treatment bipolar disorder essay

Understanding Bipolar Disorder: An In-Depth Essay

Imagine living in a world where emotions oscillate between exhilarating highs and crippling lows. Where one moment, you feel invincible, and the next, you are engulfed in a darkness so profound it seems suffocating. Welcome to the complex and enigmatic realm of bipolar disorder.

At some point in our lives, we all experience fluctuations in our moods. However, for individuals with bipolar disorder, these mood swings are extreme, unpredictable, and can have devastating consequences. It is a mental health condition that possesses the power to disrupt lives, strain relationships, and challenge society’s understanding.

In this in-depth essay, we will delve into the intricate facets of bipolar disorder, unraveling its definition, prevalence, and impact. We will explore the different types of the disorder and investigate the causes and risk factors that contribute to its development.

Furthermore, we will examine the symptoms associated with bipolar disorder and the diagnostic criteria used to identify it. We will highlight the challenges faced by individuals with bipolar disorder and the effects this condition can have on personal relationships. Additionally, we will confront the societal stigma and misunderstandings that permeate the public’s perception of bipolar disorder.

Treatment and management play a critical role in the lives of those with bipolar disorder, and we will explore the medication options, therapeutic approaches, and lifestyle changes that can provide support and stability.

To navigate such a vast and complex topic, it is important to understand how to approach writing an essay on bipolar disorder. We will discuss strategies for choosing a focus, structuring your essay, addressing controversial topics, and providing reliable sources.

This essay aims to shed light on the intricacies of bipolar disorder, debunk myths, and promote understanding and empathy. By gaining knowledge and insights into this often-misunderstood condition, we can facilitate a more inclusive and compassionate society. Join us on this journey of discovery as we strive to comprehend the multifaceted nature of bipolar disorder.

Overview of Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a chronic mental health condition that affects a person’s mood, energy levels, and ability to function effectively. It is characterized by extreme shifts in mood, ranging from manic episodes, where individuals experience heightened euphoria and energy, to depressive episodes, where they feel overwhelming sadness, hopelessness, and a lack of interest in activities.

What is Bipolar Disorder?

Bipolar disorder is a complex condition that involves various biological, genetic, and environmental factors. It affects approximately 2.8% of U.S. adults, according to the National Institute of Mental Health. The onset of bipolar disorder usually occurs in late adolescence or early adulthood, although it can manifest at any age.

During manic episodes, individuals may exhibit symptoms such as increased talkativeness, racing thoughts, impulsivity, inflated self-esteem, and a decreased need for sleep. They may engage in risky behaviors, such as excessive spending or substance abuse. On the other hand, depressive episodes are characterized by symptoms like persistent sadness, fatigue, sleep disturbances, difficulty concentrating, and thoughts of death or suicide.

Types of Bipolar Disorder

Bipolar disorder is further categorized into several subtypes:

1. Bipolar I Disorder: This is the most severe form of the illness, involving manic episodes lasting for at least seven days or requiring hospitalization. Depressive episodes lasting for two weeks or more often accompany these manic episodes.

2. Bipolar II Disorder: In this type, individuals experience recurring depressive episodes but have hypomanic episodes that are less severe than full-blown mania. These hypomanic episodes do not usually lead to significant impairment in functioning.

3. Cyclothymic Disorder: Cyclothymic disorder is a milder form of bipolar disorder where individuals have frequent, but less intense, mood swings. They experience hypomanic symptoms and depressive symptoms that persist for at least two years, with brief periods of stability.

Causes and Risk Factors

The exact cause of bipolar disorder is not fully understood. However, research suggests that a combination of genetic, biological, and environmental factors contribute to its development. Individuals with a family history of bipolar disorder or other mood disorders are at a higher risk.

Other factors that may influence the development of bipolar disorder include abnormal brain structure and function, neurotransmitter imbalances, hormonal imbalances, and high levels of stress. Substance abuse or traumatic experiences may also trigger the onset or exacerbation of symptoms.

Understanding the different types of bipolar disorder and the contributing factors can help demystify this complex condition. By recognizing the signs and seeking appropriate diagnosis and treatment, individuals with bipolar disorder can lead fulfilling lives and manage their symptoms effectively.

Symptoms and Diagnosis of Bipolar Disorder

Bipolar disorder is a complex mental health condition characterized by distinct symptoms that significantly impact an individual’s daily life. Accurate diagnosis of bipolar disorder is crucial to ensure appropriate treatment and support. In this section, we will explore common symptoms of bipolar disorder, the diagnostic criteria used for its identification, and how it is distinguished from other mental health conditions.

Common Symptoms of Bipolar Disorder

The symptoms of bipolar disorder can vary depending on the specific episode and its severity. During manic episodes, individuals often experience an intense euphoria, increased energy levels, and a heightened sense of self-esteem. They may engage in risky behavior, such as excessive spending or engaging in dangerous activities. Rapid speech, racing thoughts, and impulsivity are also commonly observed.

Conversely, depressive episodes are characterized by persistent feelings of sadness, hopelessness, and a loss of interest in previously enjoyed activities. Individuals may experience changes in appetite and sleep patterns, difficulties concentrating, and thoughts of self-harm or suicide. Fatigue, a lack of motivation, and a general feeling of emptiness are also common symptoms.

Diagnostic Criteria for Bipolar Disorder

To diagnose bipolar disorder, healthcare professionals refer to the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). According to the DSM-5, the presence of manic, hypomanic, and depressive episodes is necessary for a bipolar disorder diagnosis.

For a diagnosis of bipolar I disorder, an individual must have experienced at least one manic episode, lasting for a minimum of seven days or requiring immediate hospitalization. Depressive episodes may or may not occur alongside the manic episodes.

In bipolar II disorder, individuals experience at least one major depressive episode and at least one hypomanic episode, which is characterized by milder manic symptoms that do not cause significant impairment in functioning.

Cyclothymic disorder, a milder form of bipolar disorder, is diagnosed when an individual experiences numerous periods of hypomanic symptoms and depressive symptoms over a two-year period.

Distinguishing Bipolar Disorder from other Mental Health Conditions

Differentiating bipolar disorder from other mental health conditions can be challenging due to overlapping symptoms. Depression alone, for example, may resemble the depressive episodes experienced by individuals with bipolar disorder. However, bipolar disorder is distinguished by the presence of manic or hypomanic episodes, which are not present in unipolar depression.

Other conditions such as borderline personality disorder and attention-deficit/hyperactivity disorder (ADHD) may exhibit symptoms similar to bipolar disorder, further complicating the diagnostic process. Thorough evaluation by a mental health professional is essential to accurately differentiate bipolar disorder from other conditions and develop an appropriate treatment plan.

Understanding the symptoms and diagnostic criteria of bipolar disorder helps in early identification and intervention, leading to improved outcomes for individuals living with this complex condition. Seeking professional help and support is crucial for accurate diagnosis and developing an effective management plan to mitigate the impact of bipolar disorder on daily life.

Impact of Bipolar Disorder on Individuals and Society

Bipolar disorder not only affects the lives of individuals diagnosed with the condition but also has a significant impact on their personal relationships, daily functioning, and society as a whole. In this section, we will explore the effects of bipolar disorder on personal relationships, the challenges faced by individuals with the condition, and societal stigma and misunderstandings surrounding bipolar disorder.

Effects of Bipolar Disorder on Personal Relationships

Living with bipolar disorder can strain personal relationships. The extreme mood swings, impulsivity, and erratic behavior exhibited during manic episodes can be confusing and distressing for partners, family members, and friends. Loved ones may struggle to understand the sudden changes in mood and energy levels, leading to strained communication and emotional instability within the relationship.

During depressive episodes, individuals with bipolar disorder may withdraw from social interactions, isolate themselves, and have difficulty expressing their needs and emotions. This can result in feelings of loneliness and isolation, further impacting the dynamics of personal relationships.

Challenges Faced by Individuals with Bipolar Disorder

Individuals with bipolar disorder face numerous challenges that affect their daily lives. The unpredictability of mood swings can make it difficult to maintain stable employment or pursue educational goals. Managing relationships, parenting responsibilities, and financial stability may also become more challenging due to the episodic nature of the condition.

Additionally, the presence of comorbid conditions, such as anxiety disorders or substance abuse, further compounds the difficulties faced by individuals with bipolar disorder. The stigma associated with mental illness may also create barriers in accessing proper treatment and support, exacerbating the challenges they encounter.

Societal Stigma and Misunderstandings

Despite growing awareness and understanding of mental health, societal stigma and misunderstandings surrounding bipolar disorder still persist. Many people hold misconceptions that individuals with bipolar disorder are simply “moody” or “unstable.” Such stigmatization can lead to social exclusion, discrimination, and a reluctance to seek help.

Moreover, the portrayal of bipolar disorder in popular culture and media often exaggerates the extreme behaviors associated with the condition, further perpetuating misconceptions and reinforcing stereotypes. This portrayal not only contributes to societal misunderstandings but also hinders individuals with bipolar disorder from openly discussing their experiences and seeking support.

Reducing stigma and promoting understanding are crucial steps towards creating a compassionate society that supports individuals with bipolar disorder. Educating the public about the true nature of bipolar disorder, highlighting the strengths and resilience of individuals living with the condition, and providing resources for support and education can help combat these misconceptions.

By acknowledging the impact of bipolar disorder on personal relationships, understanding the challenges faced by individuals with the condition, and challenging societal stigma, we can foster an environment that promotes empathy, acceptance, and support for those affected by bipolar disorder.

Treatment and Management of Bipolar Disorder

Effective management of bipolar disorder is essential for individuals to lead stable and fulfilling lives. Treatment typically involves a combination of medication, therapeutic approaches, and lifestyle changes. In this section, we will explore the different options available for treating bipolar disorder.

Medication Options for Bipolar Disorder

Medication plays a crucial role in managing bipolar disorder and stabilizing mood swings. Mood-stabilizing medications are commonly prescribed, such as lithium, which has proven efficacy in reducing the frequency and severity of manic and depressive episodes. Other mood stabilizers, such as valproate or lamotrigine, may also be prescribed.

Antipsychotic medications can be used to manage acute manic or depressive symptoms. They help regulate neurotransmitters in the brain, reducing the intensity of mood episodes. Antidepressant medications may be prescribed cautiously in combination with mood stabilizers to address depressive symptoms, considering the risk of triggering manic episodes.

It is important for individuals to work closely with healthcare professionals to find the most suitable medication regimen, as each individual’s response to medication varies. Regular monitoring and adjustments may be necessary to achieve optimal symptom management.

Therapeutic Approaches for Bipolar Disorder

Therapeutic interventions, such as psychotherapy, play an integral role in the treatment of bipolar disorder. Cognitive-behavioral therapy (CBT) can help individuals identify and modify negative thought patterns and behaviors associated with the disorder. Interpersonal and social rhythm therapy (IPSRT) focuses on stabilizing daily routines and addressing interpersonal issues that may trigger mood episodes.

Family-focused therapy involves educating and involving family members in the treatment process, enhancing communication, and providing support to both the individual with bipolar disorder and their loved ones. For those experiencing difficulties with medication adherence, psychoeducation can be beneficial in promoting understanding about the disorder and the importance of treatment.

Lifestyle Changes to Support Mental Health

In addition to medication and therapy, adopting certain lifestyle changes can be beneficial in managing bipolar disorder. Regular exercise has been shown to improve overall mood, reduce stress, and promote better sleep patterns. A balanced and nutritious diet can also contribute to physical and mental well-being.

Establishing a consistent sleep schedule is crucial, as disrupted sleep patterns can trigger mood episodes. Practicing good sleep hygiene, such as creating a calming bedtime routine and maintaining a comfortable sleep environment, is recommended.

Avoiding or minimizing the use of alcohol and recreational drugs is important, as these substances can negatively interact with medication and exacerbate mood symptoms. Building a strong support system, including seeking support from support groups or engaging in individual counseling, can provide valuable emotional support.

While bipolar disorder presents unique challenges, it is a treatable condition. By finding the right combination of medication, therapeutic approaches, and lifestyle changes, individuals with bipolar disorder can stabilize their moods, reduce the severity and frequency of episodes, and lead fulfilling lives. A comprehensive treatment approach that addresses the complex biological, psychological, and social aspects of the disorder is key to managing and mitigating the impact of bipolar disorder on daily functioning. Collaborating with healthcare professionals and accessing necessary support systems are vital steps towards successful management of this condition.

Writing an Essay on Bipolar Disorder

Writing an essay on bipolar disorder allows for a deeper exploration of this complex topic. However, it is important to approach the subject with sensitivity, accuracy, and a focus on providing valuable information. In this section, we will discuss key considerations when writing an essay on bipolar disorder.

Choosing a Focus for the Essay

Bipolar disorder encompasses a wide range of topics, so it is essential to narrow down your focus based on your interests and the scope of your essay. Consider exploring specific aspects of bipolar disorder, such as its impact on creativity, the relationship between bipolar disorder and substance abuse, or the experiences of individuals living with bipolar disorder.

Structuring the Essay

Organizing your essay in a logical manner is crucial for conveying information effectively. Consider using the introduction to provide an overview of bipolar disorder and set the context for the essay. Each subsequent section can delve deeper into specific aspects, such as symptoms, diagnosis, impact on relationships, treatment options, and societal understanding. Conclude your essay by summarizing key points and highlighting the significance of promoting awareness and support for individuals with bipolar disorder.

Addressing Controversial Topics

Bipolar disorder is a complex and multifaceted subject that may touch upon controversial areas. When discussing topics such as medication use, alternative therapies, or the link between creativity and bipolar disorder, it is important to present balanced viewpoints supported by credible sources. Acknowledge differing perspectives and engage in evidence-based discussions while considering potential biases or limitations in existing research.

Providing Reliable Sources

To ensure the credibility and accuracy of your essay, consult reputable sources that provide evidence-based information on bipolar disorder. Peer-reviewed academic journals, government health websites, and renowned mental health organizations are reliable sources of information. Remember to properly cite your sources using a recognized citation style, such as APA or MLA, to give credit to the original authors and avoid plagiarism.

Writing an essay on bipolar disorder provides an opportunity to educate and inform readers about this complex condition. By selecting a focused topic, structuring your essay logically, addressing controversies with balanced viewpoints, and using reliable sources, you can create an informative and compelling piece that contributes to understanding and promoting empathy for those with bipolar disorder. It is imperative to approach the topic with sensitivity and respect, recognizing the impact it has on individuals, their relationships, and society as a whole.In conclusion, bipolar disorder is a complex and multifaceted mental health condition that significantly impacts individuals and society as a whole. This in-depth essay has provided a comprehensive understanding of bipolar disorder, covering various aspects such as its definition, prevalence, and impact on personal relationships. We explored the different types of bipolar disorder and the causes and risk factors associated with its development.

Furthermore, we delved into the symptoms and diagnostic criteria used for identifying bipolar disorder while highlighting the importance of distinguishing it from other mental health conditions. The essay also shed light on the challenges faced by individuals with bipolar disorder, including the strain on personal relationships and the societal stigma surrounding the condition.

The treatment and management of bipolar disorder were extensively discussed, emphasizing the significance of medication options, therapeutic approaches, and lifestyle changes to support mental health. By adopting a comprehensive treatment approach, individuals with bipolar disorder can stabilize their moods and lead fulfilling lives.

Moreover, this essay provided insights into writing an essay on bipolar disorder, guiding readers on choosing a focus, structuring the essay effectively, addressing controversial topics, and providing reliable sources. By following these principles, writers can effectively promote awareness and understanding of bipolar disorder.

It is crucial to recognize the impact of bipolar disorder and combat societal misunderstandings and stigmas. By fostering empathy, educating the public, and providing support systems, we can create an inclusive and compassionate society that supports and empowers individuals living with bipolar disorder.

In conclusion, understanding bipolar disorder is integral to promoting mental health and fostering a more informed and accepting society. By spreading knowledge, reducing stigma, and advocating for appropriate support and resources, we can work towards creating a world where individuals with bipolar disorder can lead fulfilling and meaningful lives.

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• Patient Care & Health Information
• Diseases & Conditions
• Bipolar disorder

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

• Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
• Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
• Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
• Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with 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 diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.

Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.

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Bipolar disorder care at Mayo Clinic

• Bipolar disorder in children: Is it possible?

Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:

• Medications. Often, you'll need to start taking medications to balance your moods right away.
• Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
• Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
• Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
• Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode.

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

Medications

A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.

Medications may include:

• Mood stabilizers. You'll typically 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 in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or 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 manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic.
• Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
• Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.

Finding the right medication

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

This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.

Side effects

Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects.

Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode. If you think you need to make a change, call your doctor.

Medications and pregnancy

A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.

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

• Psychotherapy

Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:

• Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes. A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise.
• Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
• Psychoeducation. Learning 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 issues, make a plan to prevent relapse and stick with treatment.
• Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.

Other treatment options

Depending on your needs, other treatments may be added to your depression therapy.

During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide.

Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants.

Treatment in children and teenagers

Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes:

• Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
• Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder.
• Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child.
• Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.
• Bipolar medications and weight gain
• Bipolar treatment: I vs. II
• Cognitive behavioral therapy
• Electroconvulsive therapy (ECT)
• Transcranial magnetic stimulation

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Lifestyle and home remedies

You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:

• Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
• Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.
• Create a healthy routine. Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do.
• Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder.
• Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.

Alternative medicine

There isn't much research on alternative or complementary medicine — sometimes called integrative medicine — and bipolar disorder. Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder.

If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first:

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

Coping and support

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

• Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. Help educate your family and friends about what you're going through.
• Stay focused 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 problems caused by your mood swings.
• Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
• Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
• Learn ways to relax and manage stress. Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.

Preparing for your appointment

You may start by seeing your primary care doctor or a psychiatrist. You may want to take a family member or friend along to your appointment, if possible, for support and to help remember information.

What you can do

Before your appointment, make a list of:

• Any symptoms you've had, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins, herbs or other supplements you're taking, and the dosages
• Questions to ask your doctor

Some questions to ask your doctor may include:

• Do I have bipolar disorder?
• Are there any other possible causes for my symptoms?
• What kinds of tests will I need?
• What treatments are available? Which do you recommend for me?
• What side effects are possible with that treatment?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage these conditions together?
• Should I see a psychiatrist or other mental health professional?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can have?
• What websites do you recommend?

Don't hesitate to ask other questions during your appointment.

What to expect from your doctor

Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

• When did you or your loved ones first begin noticing your symptoms?
• How frequently do your moods change?
• Do you ever have suicidal thoughts when you're feeling down?
• Do your symptoms interfere with your daily life or relationships?
• Do you have any blood relatives with bipolar disorder or depression?
• What other mental or physical health conditions do you have?
• Do you drink alcohol, smoke cigarettes or use recreational drugs?
• How much do you sleep at night? Does it change over time?
• Do you go through periods when you take risks that you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
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• Fountoulakis KN, et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BP-2017), part 2: Review, grading of the evidence and a precise algorithm. International Journal of Neuropsychopharmacology. In press. http://ijnp.oxfordjournals.org/content/early/2016/11/05/ijnp.pyw100.long. Accessed Dec. 6, 2016.
• Beyer JL, et al. Nutrition and bipolar depression. Psychiatric Clinics of North America. 2016;39:75.
• Qureshi NA, et al. Mood disorders and complementary and alternative medicine: A literature review. Neuropsychiatric Disease and Treatment. 2013;9:639.
• Sansone RA, et al. Getting a knack for NAC: N-acetyl-cysteine. Innovations in Clinical Neuroscience. 2011;8:10.
• Sylvia LG, et al. Nutrient-based therapies for bipolar disorder: A systematic review. Psychotherapy and Psychosomatics. 2013;82:10.
• Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 27, 2016.
• Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 4, 2017.
• Post RM. Bipolar disorder in adults: Choosing maintenance treatment. http://www.uptodate.com/home. Accessed Jan. 4, 2016.
• Janicak PG. Bipolar disorder in adults and lithium: Pharmacology, administration, and side effects. http://www.uptodate.com/home. Accessed Jan. 4, 2017.
• Stovall J. Bipolar disorder in adults: Pharmacotherapy for acute mania and hypomania. http://www.uptodate.com/home. Accessed Jan. 4, 2017.
• Bipolar disorder and alcoholism: Are they related?

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Bipolar Disorder

What is bipolar disorder.

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes unusual shifts in a person’s mood, energy, activity levels, and concentration. These shifts can make it difficult to carry out day-to-day tasks.

There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels. These moods range from periods of extremely “up,” elated, irritable, or energized behavior (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

• Bipolar I disorder  is defined by manic episodes that last for at least 7 days (nearly every day for most of the day) or by manic symptoms that are so severe that the person needs immediate medical care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depressive symptoms and manic symptoms at the same time) are also possible. Experiencing four or more episodes of mania or depression within 1 year is called “rapid cycling.”
• Bipolar II disorder  is defined by a pattern of depressive episodes and hypomanic episodes. The hypomanic episodes are less severe than the manic episodes in bipolar I disorder.
• Cyclothymic disorder  (also called cyclothymia) is defined by recurring hypomanic and depressive symptoms that are not intense enough or do not last long enough to qualify as hypomanic or depressive episodes.

Sometimes a person might experience symptoms of bipolar disorder that do not match the three categories listed above, and this is referred to as “other specified and unspecified bipolar and related disorders.”

Bipolar disorder is often diagnosed during late adolescence (teen years) or early adulthood. Sometimes, bipolar symptoms can appear in children. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

What are the signs and symptoms of bipolar disorder?

People with bipolar disorder experience periods of unusually intense emotion and changes in sleep patterns and activity levels, and engage in behaviors that are out of character for them—often without recognizing their likely harmful or undesirable effects. These distinct periods are called mood episodes. Mood episodes are very different from the person’s usual moods and behaviors. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

Sometimes people have both manic and depressive symptoms in the same episode, and this is called an episode with mixed features. During an episode with mixed features, people may feel very sad, empty, or hopeless while at the same time feeling extremely energized.

A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar II disorder experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize changes in mood or activity levels as possible symptoms of bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Receiving the right diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a health care provider is the first step. The health care provider can complete a physical exam and other necessary medical tests to rule out other possible causes. The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder.

Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important.

Find  tips to help prepare for and get the most out of your visit with your health care provider.

Bipolar disorder and other conditions

Many people with bipolar disorder also have other mental disorders or conditions such as  anxiety disorders ,  attention-deficit/hyperactivity disorder (ADHD) ,  misuse of drugs or alcohol , or  eating disorders.  Sometimes people who have severe manic or depressive episodes also have symptoms of  psychosis , which may include hallucinations or delusions. The psychotic symptoms tend to match the person’s extreme mood. For example, someone having psychotic symptoms during a depressive episode may falsely believe they are financially ruined, while someone having psychotic symptoms during a manic episode may falsely believe they are famous or have special powers.

Looking at a person’s symptoms over the course of the illness and examining their family history can help a health care provider determine whether the person has bipolar disorder along with another disorder.

What are the risk factors for bipolar disorder?

Researchers are studying possible causes of bipolar disorder. Most agree that there are many factors that are likely to contribute to a person’s chance of having the disorder.

Brain structure and functioning:  Some studies show that the brains of people with bipolar disorder differ in certain ways from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these brain differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.

Genetics:  Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene causes the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

How is bipolar disorder treated?

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called talk therapy.

Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Certain medications can help manage symptoms of bipolar disorder. Some people may need to try different medications and work with their health care provider to find the medications that work best.

The most common types of medications that health care providers prescribe include mood stabilizers and atypical antipsychotics. Mood stabilizers such as lithium or valproate can help prevent mood episodes or reduce their severity. Lithium also can decrease the risk of suicide. Health care providers may include medications that target sleep or anxiety as part of the treatment plan.

Although bipolar depression is often treated with antidepressant medication, a mood stabilizer must be taken as well—taking an antidepressant without a mood stabilizer can trigger a manic episode or rapid cycling in a person with bipolar disorder.

Because people with bipolar disorder are more likely to seek help when they are depressed than when they are experiencing mania or hypomania, it is important for health care providers to take a careful medical history to ensure that bipolar disorder is not mistaken for depression.

People taking medication should:

• Talk with their health care provider to understand the risks and benefits of the medication.
• Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
• Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
• Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

It is important to talk to a health care provider before stopping a prescribed medication. Stopping a medication suddenly may lead symptoms to worsen or come back. You can find basic information about medications on  NIMH's medications webpage . Read the latest medication warnings, patient medication guides, and information on newly approved medications on the  Food and Drug Administration (FDA) website. 

Psychotherapy

Psychotherapy, also called talk therapy, can be an effective part of treatment for people with bipolar disorder. Psychotherapy is a term for treatment techniques that aim to help people identify and change troubling emotions, thoughts, and behaviors. This type of therapy can provide support, education, and guidance to people with bipolar disorder and their families.

Cognitive behavioral therapy (CBT) is an important treatment for depression, and CBT adapted for the treatment of insomnia can be especially helpful as part of treatment for bipolar depression.

Treatment may also include newer therapies designed specifically for the treatment of bipolar disorder, including interpersonal and social rhythm therapy (IPSRT) and family-focused therapy.

Learn more about the  various types of psychotherapies .

Other treatment options

Some people may find other treatments helpful in managing their bipolar symptoms:

• Electroconvulsive therapy (ECT)  is a brain stimulation procedure that can help relieve severe symptoms of bipolar disorder. Health care providers may consider ECT when a person’s illness has not improved after other treatments, or in cases that require rapid response, such as with people who have a high suicide risk or catatonia (a state of unresponsiveness).
• Repetitive transcranial magnetic stimulation (rTMS)  is a type of brain stimulation that uses magnetic waves to relieve depression over a series of treatment sessions. Although not as powerful as ECT, rTMS does not require general anesthesia and has a low risk of negative effects on memory and thinking.
• Light therapy  is the best evidence-based treatment for  seasonal affective disorder (SAD) , and many people with bipolar disorder experience seasonal worsening of depression or SAD in the winter. Light therapy may also be used to treat lesser forms of seasonal worsening of bipolar depression.

Unlike specific psychotherapy and medication treatments that are scientifically proven to improve bipolar disorder symptoms, complementary health approaches for bipolar disorder, such as natural products, are not based on current knowledge or evidence. Learn more on the  National Center for Complementary and Integrative Health website  .

Finding treatment

• A family health care provider is a good resource and can be the first stop in searching for help. Find tips to help prepare for and get the most out of your visit .
• To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), visit the SAMHSA online treatment locator  , or text your ZIP code to 435748.
• Learn more about finding help on the NIMH website.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline   at 988 or chat at 988lifeline.org   . In life-threatening situations, call 911.

Coping with bipolar disorder

Living with bipolar disorder can be challenging, but there are ways to help make it easier.

• Work with a health care provider to develop a treatment plan and stick with it. Treatment is the best way to start feeling better.
• Follow the treatment plan as directed. Work with a health care provider to adjust the plan, as needed.
• Structure your activities. Try to have a routine for eating, sleeping, and exercising.
• Try regular, vigorous exercise like jogging, swimming, or bicycling, which can help with depression and anxiety, promote better sleep, and support your heart and brain health.
• Track your moods, activities, and overall health and well-being to help recognize your mood swings.
• Ask trusted friends and family members for help in keeping up with your treatment plan.
• Be patient. Improvement takes time. Staying connected with sources of social support can help.

Long-term, ongoing treatment can help control symptoms and enable you to live a healthy life.

How can I find a clinical trial for bipolar disorder?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individuals may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Researchers at NIMH and around the country conduct many studies with patients and healthy volunteers. We have new and better treatment options today because of what clinical trials uncovered years ago. Be part of tomorrow’s medical breakthroughs. Talk to your health care provider about clinical trials, their benefits and risks, and whether one is right for you.

To learn more or find a study, visit:

• NIMH’s Clinical Trials webpage : Information about participating in clinical trials
• Clinicaltrials.gov: Current Studies on Bipolar Disorder  : List of clinical trials funded by the National Institutes of Health (NIH) being conducted across the country
• Join a Study: Bipolar Disorder – Adults : List of studies being conducted on the NIH Campus in Bethesda, MD

Where can I learn more about bipolar disorder?

Free brochures and shareable resources.

• Bipolar Disorder : A brochure on bipolar disorder that offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Bipolar Disorder in Children and Teens : A brochure on bipolar disorder in children and teens that offers basic information on signs and symptoms, treatment, and finding help. Also available en español .
• Bipolar Disorder in Teens and Young Adults: Know the Signs : An infographic presenting common signs and symptoms of bipolar disorder in teens and young adults. Also available  en español .
• Shareable Resources on Bipolar Disorder :  Digital resources, including graphics and messages, to help support bipolar disorder awareness and education.
• NIMH Experts Discuss Bipolar Disorder in Adults : Learn the signs and symptoms, risk factors, treatments of bipolar disorder, and the latest NIMH-supported research in this area.
• Mental Health Minute: Bipolar Disorder in Adults : A minute-long video to learn about bipolar disorder in adults.
• NIMH Expert Discusses Bipolar Disorder in Adolescents and Young Adults :  A video with an expert who explains the signs, symptoms, and treatments of bipolar disorder.

Research and Statistics

• Journal Articles   : This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
• Bipolar Disorder Statistics : An NIMH webpage that provides information on the prevalence of bipolar disorder among adults and adolescents.

Last Reviewed: February 2024

Unless otherwise specified, the information on our website and in our publications is in the public domain and may be reused or copied without permission. However, you may not reuse or copy images. Please cite the National Institute of Mental Health as the source. Read our copyright policy to learn more about our guidelines for reusing NIMH content.

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Stanford University School of Medicine blog

Serious talk about moods with bipolar disorder expert Po Wang

We all get moody -- it's part of human nature. But if you have people in your life afflicted with bipolar disorder, you quickly realize that not all moodiness is created equally.

An estimated 4.4% of adults in the U.S. -- nearly 50 million people -- will be diagnosed with a mood disorder that falls into the bipolar classification. 

While there are many medications to help these people find a sweet spot between their fluctuating moods -- from a manic state of high energy to an often paralyzingly depressive low -- those pharmacological interventions are riddled with adverse effects and can be tricky to dial in, if they work at all. That helps explain why, despite the condition's debilitating nature, it's estimated that half of patients diagnosed with bipolar eventually stop taking medications.

Stanford Medicine researchers have been among early pioneers to home in on bipolar research and treatment thanks to Terence Ketter , MD, emeritus professor of psychiatry and behavioral sciences (psychopharmacology), who launched the Bipolar Disorders Clinic in 1995 and drew international attention for his research and seminal authorings on the neurobiology of mood disorders.

"Terry really believes bipolar is a biological disease, so he wanted to address that from a neurological standpoint," said Po Wang , MD, clinical professor of psychiatry and behavioral sciences. "He was able to grow that neurobiological understanding that this was a serious illness that required very specific treatments."

[Terence Ketter] was able to grow that neurobiological understanding that this was a serious illness that required very specific treatments. Po Wang

Wang, who was the clinic's director before handing the reins to Kristin Raj , MD, clinical associate professor of psychiatry and behavioral sciences, said he joined Stanford as a resident 25 years ago because Ketter was pushing the understanding of the disease via neuroimaging, something Wang felt was key to understanding bipolar.

In subsequent years, they moved their focus to pharmacological and talk therapy treatments, and now they're working more closely with colleagues like Nolan Williams , MD, associate professor of psychiatry and behavioral sciences, who has innovated the approach to neuromodulation , more commonly referred to as transcranial magnetic stimulation, or TMS.

March is Bipolar Awareness Month, so Wang agreed to share some of what he's learned in his quarter century of studying and helping others comprehend the still little-understood disorder that he said presents a "constellation of symptoms." It also can be deadly: Researchers estimate as many as 60% of individuals with bipolar will attempt suicide and as many as 20% will die by suicide .

Part of the extra burden bipolar carries is that it's a condition often misdiagnosed and heavily stigmatized in media portrayals because of its enigmatic presentation -- something Wang attributes to the disease's unique complexity.

It's not just pejoratively saying 'They went off the deep end' or 'They had a really bad day.' Bipolar disorder a serious biological condition that requires serious treatment, not unlike cancer or heart disease. Po Wang

"The idea of bipolar as a mood spectrum disorder, where moods just fluctuate up and down, has diluted the seriousness of the condition," Wang said. "It makes it too easy to equate someone feeling some level of moodiness to someone who needs to be hospitalized because their mania has turned into psychosis. It's not just pejoratively saying 'They went off the deep end' or 'They had a really bad day.' Bipolar disorder a serious biological condition that requires serious treatment, not unlike cancer or heart disease."

This interview has been edited for clarity and brevity.

You and Terence Ketter were able to pinpoint the key brain regions responsible for bipolar disorder many years ago.

The circuits involved in mood disorders are pretty well established, but they tend to be deep in the brain in an area called the paralimbic zone. We did a few neurosurgical interventions back then, but they were invasive and not practical for most patients. In recent years, TMS, even though it doesn't seem to go very deep, acts via the more superficial areas of the cortex to influence the same circuits we identified in earlier studies.

Might what Karl Deisseroth and the Human Neural Circuitry Program are doing have applications for bipolar?

I think it's a little early to think of therapeutics [with the HNC], but we said the same about TMS. We need technology to get us deeper into the brain. Most of the serious psychiatric illnesses tend to involve the deeper structures. Getting to that cellular level like Karl [ Deisseroth , MD, PhD, the D. H. Chen Professor and a professor of bioengineering and of psychiatry and behavioral sciences] is doing is where you want to be. You want to see how these things work in real time.

• Human Neural Circuitry program seeks to investigate deepest mysteries of brain function, dysfunction

What do you think the general population should know about bipolar but probably doesn't?

Unlike anxiety and depression, where there's typically a strong environmental component, bipolar disorder has a strong biological component. What someone with bipolar experiences from minute to minute, day to day, they can't control. People think they should be able to manage bipolar disorder themselves, but they really can't. They can influence it by getting treatment and living a healthy lifestyle. It's really something they have to accept, then work with a psychiatrist to somehow manage the illness. With bipolar, there is a lot of disability, and this can be a life-threatening condition.

How important is it to find a good treatment plan?

The treated course of illness is much, much better than untreated. With treatment, people can do quite well in their lives. If we're aggressive in treatment, people can do extremely well. But it's a collaborative approach: The person has to be willing to manage bipolar disorder and engage in it as an illness -- with medications, with psychotherapy, with sleep, with diet and exercise, and engaging social contact.

The person has to be willing to manage bipolar disorder and engage in it as an illness -- with medications, with psychotherapy, with sleep, with diet and exercise, and engaging social contact. Po Wang

Talk about the value of psychotherapy in bipolar.

The best studies are on three forms of psychotherapy -- cognitive behavioral therapy, family-focused therapy, and interpersonal and social rhythm therapy -- that have been proven to shorten the time of bipolar depression and extend the time of stable mood. One thing I tell people is that none of those studies have been done with patients not on medication. Because this is so biological, you've got to have that foundational medication first. But you've got to also have some type of therapy, just like physical therapy for a cardiac or orthopedic patient. For bipolar patients, it's psychotherapy.

It seems like there's a societal disconnect when it comes to understanding bipolar -- even for those who have it.

Psychoeducation -- that is very important. People come in and feel like they have this level of sadness or happiness that should relate to what's going on in their lives -- when really what they're feeling is largely biological. They feel that they're responsible for how they're feeling. Actually, they are responsible for getting treatment and focusing on the things that can change their lives.

Since we, as psychiatrists, don't have a lot of lab tests at our disposal, we have to be good at identifying symptoms as a medical entity and what they mean. I try to teach my patients to identify symptoms. If there is a constellation of them, we might need to ask, "Are we in an episode?" ... "Do we need a specific intervention?" The best outcomes require a very collaborative approach. 

Image: woocat

Po Wang spoke about bipolar during a National Association of Mental Illness webinar in January. Here's the link to the video on YouTube.

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Home — Essay Samples — Nursing & Health — Bipolar Disorder — Treatment, Symptoms, and Prevention Strategies for Bipolar Disorder

Treatment, Symptoms, and Prevention Strategies for Bipolar Disorder

• Categories: Bipolar Disorder

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Words: 585 |

Published: Jan 30, 2024

Words: 585 | Page: 1 | 3 min read

Table of contents

Introduction, treatment options, medication management, psychotherapy, manic episodes, depressive episodes, prevention strategies, early identification and intervention, lifestyle changes, education and awareness.

• “Bipolar Disorder”. National Institute of Mental Health , 2021, https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.
• “Bipolar Disorder”. Mayo Clinic, 2021, https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955.
• McIntyre, Roger S., et al. “The Effectiveness and Safety of Long-term Medications for Bipolar Disorder: A Systematic Review and Meta-Analysis for the UK National Institute for Health and Care Excellence.” The Lancet Psychiatry, vol. 3, no. 5, 2016, pp. 405-415., doi:10.1016/s2215-0366(15)00597-5.
• “Bipolar Disorder and Therapy”. GoodTherapy, 2018, https://www.goodtherapy.org/learn-about-therapy/issues/bipolar-disorder.

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• Bipolar Disorder

Insights From the Creative Edge of Bipolar Disorder

Photographer dan winters maintains his fiery creativity while enjoying wellness..

Posted March 18, 2024 | Reviewed by Abigail Fagan

• What Is Bipolar Disorder?
• Find counselling to treat bipolar disorder

"So, the pictures you make, the ones on fire, they literally are on fire?”

“Oh yeah,” says Dan Winters, photographer and artist whose images you've likely seen capturing key moments in American history.

I met with Winters to understand how, as a person living with bipolar disorder , he harnesses creativity while maintaining balance. “I honestly view my mental health struggles in some ways as having been very beneficial to me in my life because of the hypercreativity, hyperawareness, hyperproductivity—all of those things that go with it.”

There are times, he says, when “colors will seem like they have movement. It’s a real hyperawareness, hyperfocus. It’s almost hallucinatory at times.”

He is not alone. Many have cited the extreme highs and lows of bipolar disorder as providing a window into a different reality and facilitating creativity. Research supports this. A study of 49 people living with bipolar disorder compared with 47 healthy controls found that those diagnosed with the condition scored significantly higher on the Barron-Welsh Art Scale, suggesting an enhanced level of creativity (Santosa et al., 2007).

Additional research has demonstrated that college students who select a major in the arts have a higher lifetime prevalence of bipolar disorder than those in other disciplines (MacCabe et al., 2018). Some investigators have suggested that there may be some overlap in genetic markers of heightened creativity and bipolar disorder.

In the whirlwind of a manic episode , recognizing a need for and accepting help can create a sense of dissonance. The euphoria and energy can be intoxicating. Yet, it is deceptive. Good as the mania feels, it is not joy. It does not often lead someone directly to what matters most to them. Instead, it can trick them and hold them back.

Contrary to the stereotype, for most, bipolar disorder does not present a choice between suffering while being creative and feeling dulled but healthy. Winters emphasizes the importance of support and treatment in his utilizing the best of his abilities. For the last nine years, he says, “I’ve been put on a medication regimen that is a workable one, and I still can operate at a pretty high level of creativity without being in that danger zone.” A positive relationship with a psychiatrist he trusts has been essential in finding the right combination of medications for him.

Research documents the importance of a strong, therapeutic alliance in mental health treatment, yet finding that perfect patient-provider match can be tricky.

Winters knows from experience that someone with bipolar disorder must be proactive in noticing signs of an upcoming mania or depression , and he values the support of his wife in helping him recognize when he is nearing a mood episode. He insists that it's crucial to listen to people around one, as friends and family might notice the symptoms first.

Given the episodic nature of bipolar disorder, there are often times of wellness in addition to major mood episodes. “This isn’t a constant state, in my experience," says Winters. "It comes and goes. You operate on both sides of stable.”

Like many living with the condition, Winters confides, there were times in the past when he would try to keep oncoming manias a secret due to shame and wishing to stay in an up state.

Photography has played a role in Winters’ recovery. Taking a picture can be a way of staying in the moment: “I think photography specifically is a practice that begs for being present. We experience the world fluidly, and the goal of photography is to extract singular moments from that fluidity to create a sort of approximation of what that experience was.” It can be a kind of mindfulness .

Many people living with bipolar disorder benefit from mindfulness practice or creative arts, alongside traditional treatments. A meta-analysis showed that mindfulness-based cognitive therapy led to positive outcomes in mood and anxiety in those with bipolar disorder (Xuan et al., 2020).

Winters' story and insights will be a part of the forthcoming National Geographic documentary Photographer.

Greenwood, T. A. (2020). Creativity and bipolar disorder: A shared genetic vulnerability. Annual Review of Clinical Psychology , 16 , 239-264.

MacCabe, J. H., Sariaslan, A., Almqvist, C., Lichtenstein, P., Larsson, H., & Kyaga, S. (2018). Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: A Swedish population-based case–control study and sib-pair analysis. The British Journal of Psychiatry , 212 (6), 370-376.

Santosa, C. M., Strong, C. M., Nowakowska, C., Wang, P. W., Rennicke, C. M., & Ketter, T. A. (2007). Enhanced creativity in bipolar disorder patients: A controlled study. Journal of affective disorders , 100 (1-3), 31-39.

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Jennifer Gerlach, LCSW, is a psychotherapist based in Southern Illinois who specializes in psychosis, mood disorders, and young adult mental health.

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• Int J Bipolar Disord

The challenges of living with bipolar disorder: a qualitative study of the implications for health care and research

Eva f. maassen.

1 Athena Institute, Faculty of Earth and Life Sciences, VU University Amsterdam, Boelelaan 1085, 1081HV Amsterdam, Netherlands

2 Altrecht Institute for Mental Health Care, Nieuwe Houtenseweg 12, 3524 SH Utrecht, Netherlands

Barbara J. Regeer

Eline j. regeer, joske f. g. bunders, ralph w. kupka.

3 Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, De Boelelaan 1117, Amsterdam, Netherlands

In mental health care, clinical practice is often based on the best available research evidence. However, research findings are difficult to apply to clinical practice, resulting in an implementation gap. To bridge the gap between research and clinical practice, patients’ perspectives should be used in health care and research. This study aimed to understand the challenges people with bipolar disorder (BD) experience and examine what these challenges imply for health care and research needs.

Two qualitative studies were used, one to formulate research needs and another to formulate healthcare needs. In both studies focus group discussions were conducted with patients to explore their challenges in living with BD and associated needs, focusing on the themes diagnosis, treatment and recovery.

Patients’ needs are clustered in ‘disorder-specific’ and ‘generic’ needs. Specific needs concern preventing late or incorrect diagnosis, support in search for individualized treatment and supporting clinical, functional, social and personal recovery. Generic needs concern health professionals, communication and the healthcare system.

Patients with BD address disorder-specific and generic healthcare and research needs. This indicates that disorder-specific treatment guidelines address only in part the needs of patients in everyday clinical practice.

Bipolar disorder (BD) is a major mood disorder characterized by recurrent episodes of depression and (hypo)mania (Goodwin and Jamison 2007 ). According to the Diagnostic and Statistical Manual 5 (DSM-5), the two main subtypes are BD-I (manic episodes, often combined with depression) and BD-II (hypomanic episodes, combined with depression) (APA 2014 ). The estimated lifetime prevalence of BD is 1.3% in the Dutch adult population (de Graaf et al. 2012 ), and BD is associated with high direct (health expenditure) and indirect (e.g. unemployment) costs (Fajutrao et al. 2009 ; Michalak et al. 2012 ), making it an important public health issue. In addition to the economic impact on society, BD has a tremendous impact on patients and their caregivers (Granek et al. 2016 ; Rusner et al. 2009 ). Even between mood episodes, BD is often associated with functional impairment (Van Der Voort et al. 2015 ; Strejilevich et al. 2013 ), such as occupational or psychosocial impairment (Huxley and Baldessarini 2007 ; MacQueen et al. 2001 ; Yasuyama et al. 2017 ). Apart from symptomatic recovery, treatment can help to overcome these impairments and so improve the person’s quality of life (IsHak et al. 2012 ).

Evidence Based Medicine (EBM), introduced in the early 1990s, is a prominent paradigm in modern (mental) health care. It strives to deliver health care based on the best available research evidence, integrated with individual clinical expertise (Sackett et al. 1996 ). EBM was introduced as a new paradigm to ‘de - emphasize intuition’ and ‘ unsystematic clinical experience’ (Guyatt et al. 1992 ) (p. 2420). Despite its popularity in principle (Barratt 2008 ), EBM has also been criticized. One such criticism is the ignorance of patients’ preferences and healthcare needs (Bensing 2000 ). A second criticism relates to the difficulty of adopting evidence-based treatment options in clinical practice (Bensing 2000 ), due to the fact that research outcomes measured in ‘the gold standard’ randomized-controlled trials (RCTs) seldom correspond to the outcomes clinical practice seeks and are not responsive to patients’ needs (Newnham and Page 2010 ). Moreover, EBM provides an overview on population level instead of individual level (Darlenski et al. 2010 ). Thus, adopting research evidence in clinical practice entails difficulties, resulting in an implementation gap.

To bridge the gap between research and clinical practice, it is argued that patients’ perspectives should be used in both health care and research. Patients have experiential knowledge about their illness, living with it in their personal context and their care needs (Tait 2005 ). This is valuable for both clinical practice and research as their knowledge complements that of health professionals and researchers (Tait 2005 ; Broerse et al. 2010 ; Caron-Flinterman et al. 2005 ). This source of knowledge can be used in the process of translating evidence into clinical practice (Schrevel 2015 ). Moreover, patient participation can enhance the clinical relevance of and support for research and the outcomes in practice (Abma and Broerse 2010 ). Hence, it is argued that these perspectives should be explicated and integrated into clinical guidelines, clinical practice, and research (Misak 2010 ; Rycroft-Malone et al. 2004 ).

Given the advantages of including patients’ perspectives, patients are increasingly involved in healthcare services (Bagchus et al. 2014 ; Larsson et al. 2007 ), healthcare quality (e.g. guideline development) (Pittens et al. 2013 ) and health-related research (e.g. agenda setting, research design) (Broerse et al. 2010 ; Boote et al. 2010 ; Elberse et al. 2012 ; Teunissen et al. 2011 ). However, patients’ perspectives on health care and on research are often studied separately. We argue that to be able to provide care focused on the patients and their needs, care and research must closely interact.

We hypothesize that the challenges BD patients experience and the associated care and research needs are interwoven, and that combining them would provide a more comprehensive understanding. We hypothesize that this more comprehensive understanding would help to close the gap between clinical practice and research. For this reason, this study aims to understand the challenges people with BD experience and examine what these challenges imply for healthcare and research needs.

To understand the challenges and needs of people with BD, we undertook two qualitative studies. The first aimed to formulate a research agenda for BD from a patient’s perspective, by gaining insights into their challenges and research needs. A second study yielded an understanding of the care needs from a patient’s perspective. In this article, the results of these two studies are combined in order to investigate the relationship between research needs and care needs. Challenges are defined as ‘difficulties patients face, due to having BD’. Care needs are defined as that what patients ‘desire to receive from healthcare services to improve overall health’ (Asadi-Lari et al. 2004 ) (p. 2). Research needs are defined as that what patients ‘desire to receive from research to improve overall health’.

Study on research needs

In this study, mixed-methods were used to formulate research needs from a patient’s perspective. First six focus group discussions (FGDs) with 35 patients were conducted to formulate challenges in living with BD and hopes for the future, and to formulate research needs arising from these difficulties and aspirations. These research needs were validated in a larger sample (n = 219) by means of a questionnaire. We have reported this study in detail elsewhere (Maassen et al. 2018 ).

Study on care needs

This study was part of a nationwide Dutch project to generate a practical guideline for BD: a translation of the existing clinical guideline to clinical practice, resulting in a standard of care that patients with BD could expect. The practical guideline (Netwerk Kwaliteitsontwikkeling GGZ 2017 ) was written by a taskforce comprising health professionals, patients. In addition to the involvement of three BD patients in the taskforce, a systematic qualitative study was conducted to gain insight into the needs of a broader group of patients.

Participants and data collection

To formulate the care needs of people with BD, seven FGDs were conducted, with a total of 56 participants, including patients (n = 49) and caregivers (n = 9); some participants were both patient and caregiver. The inclusion criteria for patients were having been diagnosed with BD, aged 18 years or older and euthymic at time of the FGDs. Inclusion criteria for caregivers were caring for someone with BD and aged 18 years or older. To recruit participants, a maximum variation sampling strategy was used to collect a broad range of care needs (Kuper et al. 2008 ). First, all outpatient clinics specialized in BD affiliated with the Dutch Foundation for Bipolar Disorder (Dutch: Kenniscentrum Bipolaire Stoornissen) were contacted by means of an announcement at regular meetings and by email if they were interested to participate. From these outpatient clinics, patients were recruited by means of flyers and posters. Second, patients were recruited at a quarterly meeting of the Dutch patient and caregiver association for bipolar disorder. The FGDs were conducted between March and May 2016.

The FGDs were designed to address challenges experienced in BD health care and areas of improvement for health care for people with BD. The FGDs were structured by means of a guide and each session was facilitated by two moderators. The leading moderator was either BJR or EFM, having both extensive experience with FGD’s from previous studies. The first FGD explored a broad range of needs. The subsequent six FGDs aimed to gain a deeper understanding of these care needs, and were structured according to the outline of the practical guideline (Netwerk Kwaliteitsontwikkeling GGZ 2017 ). Three chapters were of particular interest: diagnosis, treatment and recovery. These themes were discussed in the FGDs, two in each session, all themes three times in total. Moreover, questions on specific aspects of care formulated by the members of the workgroup were posed. The sessions took 90–120 min. The FGDs were audiotaped and transcribed verbatim. A summary of the FGDs was sent to the participants for a member check.

Data analysis

To analyze the data on challenges and needs, a framework for thematic analysis to identify, analyze and report patterns (themes) in qualitative data sets by Braun and Clarke ( 2006 ) was used. First, we familiarized ourselves with the data by carefully reading the transcripts. Second, open coding was used to derive initial codes from the data. These codes were provided to quotes that reflected a certain challenge or care need. Third, we searched for patterns within the codes reflecting challenges and within those reflecting needs. For both challenges and needs, similar or overlapping codes were clustered into themes. Subsequently, all needs were categorized as ‘specific’ or ‘generic’. The former are specific to BD and the latter are relevant for a broad range of psychiatric illnesses. Finally, a causal analysis provided a clear understanding of how challenges related to each other and how they related to the described needs.

To analyze the data on needs regarding recovery, four domains were distinguished, namely clinical, functional, social and personal recovery (Lloyd et al. 2008 ; van der Stel 2015 ). Clinical recovery refers to symptomatic remission; functional recovery concerns recovery of functioning that is impaired due to the disorder, particularly in the domain of executive functions; social recovery concerns the improvement of the patient’s position in society; personal recovery concerns the ability of the patient to give meaning to what had happened and to get a grip on their own life. The analyses were discussed between BR and EM. The qualitative software program MAX QDA 11.1.2 was used (MaxQDA).

Ethical considerations

According to the Medical Ethical Committee of VU University Medical Center, the Medical Research Involving Human Subjects Act does not apply to the current study. All participants gave written or verbal informed consent regarding the aim of the study and for audiotaping and its use for analysis and scientific publications. Participation was voluntary and participants could withdraw from the study at any time. Anonymity was ensured.

This section is in three parts. The first presents the participants’ characteristics. The second presents the challenges BD patients face, derived from both studies, and the disorder-specific care and research needs associated with these challenges. The third part describes the generic care needs that patients formulated.

Characteristics of the participants

In the study on care needs, 56 patients and caregivers participated. The mean age of the participants was 52 years (24–75), of whom 67.8% were women. The groups varied from four to sixteen participants, and all groups included men and women. Of all participants 87.5% was diagnosed with BD, of whom 48.9% was diagnosed with BD I. 3.5% was both caregivers and diagnosed with BD. Of 4 patients the age was missing, and from 6 patients the bipolar subtype.

Despite the fact that participants acknowledge the inevitable diagnostic difficulties of a complex disorder like BD, in both studies they describe a range of challenges in different phases of the diagnostic process (Fig.  1 ). Patients explained that the general practitioner (GP) and society in general did not recognize early-warning signs and mood swings were not well interpreted, resulting in late or incorrect diagnosis. Patients formulated a need for more research on what early-warning signs could be and on how to improve GPs’ knowledge about BD. Formulated care needs were associated with GPs using this knowledge to recognize early-warning signs in individual patients. One participant explained that certain symptoms must be noticed and placed in the right context:

I call it, ‘testing overflow of ideas’. [….] When it happens for the first time you yourself do not recognize it. Someone else close to you or the health professional, who is often not involved yet, must signal it. (FG6)

Challenges with diagnosis (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

Moreover, these challenges are associated with the need to pay attention to family history and to use a multidisciplinary approach to diagnosis to benefit from multiple perspectives. The untimely recognition of early symptoms also results in another challenge: inadequate referral to the right specialized health professional. After referral, people often face a waiting list, again causing delay in the diagnostic process. These challenges result in the need for research on optimal referral systems and the care need for timely referral. One participant described her process after the GP decided to refer her:

But, yes, at that moment the communication wasn’t good at all. Because the general practitioner said: ‘she urgently has to be seen by someone’. Subsequently, three weeks went by, until I finally arrived at depression [department]. And at that department they said: ‘well, you are in the wrong place, you need to go to bipolar [department ]’. (FG1)

The challenge of being misdiagnosed is associated with the need to be able to ask for a second opinion and to have a timely and thorough diagnosis. On the one hand, it is important for patients that health professionals quickly understand what is going on, on the other hand that health professionals take the time to thoroughly investigate the symptoms by making several appointments.

From both studies, two main challenges related to the treatment of BD were derived (Fig.  2 ). The first is finding appropriate and satisfactory treatment. Participants explained that it is difficult to find the right medication and dosage that is effective and has acceptable side-effects. One participant illustrates:

I think, at one point, we have to choose, either overweight or depressed. (FG1)

Challenges with treatment (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

Some participants said that they struggle with having to use medication indefinitely, including the associated medical checks. The difficult search for the right pharmacological treatment results in the need for research on long-term side-effects, on the mechanism of action of medicine and on the development of better targeted medication with fewer adverse side-effects. In care, patients would appreciate all the known information on the side-effects and intended effects. One participant explained the importance of being properly informed about medication:

I don’t read anything [about medication], because then I wouldn’t dare taking it. But I do think, when you explain it well, the advantages, the disadvantages, the treatment, the idea behind it, that would help a lot in compliance. (FG1)

A second aspect is the challenge of finding non-pharmacological therapies that fit patients’ needs. They said they and the health professionals often do not know which non-pharmacological therapies are available and effective:

But we found the carefarm ourselves 1 [….]. You have to search for yourself completely. Yes, I actually hoped that that would be presented to you, like: ‘this would be something for you’. (FG3)

Participants mentioned a variety of non-pharmacological therapies they found useful, namely cognitive behavior therapy (CBT), EMDR, running therapy, social-rhythm training, light therapy, mindfulness, psychotherapy, psychoeducation, and training in living with mood swings. They formulated the care need to receive an overview of all available treatment options in order to find a treatment best suited to their needs. They would appreciate research on the effectiveness of non-pharmacological treatments.

A third aspect within this challenge is finding the right balance between non-pharmacological and pharmacological treatment. Participants differed in their opinion about the need for medication. Whereas some participants stated that they need medication to function, others pointed out that they found non-pharmacological treatments effective, resulting in less or no medication use. They explained that the preferred balance can also change over time, depending on their mood. However, they experience a dominant focus on pharmacological treatment by the health professionals. To address this challenge, patients need support in searching for an appropriate balance.

Next to the challenge of finding appropriate and satisfactory treatment, a second treatment-related challenge is hospitalization. Participants often had a traumatic experience, due to seclusion, the authoritarian attitudes of clinical staff, and not involving their family. Patients therefore found it important to try preventing being hospitalized, for example by means of home treatment, which some participants experienced positively. Despite the challenges relating to hospitalization, participants did acknowledge that in some cases it cannot be avoided, in which case they urged for close family involvement, open communication and being treated by their own psychiatrist. Still, in the study on research needs, hospitalization did not emerge as an important research theme.

In both studies, participants described challenges in all four domains of recovery: clinical, functional, social and personal (Fig.  3 ). In relation to clinical recovery, participants struggled with the symptoms of mood episodes, the psychosis and the fear of a future episode. In contrast, some participants mentioned that they sometimes miss the hypomanic state they had experienced previously due to effective medical treatment. In the domain of functional recovery, participants contended with having to function below their educational level due to residual symptoms, such as cognitive problems, due to the importance of preventing stress in order to reduce the risk of a new episode, and because of low energy levels. This leads to the care need that health professionals should pay attention to the level of functioning of their patients.

Challenges with recovery (squares) including relating research needs (white circles) and care needs (grey circles). (1): mentioned in study on research needs; (2): mentioned in study on care needs. Dotted lines: division of challenges into sub challenges. Arrows: causal relation between challenges

In the domain of social recovery, participants described challenges with maintaining friendships, due to stigma, being unpredictable and with deciding when to disclose the disorder. The latter resulted in the care need for tips on disclosure. Moreover, patients experienced challenges with reintegration to work, due to colleagues’ lack of understanding, problems with functioning during an episode, the complicating policy of the (Dutch) Employee Insurance Agency 2 in relation to the fluctuating course of BD and the negative impact of stress. These challenges are associated with the care need that health professionals should pay attention to work and the need for research on how to improve the Social Security Agency’s policy.

For their personal recovery, participants struggled with acceptance of the disorder, due to shame, stigma, having to live by structured rules and disciplines, and the chronic nature of BD. This results in care needs for grief counselling and attention to acceptance and the need for research on the impact of being diagnosed with BD. Limited understanding within society also causes problems with acceptance, corresponding with the care need for education for caregivers and for research on how to increase social acceptance. Another challenge in personal recovery was discovering what recovery means and what constitute meaningful daily activities. Patients appreciated the support of health professionals in this area. One participant described the difficult search for the meaning of recovery:

I have been looking to recover towards the situation [before diagnosis] for a long time; that I could do what I always did and what I liked. But then I was confronted with the fact that I shouldn’t expect that to happen, or only with a lot of effort. (…) Then you start thinking, now what? A compromise. I don’t want to call that recovery, but it is a recovered, partly accepted, situation. But it is not recovery as I expected it to be. (FG5)

In general, participants considered frequent contact with a nurse or psychiatrist supportive, to help them monitor their mood and help them find (efficient) self-management strategies. Most participants appreciated the involvement of caregivers in the treatment and contact with peers.

Generic care needs

We have described BD-specific needs, but patients mentioned also mentioned several generic care needs. The latter are clustered into three categories. The first concerns the health professionals . Participants stressed the importance of a good health professional, who carefully listens, takes time, and makes them feel understood, resulting in a sense of connection. Furthermore, a good health professional treats beyond the guideline, and focuses on the needs of the individual patient. When there is no sense of connection, it should be possible to change to another health professional. The second category concerns communication between the patient and the health professional . Health professionals should communicate in an open, honest and clear way both in the early diagnostic phase and during treatment. Open communication facilitates individualized care, in which the patient is involved in decision making. In addition, participants wanted to be treated as a person, not as a patient, and according to a strength-based approach. The third category concerns needs at the level of the healthcare system . Participants struggled with the availability of the health professionals and preferred access to good care 24/7 and being able to contact their health professional quickly when necessary. Currently, according to the participants, the care system is not geared to the mood swings of BD, because patients often faced waiting lists before they could see a health professional.

Is adequate treatment also having a number from a mental health institution you can always call when you are in need, that you can go there? And not that you can go in three weeks, but on a really short notice. So at least a phone call. (FG3)

Participants were often frustrated by the limited collaboration between health professionals, within their own team, between departments of the organization, and between different organizations, including complementary health professionals. They would appreciate being able to merge their conventional and complementary treatment, with greater collaboration among the different health professionals. Furthermore, they would like continuity of health professionals as this improves both the diagnostic phase and treatment, and because that health professional gets to know the patient.

We hypothesized that research and care needs of patients are closely intertwined and that understanding these, by explicating patients’ perspectives, could contribute to closing the gap between research and care. Therefore, this study aimed to understand the challenges patients with BD face and examine what these imply for both healthcare and research. In the study on needs for research and in the study on care needs, patients formulated challenges relating to receiving the correct diagnosis, finding the right treatment, including the proper balance between non-pharmacological and pharmacological treatment, and to their individual search for clinical, functional, social and personal recovery. The formulated needs in both studies clearly reflected these challenges, leading to closely corresponding needs. Another important finding of our study is that patients not only formulate disorder-specific needs, but also many generic needs.

The needs found in our study are in line with the current literature on the needs of patients with BD, namely for more non-pharmacological treatment (Malmström et al. 2016 ; Nestsiarovich et al. 2017 ), timely recognition of early-warning signs and self-management strategies to prevent a new episode (Goossens et al. 2014 ), better information on treatment and treatment alternatives (Malmström et al. 2016 ; Neogi et al. 2016 ) and coping with grief (Goossens et al. 2014 ). Moreover, the need for frequent contact with health professionals, being listened to, receiving enough time, shared decision-making on pharmacological treatment, involving caregivers (Malmström et al. 2016 ; Fisher et al. 2017 ; Skelly et al. 2013 ), and the urge for better access to health care and continuity of health professionals (Nestsiarovich et al. 2017 ; Skelly et al. 2013 ) are confirmed by the literature. Our study added to this set of literature by providing insights in patients’ needs in the diagnostic process and illustrating the interrelation between research needs and care needs from a patient’s perspective.

The generic healthcare needs patients addressed in this study are clustered into three categories: the health professional , communication between the patient and the health professional and the health system. These categories all fit in a model of patient-centered care (PCC) by Maassen et al. ( 2016 ) In their review, patients’ perspectives on good care are compared with academic perspectives of PCC and a model of PCC is created comprising four dimensions: patient, health professional, patient – professional interaction and healthcare organization. All the generic needs formulated in this study fit into these four dimensions. The need to be treated as a person with strengths fits the dimension ‘patient’, and the need for a good health professional who carefully listens, takes time and makes them feel understood, resulting in a good connection with the professional, fits the dimension ‘health professional’ of this model. Furthermore, patients in this study stressed the importance of open communication in order to provide individualized care, which fits the dimension of ‘patient–professional interaction’. The urge for better access to health care, geared to patients’ mood swings and the need for better collaboration between health professionals and continuity of health professionals fits the dimension of ‘health care organization’ of the model. This study confirms the findings from the review and contributes to the literature stressing the importance of a patient-centered care approach (Mills et al. 2014 ; Scholl et al. 2014 ).

In the prevailing healthcare paradigm, EBM, the best available evidence should guide treatment of patients (Sackett et al. 1996 ; Darlenski et al. 2010 ). This evidence is translated into clinical and practical guidelines, which thus facilitate EBM and could be used as a decision-making tool in clinical practice (Skelly et al. 2013 ). For many psychiatric disorders, treatment is based on such disorder - specific clinical and practical guidelines. However, this disease-focused healthcare system has contributed to its fragmented nature Stange ( 2009 ) argues that this fragmented care system has expanded without the corresponding ability to integrate and personalize accordingly. We argue that acknowledging that disorder - specific clinical and practical guidelines address only parts of the care needs is of major importance, since otherwise important aspects of the patients’ needs will be ignored. Because there is an increasing acknowledgement that health care should be responsive to the needs of patients and should change from being disease-focused towards being patient-focused (Mead and Bower 2000 ; Sidani and Fox 2014 ), currently in the Netherlands generic practical guidelines are written on specific care themes (e.g. co-morbidity, side-effects, daily activity and participation). These generic practical guidelines address some of the generic needs formulated by the patients in our study. We argue that in addition to disorder-specific guidelines, these generic practical guidelines should increasingly be integrated into clinical practice, while health professionals should continuously be sensitive to other emerging needs. We believe that an integration of a disorder-centered and a patient-centered focus is essential to address all needs a patient.

Strengths, limitations and future research

This study has several strengths. First, it contributes to the literature on the challenges and needs of patients with BD. Second, the study is conducted from a patient’s perspective. Moreover, addressing this aim by conducting two separate studies enabled us to triangulate the data.

This study also has several limitations. First, this study reflects the challenges, care needs and research needs of Dutch patient with BD and caregivers. Despite the fact that a maximum variation sampling strategy was used to derive a broad range of challenges and needs throughout the Netherlands, the Dutch setting of the study may limit the transferability to other countries. To understand the overlap and differences between countries, similar research should be conducted in other contexts. Second, given the design of the study, we could not differentiate between patients and caregivers since they participated together in the FGDs. More patients than caregivers participated in the study. For a more in-depth understanding of the challenges and needs faced by caregivers, in future research separate FGDs should be conducted. Third, due to the fixed outline of the practical guideline used to conduct the FGDs, only the healthcare needs for diagnosis, treatment and recovery of BD are studied. Despite the fact that these themes might cover a broad range of health care, it could have resulted in overlooking certain needs in related areas of well-being. Therefore, future research should focus on needs outside of these themes in order to provide a complete set of healthcare needs.

Patients and their caregivers face many challenges in living with BD. Our study contributes to the literature on care and research needs from a patient perspective. Needs specific for BD are preventing late or incorrect diagnosis, support in search for individualized treatment, and supporting clinical, functional, social and personal recovery. Generic healthcare needs concern health professionals, communication and the healthcare system. This explication of both disorder-specific and generic needs indicates that clinical practice guidelines should address and integrate both in order to be responsive to the needs of patients and their caregivers.

Authors’ contributions

EFM designed the study, contributed to the data collection, managed the analysis and wrote the first draft of the manuscript. BJR designed the study and contributed to the data collection, data analysis, and writing of the manuscript. JFGB contributed to the study design and critical revision of the manuscript. EJR contributed to the study conception and critical revision of the manuscript. RWK contributed to the study design, acquisition of data, and critical revision of the manuscript. All authors contributed to the final manuscript. All authors read and approved the final manuscript.

Competing interests

The authors declare that they have no competing interests.

The authors received no financial support for the research.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

1 Care farm: farms that combine agriculture and services for people with disabilities (Iancu 2013 ). These farms are used as interventions in mental care throughout Europe and the USA to facilitate recovery (Iancu et al. 2014 ).

2 A government agency involved in the implementation of employee insurance and providing labor market and data services.

Contributor Information

Eva F. Maassen, Phone: +31 (0)6 13861504, Email: [email protected] .

Barbara J. Regeer, Email: [email protected] .

Eline J. Regeer, Email: [email protected] .

Joske F. G. Bunders, Email: [email protected] .

Ralph W. Kupka, Email: [email protected] .

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Local doctor uses TMS to improve outcomes for bipolar disorder

(COLORADO SPRINGS) — Mar. 30 is National Bipolar Day or Bipolar Awareness Day. In honor of the day, and those who suffer from bipolar disorder, FOX21 interviewed local psychiatrist, founder, and Chief Medical Officer of the Family Care Center in Colorado Springs, Dr. Chuck Weber.

For the last 8 years, Dr. Weber has been using Transcranial Magnetic Stimulation (TMS) to treat bipolar disorder in his patients—and he is seeing excellent results. “The magnetic current creates electric charge,” he says. “So instead of a chemical that maybe works for a day or a few hours, we’re actually changing an electrical activity [in the brain].”

Dr. Weber and his team treat people who suffer from Bipolar I and Bipolar II, two distinct disorders. Both involve mood swings that range from mania to depression. The main difference between the two disorders is seen in the level of mania. Bipolar I is characterized by extreme mania that interferes with daily function and may lead to hospitalization while the manic episodes in Bipolar II are much less severe (this is called hypomania).

Both Bipolar I and II respond well to TMS when used alongside other traditional treatments. TMS, Dr. Weber says, is not a standalone solution, but it can be a great way to control symptoms enough to increase the effectiveness of other treatments, like talk therapy.

“If somebody is drowning,” said Dr. Weber, “you don’t talk to them about their feelings or their mother, right? You hold out a life-preserver.”

Describing the mania associated with bipolar disorder, Dr. Weber said, “It is to have excessive energy acquired for your brain, and your emotional center to be fired up without social inhibitions. It’s like your limbic system, your emotional center, is on fire.”

The behaviors often produced by Bipolar mania are “not congruent with society and preserving oneself,” Dr. Weber said, which is why finding helpful treatments for those struggling with bipolar disorder is so important for their lives and well-being.

A person with bipolar disorder struggles with perception, Dr. Weber pointed out. They may fail to see risk, or (if depressed) become unable to see positive, hopeful things, or solutions. He described the effect as a filter placed over your perception that changes how you experience the world, only letting in that which confirms the things you already believe to be true.

“You’ve heard the vernacular colloquialism of rose-colored glasses,” he says. “If you’re manic or if you’re depressed, it is very difficult to receive good information.”

“This is what leads down to self-destruction,” he continued, “substance use, impulsive and risky behaviors. It’s almost like a self-fulfilling prophecy, because of that perception, and how they’re viewing themselves. There’s a psychodynamic phrase I like to use: ‘Sometimes we create the world we think we deserve.’ So, if people are manic, they think they deserve in a grandiose sense, or if they’re severely depressed, they tend to do things that reinforce those ideas or reinforce those perceptions.”

Managing triggers is important, Dr. Weber said, and loved ones can help with this. He suggests writing down what begins a mood swing and keeping track of those routines, to develop mindfulness and understanding. “There is usually some kind of—maybe not a causation—but there is a correlation.”

Sleep is another important treatment factor for those suffering from Bipolar I and II.

“If there is anything I can get people to do,” Dr. Weber says, “it’s good sleep hygiene. And getting all screentime out of the bedroom. No TVs, things like that. And of course, diet and exercise are important, and trying to abstain from alcohol or drugs, legal or illegal.”

Dr. Weber is encouraged by the results his patients have been seeing using Transcranial Magnetic Stimulation (TMS). “I’ve never seen anybody react as quickly,” he says. “I can get you feeling better and less anxious, less depressed, less chance for mania in six weeks.”

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