Why is bipolar disorder difficult to treat

A person with bipolar disorder may have distinct manic or depressed states but may also have extended periods—sometimes years—without symptoms. A person can also experience both extremes simultaneously or in rapid sequence.

Severe bipolar episodes of mania or depression may include psychotic symptoms such as hallucinations or delusions. People with bipolar disorder who have psychotic symptoms can be wrongly diagnosed as having schizophrenia. To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania.

People with hypomania can often function well in social situations or at work. Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life; others may experience them only rarely. Moods can rapidly become more irritable, behavior more unpredictable and judgment more impaired.

During periods of mania, people frequently behave impulsively, make reckless decisions and take unusual risks. Most of the time, people in manic states are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger because some people become suicidal even in manic states. The lows of bipolar depression are often so debilitating that people may be unable to get out of bed.

Typically, people experiencing a depressive episode have difficulty falling and staying asleep, while others sleep far more than usual. When people are depressed, even minor decisions such as what to eat for dinner can be overwhelming.

They may become obsessed with feelings of loss, personal failure, guilt or helplessness; this negative thinking can lead to thoughts of suicide. Depression associated with bipolar disorder may be more difficult to treat and require a customized treatment plan. Scientists have not yet discovered a single cause of bipolar disorder.

Currently, they believe several factors may contribute, including:. To diagnose bipolar disorder, a doctor may perform a physical examination, conduct an interview and order lab tests. While bipolar disorder cannot be seen on a blood test or body scan, these tests can help rule out other illnesses that can resemble the disorder, such as hyperthyroidism. If no other illnesses or medicines such as steroids are causing the symptoms, the doctor may recommend mental health care. To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes.

The largest research project to assess what treatment methods work for people with bipolar disorder is the Systematic Treatment Enhancement for Bipolar Disorder , otherwise known as Step-BD. Step-BD followed over 4, people diagnosed with bipolar disorder over time with different treatments. People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia.

However, the highs and lows are not severe enough to qualify as either mania or major depression. To be diagnosed with cyclothymia, you must experience numerous periods of hypomania and mild depression over at least a two-year time span. Because people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, it is a condition that should be monitored and treated.

Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse.

If your doctor determines that you have bipolar disorder, he or she will explain your treatment options and possibly prescribe medication for you to take. You may also be referred to another mental health professional, such as a psychologist, counselor, or a bipolar disorder specialist. Together, you will work with your healthcare providers to develop a personalized treatment plan. A comprehensive treatment plan for bipolar disorder aims to relieve symptoms, restore your ability to function, fix problems the illness has caused at home and at work, and reduce the likelihood of recurrence.

Medication is the cornerstone of bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control.

Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood. Managing symptoms and preventing complications begins with a thorough knowledge of your illness. Lifestyle management. By carefully regulating your lifestyle , you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, eating a mood-boosting diet, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year-round.

Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. The support of friends and family is also invaluable. Most people with bipolar disorder need medication in order to keep their symptoms under control. When medication is continued on a long-term basis, it can reduce the frequency and severity of bipolar mood episodes, and sometimes prevent them entirely.

If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or combination of drugs for your needs. Because everyone responds to medication differently, you may have to try several different medications before you find one that relieves your symptoms. Check in frequently with your doctor. Getting the dose right is a delicate balancing act. Close monitoring by your doctor will help keep you safe and symptom-free.

Continue taking your medication, even if your mood is stable. Most people need to take medication long-term in order to avoid relapse. This includes surrounding yourself with supportive people, getting therapy, and getting plenty of rest. Be extremely cautious with antidepressants. Research shows that antidepressants are not particularly effective in the treatment of bipolar depression.

Furthermore, they can trigger mania or cause rapid cycling between depression and mania in people with bipolar disorder. Research indicates that people who take medications for bipolar disorder are more likely to get better faster and stay well if they also receive therapy. Therapy can teach you how to deal with problems your symptoms are causing, including relationship, work, and self-esteem issues. Three types of therapy are especially helpful in the treatment of bipolar disorder:.

In cognitive-behavioral therapy CBT , you examine how your thoughts affect your emotions. You also learn how to change negative thinking patterns and behaviors into more positive ways of responding.

For bipolar disorder, the focus is on managing symptoms, avoiding triggers for relapse, and problem-solving. Interpersonal therapy focuses on current relationship issues and helps you improve the way you relate to the important people in your life.

By addressing and solving interpersonal problems, this type of therapy reduces stress in your life. Since stress is a trigger for bipolar disorder, this relationship-oriented approach can help reduce mood cycling. Social rhythm therapy is often combined with interpersonal therapy is often combined with social rhythm therapy for the treatment of bipolar disorder.

People with bipolar disorder are believed to have overly sensitive biological clocks, the internal timekeepers that regulate circadian rhythms. When these rhythms are stable, the biological rhythms that regulate mood remain stable too. Living with a person who has bipolar disorder can be difficult, causing strain in family and marital relationships.

Family-focused therapy addresses these issues and works to restore a healthy and supportive home environment. Educating family members about the disease and how to cope with its symptoms is a major component of treatment.

For some, the process will take years, if not longer. That said, not all patients are receptive to taking medications for reasons including anxiety, cognitive dulling, fear, cost, misunderstanding, dosing frequency, lack of symptoms, worry, depression, and mistrust. However, no magic button exists, and some patients will simply refuse treatment.

At least one-quarter to one-half of patients with bipolar disorder make at least 1 suicide attempt. Psychiatrists who lose patients to suicide often feel shock, disbelief, denial, shame, and guilt.

They might obsess over what they could have said or done differently. They might even question their ability to help people. Psychiatrists tend to be caretakers who are prone to self-sacrifice. Unfortunately, these traits can cause some psychiatrists to neglect their own mental health and well-being. As a psychiatrist, you know better than anyone how impactful therapy can be, so consider seeing a professional.

Psychiatrists spend 48 hours a week at work on average. Take care of your physical health by exercising — exercise pumps you full of endorphins and works as an excellent stress reducer — and eating right. On a day-to-day basis you handle multiple patients who are going through a lot. It may be tempting to isolate yourself, but you should avoid that temptation. While your schedule is busy, make a point of scheduling lunch or coffee with friends and colleagues.