My mood episode is under control, when can I stop taking these pills??

The following question was posed by one of our blog readers: 

“If I start taking medications for bipolar, will I have to be on them my whole life?”

The answer, unfortunately, is often yes. There are some great treatments for bipolar disorder that can keep the illness under control, and maintaining that control is the best thing you can do for your health, your relationships, and hopefully your life overall.  

We can learn about the natural course of untreated bipolar disorder by looking at how the illness progressed back in the days when there were no medications to treat it at all.  Observations showed that some people would end up spending ten or more years in a depressive episode.  As the illness progressed over time there would be more and more episodes, with shorter and shorter periods of healthy stable mood in between. Luckily, this no longer has to be the case.

 

But it can be a scary and daunting thought to imagine taking a medication for your whole life, especially when there are side effects that you are having difficulty with. 

On the positive side, many studies have shown that the earlier and more comprehensive the treatment for a mental illness, the better the response.  This isn’t too different from what we would expect from any other chronic illness, like diabetes or heart disease.  Studies have also shown that mood stabilizers are actually good for the brain and can protect it. For example, lithium increases the amount of gray matter in the brain (i.e., brain cells) of bipolar patients.

Here is an article that talks about this in a bit more detail.

However, if the side effects are just too intolerable for you to imagine a life on your particular medication, that probably means it’s not the right medication for you. I always hope that my patients will be honest with me about how they really feel about the medication—I won’t take it personally if you hate what I prescribed you!  Your doctor should make you feel comfortable to express your opinions about the medications, and you should always discuss with him or her before making any changes or stopping any medications-- to be on the safe side.

Dr. Mednick

What’s Love Got to Do with It? (Couple Therapy and Bipolar Disorder)

What's love got to do with it?

By "it" I mean you and your partner’s struggle with Bipolar Disorder - a struggle that can result from a clinician breaking the news of the diagnosis, the storm and aftermath of a bad manic episode, or the dread of a never ending depression. Can working on your relationship as a couple help to deal with any of these challenges? As a psychologist who is excited about the power of couple work I’d like to say yes, there is definitely a good place for couple therapy in your effort to tame Bipolar illness. 

The opportunity of introducing couple's therapy into the treatment of Bipolar Disorder is often overlooked because of the broadly acknowledged notion that Bipolar illness is at its core a biological illness. We've all heard the many variations of this notion. Bipolar disorder is cyclical, it has a genetic component, it has little to do with the patient’s personality, it is effectively treated by medication. The truth is, there is a lot about Bipolar Disorder that we do not know, and this hefty biology tends to push the considerations of what may be going on beyond the psychiatric symptoms to the margins. For the purposes of this blog, I would like to put the biological component aside for a bit and focus on something different. 

From a relational perspective, Bipolar Disorder is a trauma to the couple’s relationship that requires healing. 

The stories that the couples typically tell often reflect the relief of being able to identify and label the irrational behaviors as well as the hope that their subjective emotional experiences of the disorder will be controlled as long as the patient’s symptoms are well managed. Here is what a clinician would often hear: 

“He was not acting like himself… she was angry at everyone all the time… he went crazy with the credit card behind my back… she was blaming me for everything… we were constantly fighting… I was thinking about divorcing him… we almost broke up…”  

And then the story continues:

 “She got diagnosed and it all made sense… I know what symptoms to watch out for… as long as he gets enough sleep and takes the medication we should be fine… as long as I can get in touch with the psychiatrist when I need to I feel safe.”  

Figuring out the diagnosis and getting the right treatment for the person with the Bipolar illness is an absolutely necessary piece for success, but is it always sufficient to get the couple to a place where they feel secure with each other and confident in their future together? Sometimes it is. Maybe the stress produced by Bipolar disorder made you even stronger on the other side, or maybe it made you see each other in a new light and have deeper respect for each other. If you are involved with the Family Center, maybe you learned about the symptoms in depth, developed an alliance with the clinician, learned some new communication skills and feel supported and hopeful. 

But what if you still feel disrupted, if not traumatized by what the Bipolar illness brought into you relationship? What if you are resentful for what your loved one’s mania put you through or for your new “sick role?” What if you feel so powerless against your moods and doubtful of your capacity to have a clear judgment that you withdraw from the relationship instead of participating in it? And, finally, what if like many couples you had had preexisting problems and the Bipolar issue only added another layer to them? 

You can let time do all the healing but you can also turn to couple therapy and use it for what it is designed to do; bring the two partners closer together and help them develop an intimate relationship that can serve as a buffer against many troubles in life, including the ones caused by the illness. We all know, and I don’t think there is a need to look for research references here, that a good relationship, in which both partners feel understood and cared for make it easier to weather almost anything; problems at work, uncertainty of the future, cultural transitions, serious losses. Moreover, there maybe a bonus to the couple’s success; some experts believe that  changing a person’s way with his or her significant other can on it’s own change his or her behaviors and emotional responses outside this relationship...in other words, produce a higher level of overall mental health.

If you have any questions about couple's therapy and bipolar disorder, please leave them in the comments section below - I'd love to hear them! 

-Dr. Kazariants

Disruptive Mood Dysregulation Disorder (DMDD): What is it, and what does it have to do with Bipolar Disorder?

Most people are aware of the controversy regarding the diagnosis of bipolar disorder in children and young adolescents.  Those on the conservative end think that the criteria for adult bipolar disorder should be strictly adhered to in these young people, whereas others have proposed slight modifications to the criteria. Others who are more liberal have gone as far to suggest that any child with persistent irritability, moodiness, and temper outbursts are budding bipolar patients.   The diagnosis is made even more unclear by the number of other disorders which have symptoms which overlap with or closely resemble symptoms of bipolar disorder, such as depression, attention deficit disorder, and some developmental disorders.  Additionally, the brains of children and adolescents are constantly developing and changing, as does the presentation of their symptoms.

 Given this complexity and variety of opinions, it is no wonder that different clinicians apply the diagnosis in different ways – which results in children and young adolescents WITHOUT bipolar disorder being misdiagnosed as bipolar, and even occasionally, children WITH bipolar disorder NOT being diagnosed when the strict adult criteria is applied.

In an effort to shed some clarity and consistency on this issue, after many years of research and study by various work groups, the American Psychiatric Association has included a new diagnosis, Disruptive Mood Dysregulation Disorder, to the most recent version of their diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). 

What IS Disruptive Mood Dysregulation Disorder (DMDD)?

DMDD is considered a depressive disorder.   It is characterized by severe recurrent temper outbursts that are out of proportion in intensity or duration to what would be expected for the situation. They are inconsistent with the child’s developmental level, and occur, on average more than 3 times per week. The child’s mood in between these episodes is persistently irritable most of the day, nearly every day, and observable by others (parents, teachers, peers, etc.).  This diagnosis is given if these symptoms have lasted for over a year without a symptom free period of more than 3 months.  The age of onset is defined as before 10 years of age. The diagnosis cannot be given if the child is under 6.   Additionally, this diagnosis is not given if the child has met full criteria for a manic episode, or if the symptoms are better explained by another diagnosis, such as a developmental disorder, a major depressive episode, or a substance abuse problem.

Preliminary information available suggests that the majority of children who meet criteria for this diagnosis do not go on to develop bipolar disorder, but are more likely to suffer from depression.  Although this diagnosis will surely better describe some children who may have previously been diagnosed with bipolar disorder, it alone will not solve all of the complexities and intricacies of accurately diagnosing these challenging children.