What meds for bipolar

Electroconvulsive therapy (ECT) is sometimes used for severely manic or depressed patients and for those who don't respond to medication or for those women who, while pregnant, experience symptoms. Because it can act quickly, it may be especially helpful for severely ill patients who are at high risk for attempting suicide. ECT fell out of favor in the 1960s partly due to distorted, negative portrayals of its use in the media. But modern procedures have been shown to be both safe and highly effective. The patient is first anesthetized and a muscle relaxant is given. Then, while the patient is asleep, a small electric current is passed through electrodes placed on the scalp to produce a grand mal seizure of short duration -- less than one minute. A course of treatment usually involves 6-12 treatments, typically administered three times per week. During the course of ECT treatments -- usually two to four weeks -- lithium and other mood stabilizers are sometimes discontinued to minimize side effects.They are then resumed after completion of the treatment.

The newer types of non pharmocological treatments of depression are:

• VNS (Vagus or Vagal Nerve Stimulation) involves implantation of a device that sends electrical signals to the vagus nerve in order to treat depression.
• TMS (Transcranial Magnetic Stimulation) is a procedure which involves the use of an electromagnetic coil to create electrical currents and stimulate nerve cells in the mood centers of the brain as a treatment for depression.
• Light therapy has proved effective as an additional treatment when bipolar disorder has a connection to seasonal affective disorder. For those people who usually become depressed in winter, sitting for 20 minutes to 30 minutes a day in front of a special light box with a full-spectrum light can help treat depression.

Home Environment and Bipolar Disorder

If someone you live with has bipolar disorder, maintain a calm environment, particularly when that person is in a manic phase. Keep to regular routines for daily activities -- sleeping, eating, and exercise. Adequate sleep is very important in preventing the onset of episodes. Avoid excessive stimulation. Parties, animated conversation, and long periods of watching television or videos can exacerbate manic symptoms. Alcohol or illicit drug use can cause or worsen mood symptoms and make prescription medicines work less effectively.

IMPORTANT! Help and Support

In the manic phase of bipolar disorder, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car. Drinks and foods containing caffeine -- tea, coffee, and cola-- should be allowed in moderation. Avoid alcohol at all times. It is very important for a patient experiencing manic symptoms to receive prompt psychiatric assessment. Family members may need to contact the doctor, because oftentimes patients in a manic or hypomanic episode have little insight into their illness and may refuse treatment. But prompt intervention, including possible medication adjustments at an early point in an episode, may prevent further problems and the need for hospitalization.

Bipolar Disorder Guide

1. Overview
2. Symptoms & Types
3. Treatment & Prevention
4. Living & Support

Treatment of bipolar disorder: what methods and drugs do doctors use?

Modern psychiatry is represented by new generation drugs, innovative approaches in psychotherapy. They are used in bipolar disorders. Patients should not be treated as if they were depression or schizophrenia - the drug regimen is selected depending on the phase and condition of the patient. If we are talking about depression, antidepressants are selected, if about mania, they are contraindicated, anxiolytics and sedatives are prescribed. nine0003

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Bipolar personality disorder is quite complex in terms of the treatment of the disease. Building a therapy strategy can only be entrusted to an experienced psychiatrist. In no case should patients self-medicate, as this may lead to a worsening of the condition. Treatment is primarily medical, but psychotherapy and lifestyle changes are also recommended. The treatment regimen is selected by the doctor individually, depending on the characteristics of the course of the disease and the psychotype of the patient. Abuse of antidepressants or refusal to take medications with a temporary improvement in well-being can lead to complications, so the patient should be constantly under the supervision of the attending physician. nine0003

Treatment of bipolar disorder: what methods and drugs do doctors use?

If you or someone close to you suffers from bipolar disorder, do not delay seeking qualified help. The sooner you start treatment, the higher your chances of success. Timely and effective treatment of bipolar disorder relieves its symptoms, reduces the frequency and intensity of mood swings, and helps to live a normal life. In a previous article on bipolar disorder, I have already looked at the general aspects of this disorder. Today's post is entirely dedicated to the treatment of bipolar disorder. In this regard, before you start reading, I will answer the most common question: Can bipolar disorder be cured on its own? The short and simple answer is NO! You can greatly help the treatment, make the process easier and more effective, but nothing more. For non-believers, I'll explain why. If the fact of the disease is established, then it manifested itself through the symptoms. Symptoms are what we see. Therefore, the disease takes over the mind, since we see its manifestations. If a person could suppress the manifestation of symptoms by willpower, then no one would ever know about any disease, that is, it would not exist. Any person experiences different emotions from time to time, but as long as he can control them, he is mentally healthy. If emotions take over and control the consciousness of a person, he is sick. How can a sick person fight on his own with what he cannot control? - No way! In this case, it is impossible to do without outside help. nine0003

Overview of bipolar disorder and its treatment

Bipolar disorder is a lifelong condition. Its manifestations are always unpredictable, so "ups" and "downs" alternate without any apparent pattern. If treatment is delayed, these ups and downs can be devastating. The recurring episodes of manic and depressive phases that characterize the disease make it difficult to lead a normal, stable, and productive life. In a manic phase, you may be hyperactive and irresponsible; in a depressive phase, it may be difficult for you to do anything at all. Early diagnosis and treatment will undoubtedly help to avoid these problems. The success of treatment for bipolar disorder depends on a number of factors. Medications alone are not enough. In order to get the most out of your treatment, it is very important to educate yourself and educate yourself about your illness, communicate with doctors and psychologists, and provide yourself with a strong support system to lead a healthy lifestyle and stick to your treatment plan. The healing process for bipolar disorder is long and will not happen overnight. Like the mood swings of bipolar disorder, treatment too will have its ups and downs. Finding the right treatment will take time, and failures happen along the way. But with proper attention to the disease, as well as a consistent commitment to the desire to improve your condition, you can take control of the symptoms of bipolar disorder and live life to the fullest. What can you do to feel better? Know the difference between the symptoms of the disease and the characteristics of your psyche. The professionals you turn to for help can help separate your personality traits from the symptoms of the disease, which will allow you to recognize in which cases changes in your behavior are caused by the disease and which are not. To do this, you must be open and honest about your behavior, because you will have to monitor it in order to improve the recognition of episodes of bipolar disorder. · Educate your family members and involve them in the process of fighting the disease. Your loved ones can help identify symptoms and monitor your behavior. They will also motivate and support you, which will certainly allow you to deal with future crises much more effectively. · Live a healthy life. A normal and healthy lifestyle, including regular sleep, a healthy diet, the absence of alcohol, drugs and risky behavior is one of the main conditions for recovery. Develop an individualized treatment plan. Talk to your doctor about your medications, especially side effects that may be bothering you. There are many options for drug exposure and there is always plenty to choose from. It is very important to consult with specialists before making any changes in the treatment process, from the set of medications used, the schedule for taking them, and ending with the daily routine. nine0003

Accurate diagnosis of bipolar disorder

Obtaining an accurate diagnosis is the first step in the successful treatment of bipolar disorder. This is not always easy to do. The mood swings of bipolar disorder can be difficult to distinguish from other mental health problems such as depression, ADHD (attention deficit hyperactivity disorder), or borderline personality disorder. For many people with bipolar disorder, it takes years and multiple visits to the doctor before the problem is identified and properly diagnosed. Correctly diagnosing bipolar disorder can be difficult even for qualified professionals, so it is better to consult a psychiatrist with experience in the treatment of bipolar disorder, and not just a psychotherapist in an outpatient clinic or a local doctor. An experienced psychiatrist who specializes in the treatment of bipolar disorder is likely to be much better informed about the latest research in the field and advanced treatments. He also probably maintains contact with other specialists, which will make your treatment more effective. What to expect from the diagnosis? A diagnostic evaluation for bipolar disorder typically consists of the following: · Psychiatric evaluation - a complete psychiatric history (data collection and medical history) will be taken by a medical specialist. You will answer questions about your symptoms, tell your history of concerns, any treatment you may have received in the past, and your family history of mood disorders. · Physical Examination and Investigations – There are no specific laboratory tests to detect bipolar disorder. But the doctor must take a medical history and conduct a series of tests to rule out diseases or medications that may be causing your symptoms. For example, screening for thyroid disorders is especially important, as thyroid problems can cause mood swings that mimic the symptoms of bipolar disorder. In addition to a psychiatric evaluation and physical exam, your doctor may talk to family and friends about your mood and behavior. Very often, people around you can give a more accurate and objective picture of your symptoms. Diseases and drugs that can mimic symptoms of bipolar disorder Thyroid disorders Corticosteroids Antidepressants Adrenal disorders (eg, Addison's disease, Cushing's syndrome) Anxiety drugs Drugs for Parkinson's disease Vitamin B12 deficiency Neurological disorders (e.g. epilepsy, multiple sclerosis)

Types of Bipolar Disorder

I have already covered the types of this disorder in the article Bipolar Disorder, which you can read if some of the terms are not clear to you. But in order not to refer those who know what is at stake to another publication, I will once again remind you of the types of bipolar disorder, only in more detail. Each type of bipolar disorder is defined by the nature of the episodes of mania and depression. Treatment may differ depending on the type of bipolar disorder you have been diagnosed with. · Bipolar I disorder (mania and depression) - Bipolar I disorder is the classic form of the disease and also the most typical type of bipolar disorder. It is characterized by at least one episode of mania or a mixed episode. The vast majority of people with bipolar I disorder also have at least one episode of depression, although this is not necessary for a diagnosis. · Bipolar II disorder (hypomania and depression) - full-blown mania does not appear here. Instead, the illness involves recurring episodes of depression and hypomania (a mild form of mania). In order to be diagnosed with Bipolar II, you must have had at least one episode of hypomania and one major depressive episode. If you have had a manic episode at least once in your life, your diagnosis will be changed to Bipolar I disorder. · Cyclothymia (hypomania and mild depression) - Cyclothymia is a mild form of bipolar disorder. Like any bipolar disorder, cyclothymia is made up of cyclical mood swings. However, the highs and lows are not severe enough to unambiguously qualify as mania or depression. For a diagnosis of cyclothymia, you must experience multiple episodes of hypomania and mild depression over at least a two year period. Since people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, this form of the disease needs to be carefully screened for accurate and timely diagnosis. nine0003

Bipolar disorder or depression?

Bipolar disorder is often misdiagnosed as depression. One reason for this is that most people with bipolar disorder seek help when they are in the depressive phase of the illness. If a person is going through a manic phase, he rarely sees a doctor because he doesn't acknowledge that there is a problem. In addition, in people with bipolar disorder, a significantly greater percentage of the time is spent in depressive phases than in manic or hypomanic phases. Misdiagnosed, bipolar disorder is a potentially dangerous problem because the treatment for bipolar depression is different from that for regular depression. In fact, antidepressants used to treat regular depression can significantly worsen bipolar disorder. Therefore, it is very important to contact a specialist in a timely manner, who will help you understand what is really happening. Signs that your depression is really bipolar disorder: · Episodes of depression are recurring. · You had your first episode of depression before the age of 25. · You have a relative with bipolar I disorder. · When you are not depressed, your mood and energy levels are higher than those of most other people. · When you are depressed, you sleep a lot and overeat. Episodes of depression are short (less than 3 months). You lose touch with reality when you are depressed. · You have had a case of postpartum depression. · You have had episodes of mania or hypomania while taking antidepressants. · Your antidepressants stopped working a few months after you started taking them. · You have tried 3 or more antidepressants without success, but nothing worked for you. nine0003

Treatment options for bipolar disorder

If your doctor determines that you have bipolar disorder, they will offer treatment options and possibly prescribe medication. You may also be referred to other specialists for advice and development of an individual treatment plan.

Comprehensive treatment for bipolar disorder

Comprehensive treatment plan for bipolar disorder aims to: Relieve symptoms Restore the ability to act and solve problems both at home and at work Reduce the chance of relapses A complete treatment plan includes: Medications - Medications are the backbone of the bipolar disorder treatment process. By taking stabilizing drugs, you minimize the "ups" and "downs" and retain the ability to manage the situation. · Psycho1therapy - necessary to deal with bipolar disorder and the problems that the disease has caused in your life. Working with a doctor, you will learn about how to deal with difficult or unpleasant emotions, reconnect with others, deal with stress, and learn how to manage your mood. · Education - Managing symptoms and preventing complications begins with an in-depth understanding of one's illness. Education is a key component of treatment. The more you and your loved ones know about bipolar disorder, the easier it will be to avoid problems and deal with setbacks. · Lifestyle changes – By carefully following a healthy lifestyle, you can minimize the impact of bipolar disorder symptoms. This includes maintaining a regular sleep pattern, avoiding alcohol and drugs, a consistent exercise program, avoiding conflict, avoiding stressful situations, and maintaining a positive mindset at all times. · Support – Life with bipolar disorder can be challenging, so having a strong support system can help change your outlook and increase positive motivation. Participation in a bipolar disorder support group will give you the opportunity to share your experiences and learn from those who have already gone through the stages that you are just going through now. The support of friends and family is also invaluable. nine0003

The role of medication in treating bipolar disorder

Most people with bipolar disorder need medication to keep their symptoms under control. Long-term drug treatment can reduce the frequency and severity of episodes of the disease, and sometimes prevent them completely. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or drug combination that is best for you. Because everyone reacts differently to medications, you may try a wide variety of medications before you find one (or group of medications) that relieves symptoms. Do not take it into your head to "get" medicines and take them - the consequences can be not just bad, but terrible · Visit your doctor regularly. It is important to have regular blood tests to ensure that the blood level of the drug is in the therapeutic range (sufficient for a therapeutic effect, but not so high as to aggravate the situation). Determining the exact dose of medication you need is a constant balancing act between too little and too much, so regular monitoring will help keep you from showing symptoms and keep you healthy. · Continue taking your medicines even if your mood is stable. Do not stop taking your medicines as soon as you start to feel better. Most people need to take medication on a regular basis to avoid relapses. · Don't expect medicines to solve all your problems. For bipolar disorder, medications can help reduce symptoms of mania and depression, but in order to feel better, it's important to lead a lifestyle that supports good health. This includes the support of others, therapeutic treatment and proper rest. · Be extremely careful with antidepressants. Studies show that antidepressants are not particularly effective in treating bipolar depression. In addition, they can cause mania or sudden and frequent jumps between depression and mania. nine0003

Psychotherapy as an important part of treatment

People who take drugs to treat bipolar disorder are much more likely to be cured if they also receive medical treatment. In therapy, you will learn how to deal with issues that cause symptoms of bipolar disorder, such as relationship issues and self-esteem. Therapy sessions will address other issues you struggle with, such as substance abuse or anxiety. Particularly useful in the treatment of bipolar disorder are the following three therapies: Cognitive Behavioral Therapy Interpersonal and Social Rhythm Therapy Family Therapy

Cognitive Behavioral Therapy

In Cognitive Behavioral Therapy sessions, you will learn about how your thoughts affect your emotions, and you will learn to change negative thought patterns into more positive ways of responding. In the treatment of bipolar disorder, the emphasis is on managing symptoms, avoiding relapse triggers, and dealing with problems that arise.

Interpersonal and social rhythm therapy

Interpersonal Therapy addresses the most pressing relationship issues to help you connect better with those around you. This type of treatment aims to reduce stress levels, and since stress is a trigger for bipolar disorder, interpersonal and social rhythmic therapy will help reduce mood swings, making them less frequent and less severe. In the treatment of bipolar disorder, interpersonal therapy is often combined with social rhythm therapy. It has been proven that people with bipolar disorder have an increased sensitivity to biological rhythms. In turn, biological rhythms can be easily disturbed by a mismatch between biorhythms and social rhythms. Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, working hours. When these rhythms are stabilized, the biological rhythms that control mood also remain stable. nine0003

Family therapy

Living with a person who suffers from bipolar disorder is very difficult, which leads to tension in family relationships. Family therapy is focused on solving these problems and is aimed at restoring a healthy and supportive home environment. Informing family members about the disease and teaching them how to deal with its symptoms is a major component of family therapy.

Alternative treatments for bipolar disorder

Most alternative treatments for bipolar disorder are actually complementary treatments, meaning they must be used in conjunction with medication, therapy, and lifestyle changes. Here are some useful additions: Day and Night Therapy — Like Social Rhythm Therapy, Day and Night Therapy focuses on the biological rhythms of people with bipolar disorder. This therapy offers assistance in organizing biorhythms by properly adjusting lighting at different times of the day to provide darkness when nighttime rest is needed and light when wakefulness is needed. One of the main components of this therapy is the restriction of daylight or artificial light for ten hours each night. · Focus and Meditation - Research has shown that focus based cognitive therapy and meditation help fight and prevent depression, anger, anxiety, and anxiety. Meditation, yoga, breathing exercises and focusing on one's own mind help break down negative thinking patterns. · Acupuncture — Acupuncture is currently being studied as an additional treatment for bipolar disorder. Some researchers believe that it may help people with bipolar disorder by modulating their response to stress. Research on acupuncture in the treatment of bipolar depression has already shown a reduction in symptoms, and every year there is more and more evidence that acupuncture can relieve the symptoms of not only depression, but also mania. nine0003

symptoms of bipolar disorder, how it proceeds, how to find a psychiatrist, diagnosis and treatment

Victoria K.

lives with bipolar disorder

The first signs of the disease appeared in my teenage years, and the psychiatrist diagnosed bipolar disorder at the age of 26.

According to WHO, 45 million people worldwide suffer from bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to do everyday things. nine0003

I will tell you how I have BAD and what I do to cope with the disorder and live like all ordinary people.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you. nine0003

What is Bipolar Affective Disorder?

Bipolar Affective Disorder, or BAD, is a mental disorder with alternating emotional ups and downs in mood. It is affective just because it is associated with violations of the emotional state, that is, mood - in psychiatry, the manifestation and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.

Bipolar Disorders - A Physician's Handbook MSD

Why BAD develops is not exactly known. Among the reasons are heredity, traumatic events, violations of the production of neurotransmitters - substances due to which signals are transmitted between brain neurons. The disease often manifests itself in adolescence or in the period between 20 and 30 years.

How Bipolar Disorder Manifests

BAD usually starts abruptly, followed by periods without symptoms and periods of exacerbations. The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states that can replace each other in an arbitrary order. nine0003

Bipolar Disorder - Mayo Clinic Blog Article

For example, when the illness escalates, the following conditions may occur.

Mania - a state of elevated or irritable mood. The person feels energetic, actively engaged in something, such as finding a new hobby or even trying to open a business. As a rule, he sleeps little, is self-confident, talkative, he has a lot of ideas, often crazy. Risk sensitivity may decrease - for example, a person invests all the money in a hopeless business or gets into a loan. Hobbies for gambling, extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively. nine0003

The extreme degree of mania is manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.

Hypomania is a kind of mild mania. A person is in a state of emotional uplift, but this uplift is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoric, and his productivity increases. Although in some people such periods may be accompanied by irritability and a decrease in concentration. nine0003

Depression - low mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration. Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the futility of one's own life.

/bye-depression/

“It reminded me of a strict regime sanatorium”: how much I spent on treating depression

Between exacerbations, a person can return to normal, although it happens that his performance is still reduced. nine0003

Manifestations of the phases of bipolar disorder, according to the National Institute of Mental Health USA

Mood

Excitement, joy, irritability, resentment

Sleep

Decreased need for sleep

Appetite

Loss of appetite

Communication

Talking

Concentration

Feeling of thoughts, multitasking

behavior

Risk, unbridled sex

Subjective sensations

Feelings of

Mood

Sadness, depression, emptiness, anxiety, hopelessness

Sleep

Trouble falling asleep, getting up early or sleeping too much

Appetite

often increased appetite, weight gain

Communication

Slow speech, forgetfulness

Concentration

Problems with attention and making decisions, Dispersibility

behavior

Lack of pleasure and interest in something, decrease in libido

Subjective feelings

Feelings of worthlessness, suicidal thoughts, suicide attempts

There are two main types of bipolar disorder according to how the disease manifests itself:

1. When there was at least one manic episode and depressive episodes recur.
2. When there are periods of depression and at least one episode of hypomania, but without full mania.

Bipolar Disorder - National Institute of Mental Health USA

I just have bipolar affective disorder type 2. This means that there are no full-fledged manias, but there are hypomanias and severe depressions.

Hypomania is a very cool time for me. You can do everything: get a second degree, run a marathon, learn English, go on an unplanned trip. And so for several months during which you do not sleep, do not eat, acquire new friends, start novels, end old relationships. You feel all sensations in the maximum range. During the day, it can throw several times from tears and the desire to die to incredible happiness. nine0003 This is what mania looks like in BAD. Source: Twitter

After hypomania comes depression. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary things. The most understandable image of depression for me is “pressed down by a concrete slab. ” It becomes hard to do the simplest things: wash the dishes, change clothes, go to the store.

Unfortunately, the brighter the hypomania goes, the worse the depression gets later — that's why, with experience, I stopped enjoying the active phase. nine0270 Now it's even more difficult for me: I understand what is happening with my brain, but I can't control it.

As I remember now, my first hypomania happened at the age of 12. Then there were periods of exacerbations clearly in a year and a half: hypomania lasts 2-3 months, usually May - July, depression - 5-6 months, usually in October - March, in between remission occurs when I feel normal. If I am in a long-term remission, then I hardly notice phase changes: mood swings are smoothed out with the help of medications or psychotherapy. nine0003

10 podcasts about health and medicine

The usual course of bipolar affective disorder

Viktor Lebedev

psychiatrist, science journalist

During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate. There is a clear separation of phases: first a hypomanic or manic episode, then a depressive episode, it happens that there are recurring episodes of depression, then hypomania. In the latter case, hypomanic phases are sometimes not noticed, a person may be diagnosed with recurrent, that is, recurring depression, and may be prescribed the wrong treatment. nine0003

In fact, in BAD, the phases can alternate in any order, the diagnosis is made if there is any combination of manic and depressive episodes. The first time the disease usually begins with an episode of mania or hypomania, which develops into depression. Less commonly, it starts with depression, then mania or hypomania occurs. But in any case, there must be affective disturbances, that is, mood disturbances.

The exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medical treatment. If you respond quickly to an exacerbation, you can sometimes return to normal health in a week. If not treated, the exacerbation can last for several months - especially the depressive phases, episodes of hypomania and mania usually pass faster. nine0003

Seasonality of phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder notice it.

How I suspected I had BAD

The first time I thought I was going crazy was when I was 18 years old. Painful relationships ended, obsessive thoughts and images swirled in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, they didn’t talk about mental disorders then, so I didn’t even know where to turn. Then this state passed by itself. nine0003

I did not see a psychiatrist until seven years later, when I again had a similar severe condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances. Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, and therefore no reason to seek help.

Then I just went to the district polyclinic - it turned out that a psychotherapist was there. She checked my symptoms on the Beck scale, diagnosed me with an anxiety-depressive disorder, and prescribed a common antidepressant that is often prescribed for depression. nine0003

Beck Depression Scale - online test

It seemed to me that antidepressants helped me immediately: my mood improved, I got energy, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants usually take a long time to work: it takes about three weeks for the effect to appear, and I got better after a few days. In addition, in bipolar affective disorder, antidepressants can cause hypomania if not mitigated by other drugs. nine0003 This meme is well understood by those who were not immediately given the correct diagnosis. If you add Mentos to Coca-Cola, you get a foamy fountain that will splash out of the bottle. Antidepressants, in particular SSRIs - selective serotonin reuptake inhibitors - have the same effect on the mood of people with BAD

I went to this psychotherapist several more times, but she did not track my sharp mood swings, and I had one of the most severe hypomanias . I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping. nine0003

After a couple of months, my condition stabilized a little, but I continued to take antidepressants: I knew that they should not be stopped abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had previously had mood swings, ups and downs, depressions. Then everything was fine because of taking antidepressants, so I denied everything.

A year later, as the doctor ordered, I smoothly stopped taking antidepressants, and a few months later I was overcome by one of the most severe depressions. If last time I could attribute depression to circumstances - burnout, relationship difficulties, fatigue - now there was no reason for it. I had a job I loved, a great relationship with my husband, financial stability, a new city. And I wanted to die. nine0003

/psychotherapy-search/

How to choose a psychotherapist

This moment became a turning point in the diagnosis. I already knew that there is such a disease as bipolar affective disorder, what are its symptoms and features. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.

I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in the hypomania of 2012, I worked two jobs, passed the state exams, wrote a diploma, hung out with friends until the middle of the night and completely took care of the life of the family. In hypomania in 2014, she entered the magistracy, graduated from a driving school, traveled, and also ran a marathon. nine0003

Every upswing was followed by a downturn: I stopped running, didn't pass the exam in the traffic police, and dropped out of the master's program. Each such exacerbation generally lasts a year and a half, and then repeats.

How I was looking for a suitable psychiatrist

After collecting information about BAD, I decided to find a psychiatrist to confirm or deny my diagnosis. It didn't happen right away.

First I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor saw me in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants. And not the ones that were assigned to me last time, but others. I was too depressed to stand my ground, so I just started looking for another doctor. nine0003

6 useful services for finding a psychotherapist

The second doctor was in a state clinic, she was recommended to me on Facebook. At first, I waited a long time for an appointment - the doctor was half an hour late, then I started asking about birth injuries and vascular dystonia. This consultation didn't work for me either. I paid 2,000 rubles for her.

The third appointment was successful: I found a psychiatrist, whom I still go to. She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.

2500 Р

I pay a psychiatrist for one appointment

The institute where the doctor sees, I was advised somewhere in the comments on the Internet. I called the reception and asked to sign me up for a doctor specializing in affective disorders as soon as possible.

The search for a suitable psychiatrist took about a month, so I went to see a doctor in a completely crushed state, in tears and hysteria. The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was controlling myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation. As a result, I continued the treatment at home. nine0003

When hospitalization is needed for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Hospitalization for bipolar affective disorder may be necessary if during a manic episode the patient develops strong arousal, he completely loses a critical attitude to his condition, and hallucinations appear rave. Such a condition can end badly for the patient himself or his relatives. In a depressive episode, indications for hospitalization will be suicidal thoughts or suicide attempts. nine0003

Inpatient treatment may also be needed in case of a severe decrease in working capacity.

If you suspect you have bipolar disorder, but are not in the acute phase of the disease, help is not urgent, it is better to spend time looking for a psychiatrist who specializes in bipolar disorder or affective disorders in general. Such a doctor is likely to quickly make the correct diagnosis and select the best treatment.

Before taking, it is worth writing down all the symptoms that bother you, and also, if possible, make a retrospective graph of the expected phases - mania and depression, write down when they occurred and how long they lasted. This will help the doctor understand if this is BAD or something else. nine0003 This is how the BAR phase sequence looks like in my case

BAD treatment

The psychiatrist first wrote me a prescription for several drugs: antidepressants and mood stabilizers. They are usually prescribed to people with affective disorders.

As explained to me, treatment is, among other things, checking for the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. nine0270 About two months later, my diagnosis was officially confirmed: bipolar affective disorder type 2.

How bipolar disorder is diagnosed

Viktor Lebedev

psychiatrist, science journalist

Bipolar affective disorder is diagnosed by what problems a person is worried about. His story should contain a description of typical mood and behavioral disorders, usually there is an alternation of phases of the disease.

Complaints and a history of the disease are enough for diagnosis, sometimes the testimonies of relatives are also taken into account, which can tell about a person's behavior. It happens that a doctor can send you to a clinical psychologist for a psychological examination, but usually an ordinary psychodiagnostic conversation is enough. nine0003

You can suspect the disease on your own, although with hypomania or mania, criticality to one's condition often decreases, that is, a person does not understand that something is wrong with him. Sometimes relatives of the patient come for help, and not he himself. It is better to apply for a diagnosis to a specialist who has worked with BAD, knows what the manifestations of the disease look like.

In general, drug therapy for bipolar disorder consists of several types of drugs that relieve different manifestations of the disease. These are normotimics that stabilize mood, antidepressants that help to cope with depression, antipsychotics that relieve excessive arousal. nine0003

Medication for Bipolar Disorders - MSD Handbook

Bipolar Disorder in Adults: Choice of Therapy - Article for Physicians Uptodate

The doctor selects the type of medication and dosage based on the phase the patient is in. Antidepressants are usually used in depressive phases and in combination with mood stabilizers. Antipsychotics - only in manic episodes and also together with normotimics.

In severe cases, a person with bipolar disorder may take up to six different drugs. But you need to strive to get by with one or two. nine0003

I started taking prescribed antidepressants and mood stabilizers immediately after seeing a psychiatrist. This time, the process of getting out of depression was long and smooth.

How therapy is selected for bipolar affective disorder

Viktor Lebedev

psychiatrist, scientific journalist

The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase - some drugs, in the hypomanic phase - others, in mania - still others.

It is important to combine drugs correctly. So, if a patient with bipolar disorder is prescribed only antidepressants, this can worsen the situation, even if he is depressed. Antidepressants can "disperse" his condition to hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, so therapy includes normotimics. nine0003

The fact is that depression in BAD is not the same depression as usual, they are not always similar even in external manifestations, there are differences from a biological point of view, that is, in how processes in the brain change.

I visit my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times - it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a presumptive phase change - about four times a year, once every three to four months. It costs 10,000 R per year. In total, I have been seeing a doctor for three years now. nine0003

For two years, until recently, I took antidepressants and mood stabilizers in the minimum dosage. A pack of antidepressants for a month cost about 400 R, mood stabilizers - 600 R. That is, during the period of remission, the pills took 1000 R per month.

1000 R

I spend on pills a month in remission

However, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of mood stabilizers - 2.5 times, and added antipsychotics. During the exacerbation, which lasted two months, 4000 R per month was spent on tablets. Now 2000 R will go away - the dose of mood stabilizers has been reduced by one and a half times and neuroleptics by half, antidepressants have been removed. nine0003

It is interesting to observe how quickly drug therapy changes the state of the body and how it then returns to normal. Often, drugs do not fit the first time, so you need to regularly visit a psychiatrist and monitor your well-being. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.

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BAD treatment cannot be found once and for all

Each patient who is responsible for the treatment of bipolar disorder and is in contact with the doctor has his own scheme for changing the dosage or types of medications, taking into account well-being. For example, if you cannot sleep for more than a few days and stop eating, you add an antipsychotic. If you fall into an abyss of self-hatred and don’t swim for more than a week, an antidepressant will help.

Of course, this does not cancel regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated. Now I can regulate a lot myself, depending on how I feel, but I still see a specialist. nine0003

At the same time, bipolar affective disorder cannot be cured once and for all - you can only go into a long remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start the countdown again.

Also, as far as I know from my experience and the experience of people with the same diagnosis, at some point there is an illusion that everything is cool, there is no illness, it seemed to you that you are doing great. At this point, people stop taking pills - this is a bad decision, never do this. If you feel good, first of all, you should check if this is the beginning of hypomania. And secondly, be glad that you have entered remission. nine0003

During these three years, I once stopped drinking pills - I got depressed, once I did not pay attention to the symptoms - I got severe hypomania, now I'm trying to go into remission again.

BAD treatment

The effectiveness of treatment of bipolar affective disorder can be increased by combining drug therapy with psychotherapy. Cognitive behavioral therapy is often used for bipolar disorder. It teaches you how to cope with stress factors, monitor your condition, manage the symptoms of the disease. Even during the sessions, together with the doctor, they work out trigger situations, that is, what can provoke an exacerbation of the disease. nine0003

Bipolar affective disorder and supportive psychotherapy - article on the Uptodate physician website

For example, I have trouble admitting my own mistakes. Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, oversights cause great anxiety. I also have an ideal image of what I should be: read a lot, earn money, keep my house perfectly clean, have six-packs, study, know two foreign languages, go to exhibitions. Obviously, this is impossible, but a persistent desire to reach an unattainable height is also stressful. I work through all this with a psychotherapist. nine0003

I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own. At first she was in therapy with a psychotherapist, whom she found through the Inhale project, which helps burnt out employees from the charitable field. I worked with her on this project, then continued after completion.

We looked at situations that increase my anxiety, including fear of making mistakes and being judged, as well as difficulties in life in general. The cost within the project was 400 R per meeting, there were about ten of them in total, then, already outside the project, the price increased to 2400 R.

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Now I went to another psychotherapist - she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people, and the fear that I cannot control it.

The cost of sessions with this specialist is 2500 R per visit. Now I go to her every 10-14 days, that is, 2-3 times a month. In general, I have been working with my condition on my own for quite a long time, so the therapist only directs me in the right direction. nine0003

Is psychotherapy mandatory for bipolar disorder

Viktor Lebedev

psychiatrist, science journalist

Cognitive behavioral therapy is most often prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you only need to take medication. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, better cope with your illness. nine0003

Many also benefit from support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t work for me: I don’t want to define myself through illness, this is part of my life - but not me.

The largest project holding such meetings is Sunday BAR. They support not only people with bipolar disorder, but also their loved ones. Meetings are held online and offline.

List of support groups in different cities for people with BAD and other disordersPDF, 275 KB

BAD treatment

Universal advice given for bipolar disorder and beyond includes the following recommendations: maintain sleep and work-life balance, eat right, do not drink alcohol, play sports.

All this really helps, but in fact, organizing your life is difficult: meetings with friends, vacations, unexpected work do not fit into the routine, you want to work more, and alcohol looks like a great way to cope with anxiety, although in fact it can lead to depression. nine0003

I try to keep the correct regimen to the best of my ability. True, according to my feelings, depression comes by itself, without any triggers from the outside, and I cannot influence it. But hypomania is fueled by new projects, loves, and other emotions. For example, even a small amount of falling in love causes hypomania, which, in turn, increases falling in love. It doesn't end well.

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I lived in St. Petersburg for quite a long time, there during the white nights you don’t feel like sleeping at all - and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for some time.

Now I have an established sleep and eating regime, I quickly notice its violation - this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is knocked down by external circumstances, then it is more difficult to notice the exacerbation of BAD.

Sleep is very important to me, it is my priority. I try not to hang out until the middle of the night, and if I didn’t manage to get enough sleep, then I try to sleep in the afternoon. I usually go to bed around midnight, get up at 8-9hours of the morning is a comfortable mode for me and my work. I very rarely stay awake at night or wake up later than 10 am.

I have a fitness bracelet that tracks the phases and amount of sleep - it helps to see the dynamics and notice deviations. When I see a sleep disorder, I start drinking light tranquilizers and antipsychotics to return to a comfortable mode.

I am lucky that I take my job seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps me to keep the regime.

What to do to reduce the frequency of exacerbations

Viktor Lebedev

psychiatrist, science journalist

In bipolar disorder, the daily routine is important, which allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, give yourself a rest. Doctors usually insist on the exclusion of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person. nine0003

Exacerbations of the disease can occur on their own, without the influence of external factors, or they can be caused by external events, both tragic, such as the death of a loved one or a break in relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.

How I live with BAD now

Accepting the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated. On the other hand, this is a diagnosis for life. You need to constantly monitor your condition, take pills, consult with doctors. nine0003

The most difficult thing for me was the inability to separate myself as a person from the disease. What of what I did in life was the result of my choice, and what was a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies - what if all this is just a disease, and I'm not behind it? Three years have passed - and I still cannot separate myself from BAD, it seems impossible.

Now life has become easier: now I know what to expect in the near future, because the phase schedule is still respected. It is clear when to slow down with the pace of life, and when to add antidepressants. nine0003

My work is related to people. Of course, the disease affects my mood and state: in depression I have less strength and the ability to give out emotions, in hypomania, on the contrary, there are a lot of emotions, but there is not enough concentration. It's good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania - a little more.

At the time of my first diagnosed depression, I had an unloved job, it took the entire resource. I cried in the mornings, afternoons and evenings because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes. nine0003

I continue to take medication, see a psychiatrist several times a year and a psychotherapist several times a month. In March, at the most difficult moment of the exacerbation, I spent on medicines, an appointment with a psychiatrist and three meetings with a psychologist 13,000 R.

13,000 R

I go into remission and spend about 8,000-10,000 R per month on medications, a psychologist, and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state. nine0003

The unobvious difficulty of living with bipolar disorder is the need to strictly control one's financial situation. In hypomania, money flies away easily, you make decisions instantly - for example, you can decide in a minute to fly to Spain and buy tickets. When you are depressed, you spend less, but it is also difficult to earn money. I try to keep a financial cushion in case of an aggravation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than bipolar, so there has never been a credit card debt. nine0003

I spent 58,800 rubles on BAD treatment in a year

Reception of a psychiatrist

10 000 R, total 4 receptions of 2500 r

Reception of a psychotherapist

25 000 R, total 10 doses of 2500 r

antidepressants

4800 r, 12 packages of 400 p

neuroleptic neuroleptic

7000 R, 7 packs of 1000 R

Normotimics

12000 R, 15 packs of 800 R

Books I recommend reading about bipolar affective disorder

The most famous book about living with bipolar disorder is The Restless Mind.

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