Bipolar disorder is one of the common mental illnesses that are prevalent among adults. It is a condition that affects one’s mood and reaction to stimuli. The disease is, therefore, a significant concern in modern society. This study creates an awareness of the disease, its inherent characteristics, stages, and types. It also establishes how the disease can be controlled pharmacologically and through psychotherapy. Ultimately, the study assesses how the two medications should be marged to achieve better outcomes in terms of bipolar disorder management. It uses sources from medical publications and websites to affirm its claims and draw support for the suggestion of combining pharmacological and therapeutic approaches in managing the bipolar condition.
The health sector has had various challenges from time to time. One of the most common challenges evident in multiple locations is diagnosing, treating, and preventing various diseases. In the contemporary world, mental illnesses have been a concern in various places. The emergency of COVID-19 has fueled an upward trajectory on the rise of cases of mental illness (De Kock et al., 2021; Haider et al., 2020). Mental illnesses often challenge a good percentage of American adults in their lifetime. This phenomenon has been facilitated by the fact that there is minimized interaction and economic downfall in various environments. Underling conditions and causative mental distractors and disorders such as stress, anxiety, and depression have been some of the common conditions befalling people in recent days (Haider et al., 2020). Bipolar disorder has, however, been one of the common mental health disorders prevalent in almost every social environment. It is one of the most common disorders, alongside anxiety and major depression (“Three Most Common Mental Health Disorders in America,” 2021). Bipolar disorder prevalence among adults in their lifetime stands at 1%, and prevalence within a year is 0.5% (“Three Most Common Mental Health Disorders in America,” 2021). Bipolar disorder I have a higher prevalence than bipolar disorder II. According to the National Institute of Mental Health, 2.8% of adults in the United States were diagnosed with the disorder (“Bipolar Disorder,” n.d.). Males are more likely to fall victim to the health condition than women. Young adults (age 18-29 years) have a higher prevalence compared to other groups (“Bipolar Disorder,” n.d.). This situation is a disaster for the economy since the potentially most productive (18-44 years) are the most affected (“Bipolar Disorder,” n.d.). The mental health prevalence and its impacts, therefore, necessitate the need to seek interventions that achieve ultimate outcomes.
Bipolar disorder is a major health condition affecting people, especially adults. It is a mood disorder that causes extreme swings in emotions (Preston et al., 2021). These moods can occur at any time but usually last for several weeks and can last for months. They are separated by periods of normal moods called euthymic episodes (Grande et al., 2016). It is associated with various ill-health symptoms that are distinctive from other mental disorders. The health condition has vast symptoms which are largely related to the mind. They may often include extreme mood swings of hypomania or mania (highs) and depression (lows) (Preston et al., 2021). This characteristic may affect one’s operative functions and interactions. It is bound to affect one’s sleep patterns. On some occasions, victims may have too much or insufficient sleep, varying from one person to another (Grande et al., 2016). One may also experience a change in appetite, where a person may eat too much or too little. The change in one’s mood affects their reactions to different phenomena, making one easily irritated or angered (Grande et al., 2016). Such people are likely to overreact whenever a person tends to irritate their feelings (Preston et al., 2021). Bipolar disorder can also distract people from the norms and activities they often engage in. Victims may quit participating in their hobbies and activities through which they could enjoy pleasure (Vieta et al., 2018). Since their emotional stability gets tampered with, bipolar patients may experience restlessness and develop agitated feelings without the introduction of any stimuli. The emotional variations of mania and hypomania can make a person feel guilty or worthless hence developing suicidal or death thoughts (Vieta et al., 2018). Such people are more likely to have difficulty concentrating, fatigue, and decreased energy (Vieta et al., 2018). The symptoms may vary from mild to difficult situations and can last for weeks or months. A person with such symptoms is therefore asked to seek medical intervention to determine the underlying problem.
The neurological condition can affect a person in stages that differ in intensity and characteristics of inherent behaviors. The first and mildest stage is hypomania, which is marked by an elevated mood. This condition may be related to a lack of sleep or other stimulants (Preston et al., 2021). Hypomania can last for several days and can include symptoms such as increased energy, decreased need for sleep, and decreased appetite (Duffy et al., 2010). The second stage is full-blown mania or hypomanic episodes. In this case, the person may have increased activity levels and/or agitation (Preston et al., 2021). They may also have increased confidence levels, increased social interaction, and reduced need for sleep (Preston et al., 2021). People in this stage feel like they have unlimited energy, are full of joy and enthusiasm, and take on extra-large projects and responsibilities at work or home (Duffy et al., 2010). They may also feel irritable and impulsive—but unlike someone with a personality disorder, who may lash out or be unable to control themselves due to their anger, people with bipolar disorder have no control over their actions when they are in this stage (Preston et al., 2021). If left untreated, these episodes could lead to psychosis or suicidal ideation in some cases (Preston et al., 2021). The depression phase of bipolar disorder (also known as depression) is characterized by a low mood combined with significant changes in appetite or sleep habits, among other things (Duffy et al., 2010). Patients suffer from persistent sadness or hopelessness accompanied by decreased energy and motivation to carry out routine activities or engage in pleasurable activities (Duffy et al., 2010). This situation may build guilt and the development of a sense of worthlessness in behavior and appearance. Sometimes, a person may inhibit the characteristics of the mania stage and depression, becoming psychotic (Duffy et al., 2010). The stages are therefore successive hence calling for attention at early stages.
The disorder can unfold in different ways, which are used to classify its types. The types of bipolar disorder are: bipolar I, bipolar II, cyclothymic disorder, and bipolar disorder not otherwise specified (NOS). Bipolar I disorder patients experience severe symptoms of depression and mania (or hyperactivity) (Johnson et al., 2016). The symptoms can include a depressed mood for most or all days during the 1-month period before the manic episode begins. This may include at least five days when a person experiences a very depressed mood, loss of interest in usual activities, difficulty concentrating or remembering details, or slowed thinking or speaking (Johnson et al., 2016). Bipolar II disorder has less severe symptoms than those with bipolar I and fewer depressive episodes than those with bipolar I. They also experience fewer manic episodes than those who have bipolar I (Bobo, 2017). Bipolar II, therefore, affects patients to a lesser extent than bipolar I; however, its impact affects a person’s mood and emotional behaviors. Conversely, cyclothymic disorder is characterized by milder symptoms of bipolar depression than pure mania or pure hypomania (Bielecki & Gupta, 2017). The three bipolar conditions, therefore, differ depending on the intensity of the mental illness. They, however, share characteristics despite the fact that they change on the intensity and stages of infection. The disorder may, however, fail to meet the classifying symptoms hence classified as bipolar disorder NOS or subthreshold bipolar disorder.
Pharmacological treatments for bipolar disorder are based on the idea that mood swings occur when brain chemistry is out of balance. This can be caused by a number of factors, including stress, sleep deprivation, and lifestyle choices (Baldessarini, 2019). The goal of pharmacological treatments is to restore normal levels of neurotransmitters and hormones in the brain so that patients can feel better without having to rely on drug therapy (Bhandari, 2022). There are several pharmacological treatments available to treat bipolar disorder. These medications are either prescribed as part of an initial treatment plan or used after symptoms have stabilized by someone who has been trained in their use (Baldessarini, 2019). Most of the medications are either antidepressants or mood stabilizers. Antidepressants are used to treat symptoms such as low energy and agitation (Bhandari, 2022). They are also effective in treating anxiety symptoms such as restlessness or irritability. Mood stabilizers work by slowing down the activity of chemicals in the brain that contribute to manic episodes (Baldessarini, 2019). They can be taken orally or injected into a vein (intravenous) (Bowden, 2002). Some examples of mood stabilizers include lithium, carbamazepine, and valproic acid (Bowden, 2002).
Psychotherapy interventions are done with the goal of helping the patient to learn how to live with their symptoms and cope with the stresses and strains of their symptoms. These interventions help patients learn how to manage themselves in stressful situations and also help them to improve their relationships (Swartz & Swanson, 2014). Some types of psychotherapy include cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavioral therapy (DBT). CBT changes negative thinking patterns about oneself or the world around them (Ye et al., 2016). It is a common type of treatment for anxiety disorders, depression, and other mental health problems. In CBT, patients learn skills such as problem-solving and coping with stress in everyday life situations (Ye et al., 2016). They also learn how to identify negative automatic thoughts (such as “I’m worthless”) and replace them with positive ones that encourage self-improvement instead of self-blame or self-doubt (Ye et al., 2016). IPT focuses on relationships between people by helping patients understand how their relationships affect them emotionally, physically, and mentally (Frank et al., 2019). DBT regulates emotions and behaviors through skill-building techniques such as mindfulness meditation or acceptance-based strategies such as mindfulness breathing exercises (Eisner et al., 2017). Through their inherent goals, the three interventions are geared towards shaping emotional stability allowing for easy management of the bipolar disorder.
Treatment of the bipolar disorder is usually lifelong and often involves a combination of medications and psychotherapy. Psychotherapy is often helpful in managing bipolar symptoms such as depression or anxiety (Lauder et al., 2010), while medications are used to help stabilize moods, so they do not get out of control again (Geddes & Miklowitz, 2013). The two approaches can get integrated to yield the best results (Bhandari, 2022; Swartz & Frank, 2001). The two approaches target a specified aspect of the condition and are compatible and regulatory-approved for treating bipolar disorder (Geddes & Miklowitz, 2013). Parikh et al. (2015) and Swartz et al. (2017) suggest that a combination of the two interventions provides an improved course of healing. Supplementing therapeutic interventions are observed to reduce the recurrence rate of the disorder as well as allow easy management of the symptoms (Miklowitz, 2020). Consequently, pharmacological and therapeutic interventions should be marged to achieve promising results in the management of the bipolar disorder.
Bipolar disorder has a high prevalence, and there is a need to incorporate a combination of interventions that help achieve the best outcomes. The disease has distinctive characteristics that combine various factors relating to the human mood and emotional reaction. It can have different characteristics according to the levels and type that befalls a person. These symptoms can, however, get controlled through pharmacological or psychotherapy approaches. The two interventions achieve diverse outcomes in controlling the disorder. Combining the two helps achieve better results in managing the condition. Scholars have affirmed their compatibility and potential in preventing the adverse effects of bipolar disorder. Conducting this research has facilitated the creation of an in-depth understanding of the symptoms of bipolar disorder, its types, and its distinctive stages. It also creates a sense of how the intervention measures deal with the condition.
Baldessarini, R. J., Tondo, L., & Vázquez, G. H. (2019). Pharmacological treatment of adult bipolar disorder. Molecular psychiatry, 24(2), 198-217.
Bhandari, S. (2022). Understanding Bipolar Disorder — Treatment. WebMD. Retrieved 15 September 2022, from https://www.webmd.com/bipolar-disorder/guide/understanding-bipolar-disorder-treatment#:~:text=Typically%2C%20treatment%20entails%20a%20combination,Depakote%20or
Bielecki, J. E., & Gupta, V. (2021). Cyclothymic Disorder. In StatPearls [Internet]. StatPearls Publishing.
Bipolar Disorder. National Institute of Mental Health (NIMH). Retrieved 15 September 2022, from https://www.nimh.nih.gov/health/statistics/bipolar-disorder#:~:text=Prevalence%20of%20Bipolar%20Disorder%20Among%20Adults,-Based%20on%20diagnostic&text=An%20estimated%202.8%25%20of%20U.S.,%25)%20and%20females%20(2.8%25).
Bobo, W. V. (2017, October). The diagnosis and management of bipolar I and II disorders: clinical practice update. In Mayo Clinic Proceedings (Vol. 92, No. 10, pp. 1532-1551). Elsevier.
Bowden, C. L. (2002). Pharmacological treatment of bipolar disorder. Bipolar disorder, 5, 191-279.
De Kock, J. H., Latham, H. A., Leslie, S. J., Grindle, M., Munoz, S. A., Ellis, L., … & O’Malley, C. M. (2021). A rapid review of the impact of COVID-19 on the mental health of healthcare workers: implications for supporting psychological well-being. BMC public health, 21(1), 1-18.
Duffy, A., Alda, M., Hajek, T., Sherry, S. B., & Grof, P. (2010). Early stages in the development of bipolar disorder. Journal of affective disorders, 121(1-2), 127-135.
Eisner, L., Eddie, D., Harley, R., Jacobo, M., Nierenberg, A. A., & Deckersbach, T. (2017). Dialectical behavior therapy group skills training for bipolar disorder. Behavior therapy, 48(4), 557-566.
Frank, E., Swartz, H. A., & Kupfer, D. J. (2019). Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. The Science of Mental Health, 257-268.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572.
Haider, I. I., Tiwana, F., & Tahir, S. M. (2020). Impact of the COVID-19 pandemic on adult mental health. Pakistan Journal of Medical Sciences, 36(COVID19-S4), S90.
Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of abnormal psychology, 125(1), 40.
Lauder, S. D., Berk, M., Castle, D. J., Dodd, S., & Berk, L. (2010). The role of psychotherapy in bipolar disorder. Medical Journal of Australia, 193, S31-S35.
Miklowitz, D. (2020). Psychotherapy in Addition to Medication Helps Bipolar Disorder Patients Avoid Relapse and Manage Their Symptoms, Study Determines. Brain & Behavior Research Foundation. Retrieved 15 September 2022, from https://www.bbrfoundation.org/content/psychotherapy-addition-medication-helps-bipolar-disorder-patients-avoid-relapse-and-manage.
Parikh, S. V., Hawke, L. D., Velyvis, V., Zaretsky, A., Beaulieu, S., Patelis‐Siotis, I., … & Cervantes, P. (2015). Combined treatment: impact of optimal psychotherapy and medication in bipolar disorder. Bipolar disorders, 17(1), 86-96.
Preston, J. D., O’Neal, J. H., Talaga, M. C., & Moore, B. A. (2021). Handbook of clinical psychopharmacology for therapists. New Harbinger Publications.
Swartz, H. A., & Swanson, J. (2014). Psychotherapy for bipolar disorder in adults: a review of the evidence. Focus, 12(3), 251-266.
Swartz, H. A., & Frank, E. (2001). Psychotherapy for bipolar depression: a phase‐specific treatment strategy. Bipolar Disorders, 3(1), 11-22.
Swartz, H. A., Rucci, P., Thase, M. E., Wallace, M., Carretta, E., Celedonia, K. L., & Frank, E. (2017). Psychotherapy alone and combined with medication as treatments for bipolar II depression: a randomized controlled trial. The Journal of clinical psychiatry, 78(2), 16290.
Three Most Common Mental Health Disorders in America. Access Community Health Network. (2021). Retrieved 15 September 2022, from https://www.achn.net/about-access/whats-new/health-resources/3-most-common-mental-health-disorders-in-america/#:~:text=The%20most%20common%20are%20anxiety%20d
Vieta, E., Berk, M., Schulze, T. G., Carvalho, A. F., Suppes, T., Calabrese, J. R., … & Grande, I. (2018). Bipolar disorders. Nature reviews Disease primers, 4(1), 1-16.
Ye, B. Y., Jiang, Z. Y., Li, X., Cao, B., Cao, L. P., Lin, Y., … & Miao, G. D. (2016). Effectiveness of cognitive behavioral therapy in treating bipolar disorder: A n updated meta‐analysis with randomized controlled trials. Psychiatry and clinical neurosciences, 70(8), 351-361.