered Therapy.Family support and communication can help you stick to your treatment plan and help you and your loved ones recognize and manage the warning signs of mood swings.

Other treatment options

Depending on your needs, other treatments can be added to your depression regimen.

During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally causing a brief seizure. ECT appears to cause changes in brain chemistry that can reverse the symptoms of certain mental illnesses. ECT can be an option for bipolar treatment if you are not getting better with medication, you have medical reasons such as B. Pregnancy, cannot take antidepressants or are at high risk of suicide.

Transcranial magnetic stimulation (TMS) is being explored as an option for those who have not responded to antidepressants.

treatment in children and adolescents

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

• medication.Children and adolescents with bipolar disorder are often prescribed the same medications that are given to adults. There is less research on the safety and effectiveness of bipolar medications in children than in adults; Therefore, treatment decisions are generally based on research in adults.
• Psychotherapy.Initial and long-term therapy can help prevent symptoms from recurring. Psychotherapy can help children and adolescents to manage their routines, develop coping skills, deal with learning difficulties, solve social problems and strengthen family bonds and communication. And if needed, it can help address substance abuse problems that are common in older children and adolescents with bipolar disorder.
• PsychoedukationPsychoeducation can include learning about the symptoms of bipolar disorder and how behavior differs in relation to your child's developmental age, situation, and culturally appropriate behavior. Understanding bipolar disorder can also help you support your child.
• Support.Working with teachers and school counselors and the support of family and friends can help identify services and encourage success.

clinical trials

Explore the Mayo Clinic studiesTesting new treatments, interventions, and tests as a means of preventing, detecting, treating, or treating this condition.

lifestyle and home remedies.

You may need to make lifestyle changes to break the behavioral cycles that are making your bipolar disorder worse. Here are some steps to follow:

• Stop drinking or using recreational drugs.One of the biggest problems with bipolar disorder is the negative consequences of risky behavior and drug or alcohol abuse. Get help if you're having trouble quitting on your own.
• Build healthy relationships.Surround yourself with people who are a positive influence. Friends and family can support you and help you spot warning signs of mood swings.
• Create a healthy routine.A regular sleep, meal, and physical activity routine can help balance your mood. Consult your doctor before beginning any exercise program. Eat healthy. If you're taking lithium, talk to your doctor about staying hydrated and eating enough salt. If you have trouble sleeping, talk to your doctor or psychologist about what you can do.
• Check first before taking other medicines.Call the doctor treating you for bipolar disorder before taking any medicines or dietary supplements prescribed by another doctor, or over-the-counter medicines. Sometimes other medicines trigger episodes of depression or mania, or can interfere with the medicines you are taking for bipolar disorder.
• Consider keeping a sentiment chart.By keeping track of your daily moods, treatments, sleep, activities, and feelings, you can identify triggers, effective treatment options, and when treatment needs to be adjusted.

alternative medicine

There isn't much research on complementary or alternative medicine, sometimes referred to as integrative medicine, and bipolar disorder. Most studies relate to major depression, so it's not clear how these non-traditional approaches to bipolar disorder work.

If you decide to use complementary or alternative medicine in addition to the treatment recommended by your doctor, first take some precautions:

• Do not stop taking prescribed medications or skip therapy sessions.Alternative or complementary medicine is not a substitute for regular medical attention when treating bipolar disorder.
• Be honest with your doctors and psychiatrists.Tell them exactly what alternative or complementary treatments you would like to use or try.
• Be aware of the possible dangers.Alternative and complementary products are not regulated in the same way as prescription drugs. Just because it's natural doesn't mean it's safe. Before using complementary or alternative medicine, talk to your doctor about the risks, including possible serious drug interactions.

face and support

Dealing with bipolar disorder can be challenging. Here are some strategies that may help:

• Learn more about bipolar disorder.Education about your condition can empower and motivate you to follow your treatment plan and recognize mood swings. Help educate your family and friends about what's going on.
• Concentrate on your goals.Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind 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 facing similar challenges and share experiences.
• Find healthy outlets.Discover healthy ways to channel your energy, like hobbies, exercise, and recreational activities.
• Learn how to relax and manage stress.Yoga, tai chi, massage, meditation, or other relaxation techniques may be helpful.

Preparing for your date

You can start by seeing your family doctor or a psychiatrist. If possible, you may want to bring a family member or friend to your appointment for support and to help you remember the information.

What can you do

Before your appointment, make a list of:

• Any symptoms you hadincluding any that appear unrelated to the reason for the appointment
• important personal data,including major stresses or recent life changes
• all medicines,Vitamins, herbs, or other supplements you are taking and the dosages
• Questions to askyou doctor

Some questions to ask your doctor may include:

• Do I have Bipolar Disorder?
• Are there other possible causes of my symptoms?
• What types of tests do I need?
• What treatments are available? Which would you recommend?
• What side effects are possible with this treatment?
• What are the alternatives to the main approach you propose?
• I have these other health conditions. How can I best manage these conditions together?
• Should I see a psychiatrist or another psychologist?
• Is there a generic alternative to the medication you are prescribing?
• Are there brochures or other printed materials I could have?
• Which sites do you recommend?

You are welcome to ask further questions during the consultation.

What to expect from your doctor

Your doctor will likely ask you several questions. Prepare to answer them and take the time to go through the points you want to focus on. Your doctor may ask:

• When did you or your loved ones start noticing your symptoms?
• How often does your mood change?
• Have you ever had suicidal thoughts when you were feeling depressed?
• Are your symptoms interfering with your daily life or relationships?
• Do you have a blood relative with bipolar disorder or depression?
• What other mental or physical health problems do you have?
• Do you drink alcohol, smoke cigarettes, or take recreational drugs?
• how much do you sleep at night Does it change over time?
• Are there times when you take risks you wouldn't normally take, such as B. unprotected sex or reckless and spontaneous financial decisions?
• What seems to improve your symptoms?
• What seems to make your symptoms worse?