STRUGGLING with DEPRESSION, ANXIETY, or BIPOLARITY? LEARNING can really HELP. Start with ARTICLES above or Topics below. Ty! Bill

Bipolar Treatment: Hope Comes Hard

Dealing With Bipolar

“Don’t even tell me you think I have bipolar disorder. I’ve traveled that treatment route before. Sorry, no thanks!”

One of the toughest thing a therapist has to do is tell a client bipolar disorder is a possibility. And it’s even more difficult if the client has heard it before, and began a treatment regimen (and quit).

Bipolar disorder treatment is the very essence of how little we know about the emotional/mental health disorders – and their crap-shoot “fixes.”

But fact is, most any bipolar disorder intervention is often difficult to facilitate without chemical mood-stabilization.

Given all of the above, I’d like to present a series on the treatment of bipolar disorder. My primary reference source is Dr. Jim Phelps, a cutting-edge/outside-the-box thinking psychiatrist.

Rule-Outs Are Primo

As with the treatment of any emotional/mental health disorder, medical rule-outs are the first order of business. If a bipolar diagnosis is under consideration you need to make sure all is well in the thyroid neck of the woods.

A TSH – thyroid stimulating-hormone – test will get the job done. The test is also important because some bipolar treatment options may impact the thyroid, so knowing a functioning baseline is important.

There are other medical rule-outs to consider, which you can discuss with your psychiatrist and/or primary care physician.

Three Bipolar Treatment Principles

Dr. Phelps suggests three bipolar treatment principles that make a whole lot of sense to me. Let’s take a look…

Maximize Non-Medication Approaches

Bipolar treatment isn’t a 100% meds proposition. And if meds become a necessity, working the following will serve to lighten the load (‘course, if you ignore them the intensity of the meds assault will have to be ramped-up).

By the way, a therapist can be of great assistance in facilitating these…

  • Establish a regular daily schedule/routine
  • Exercise regularly
  • Minimize alcohol
  • Monitor and change your patterns of thought/belief
  • Learn all you can about bipolar disorder
  • As difficult as it may be, accept your illness
  • Light therapy (for the depressive piece)
  • Establish a well-educated support team (family members, friends, psychiatrist, therapist, clergy, etc.)
  • Do all you can to help those closest to you cope

Medication

Using mood-stabilizing meds to manage bipolarity is often difficult; however, very likely necessary. And it isn’t about using just any meds – we’re talking meds that are known to work for the variation of bipolar with which you’re dealing.

Phelps believes there are at least five options (and growing) for choosing mood-stabilizing meds. And selecting the best option for you is a decision you’ll make with the input of your psychiatrist…

The decision will ultimately be made by balancing benefits, side effects, and other risks.

Speaking of risks, a great point is to be made here. It’s easy to understand why someone would be – well – frightened to use the mood-stabilizing meds prescribed for bipolar disorder. Yet, no one seems to bat an eye about taking antidepressants.

Believe me, using any antidepressant – Zoloft, Effexor, Wellbutrin, Paxil, Pristiq, Lexapro, Viibryd, etc. – is not the cakewalk Big Pharma may have hyped when the meds were introduced.

Now, it’s up to you to research the meds your psychiatrist recommends. Why? Because for any number of reasons you can’t rely solely upon your psychiatrist for decision-making. Maybe she/he only prescribes meds they’re comfortable with. Perhaps she/he is being influenced by a pharmaceutical company. Who knows?

Bottom-line: The more you independently learn, the greater your chances of selecting the right med for you.

Antidepressants: Caution!!!

If you’ve been diagnosed with bipolar disorder, major depressive episodes are in the mix. And that often means – right or wrong – the prescribing and use of antidepressants (ADs).

ADs can make bipolar disorder worse because they cause major mood cycling issues. Maybe it’s a handful of depressive, manic, hypomanic, or mixed episodes in a year – or several in a day’s time.

ADs generate manic or hypomanic symptoms at an estimated rate of 20-40% when a depressed individual with bipolar disorder uses them.  This is known as switching. ADs can also induce mixed episodes – depression and mania/hypomania c0-occuring.

Actually, ADs may lead to an overall destabilization of mood. That means increased cycle frequency over a longer period of time, as well as more mood episodes or more rapid switches from one mood state to another.

Last, but certainly not least, ADs may cause a phenomenon known as kindling. In short, it’s about an illness worsening more quickly over time than it may have naturally. Here’s a link to a chipur article on kindling.

Hugely important! Don’t get spooked to the point where you suddenly stop taking your AD. Rather, sit down with your psychiatrist and talk things over.

Let’s Wrap Part 1

Okay, that’s more than enough info to get us off to a good start. You may see part-two tomorrow, but let’s for-sure go with Tuesday evening, okay? Be sure to keep checking-in.

In the interim, I encourage you to visit Dr. Phelps’ website at psycheducation.org. And for chipur articles on bipolar disorder, click away here.

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  • BCat

    Oh wow, I am so glad you pointed out what happens with antidepressants and bipolar. I was on every type of SSRI, SNRI, tricyclics, blah blah, with little relief and quick poop-out. So the docs keep upping the dose and what happens? MIXED-STATES!!! The most unholy god-forsaken bleak condition in the universe and the most dangerous. Not only do you feel like ending it, you have more than enough energy to do it. So I go on a ‘mood stabiIzer’, seroquel. Instant fat pill. It’s not only guys who get moobs from that crap. I’ve been out to Jim Phelps site for years and it’s really good.

    “… you can’t rely solely upon your psychiatrist for decision-making. Maybe she/he only prescribes meds they’re comfortable with. Perhaps she/he is being influenced by a pharmaceutical company…” Amen to that, bro’. There’s no excuse for the ignorance and venality of the majority of mechanized health care. We’ve got to become our own informed health advocates, very difficult when in despair and desperation. That’s why we’re so lucky to have this site.

    • Well, you’re just all over Chipur, aren’t you, BC? And I accept that as a compliment, because I know you’re one smart cookie. Wrote this article just about 3.5 years ago. Always interesting to see changes in writing, formatting style – maturity?. Heck, even found a typo in this baby (“Where’s Waldo?”).

      Phelps is a good guy. Remember emailing him after reading his book, Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder. And he sent the nicest email in return.

      Thank you for your faithful readership and participation, BC…

      Bill