Stroker 1

Cecelia Stroker

Dr. Cassel

English Composition II

15 December 2019

Effectively Combating Bipolar Disorder

Bipolar Disorder is a complex and potentially life-threatening mental illness. People

suffering with Bipolar Disorder experience severe emotional mood swings. The National

Institute of Mental Health estimates approximately 2.8% of adults in the United States suffer

from Bipolar Disorder. The number of people with Bipolar continues to grow and there are just

as many people that go undiagnosed. Doctors are quick to diagnosis, prescribe medication, and

send patients on their way. Despite medication being an essential feature in the treatment of

Bipolar Disorder, there are other treatment strategies that must be used to create a more holistic

and more successful treatment plan. The most successful treatments for Bipolar Disorder include

a combination of medication, therapy, and lifestyle changes.

The first treatment route for most cases of Bipolar Disorder involves medication. These

medications are used to lessen symptoms of Bipolar Disorder, sometimes resulting in the

elimination of symptoms all together while also reducing reoccurring manic and/or depressive

episodes. Bipolar Disorder medication can be organized into four different types of medication:

mood stabilizers, antidepressants, antipsychotics, and anti-anxiety medications. Mood stabilizers,

the main type of Bipolar Disorder medication used, work to prevent manic episodes, which are
 Stroker 2

characterized by periods of extreme highs, and depressive episodes, which are characterized by

periods of extreme lows. Examples of mood stabilizers include Carbamazepine, Divalproex,

Lamotrigine, and Lithium. Lithium is one of the most popular mood stabilizers. It has been

around since the nineteenth century, and is considered to be one of the most effective

medications used for treating Bipolar Disorder (Won). This drug has been proven to be effective

in treating the manic and depressive episodes, lessen the amount of reoccurring mood episodes,

and minimize possibly suicidal periods.

Some people are successfully treated with just a mood stabilizer; however, most people

will need a combination of medications to address their specific symptoms. As seen in Figure 1,

42 percent of patients with Bipolar Disorder were prescribed one form of medication, 42 percent

were prescribed two forms of medication, and 16 percent used three or more types of

medications. Mood stabilizers are the most common medication used; however, some patients

will need to be treated with a combination of medications to offset the multiple symptoms and

complications of Bipolar Disorder (Cascade).

Figure 1: Treatment of Bipolar Disorder Number of Medications Taken

 Stroker 3

Most people with Bipolar Disorder experience more depressive states than manic states.

Antidepressants are sometimes taken with a mood stabilizer in order to treat the effects that

occur during depressive states. However, antidepressants are used with caution, as there is

evidence that they could trigger mania or mood instability. Antipsychotics are also often taken

with a mood stabilizer because antipsychotics help with managing manic episodes and psychotic

symptoms, such as having hallucinogenic experiences or delusional thoughts. Anxiety,

characterized by worry, agitation, restlessness, and irritability, is something people with Bipolar

disorder can possibly suffer from too. To treat anxiety, anti-anxiety medication can also be

prescribed for people with Bipolar Disorder.

My sister Damaris was diagnosed with Bipolar Disorder this past summer. In a recent

interview I conducted with her, she discussed her medication treatment plan. Originally, her

doctors had her taking only one medicine, an antipsychotic named Abilify, for about a month.

While on Abilify, Damaris mentioned that she had experienced trouble sleeping and gained

about ten pounds. She also said she felt “bland and unemotional.” After a few follow up sessions

with her doctor and therapist, they decided to combine her current prescription of Abilify with a

prescription of Lithium. When Damaris was diagnosed with Bipolar Disorder, she displayed

more manic symptoms then depressive symptoms, so her doctor decided to slowly ween her off

of Abilify and target her manic symptoms with Lithium. Before starting Lithium, Damaris had

blood work done to get a base level for doctors to ensure her Lithium levels were adequate. Now,

Damaris has blood work done every two to three weeks to monitor her Lithium levels and ensure

that she is not experiencing any adverse effects on her internal organs from the Lithium. She has

been taking Lithium for about two months now, and she has not had any manic episodes or

significant side effects since this prescription.

 Stroker 4

Medications are vital in treating Bipolar Disorder, and there is not a one size fits all

magic pill that works for every symptom and everyone. Finding the right medication may take

time, and it is recommended that patients enlist the help of a psychiatrist or medications manager

specialist to find the best and safest medication that works for an individual. Unfortunately,

medications have side effects, so it is critical to monitor and note any side effects with your

provider to create a safe medications plan. In the case of lithium, it is also important to get

periodic blood tests to ensure toxic levels are within safe tolerances (Won). Regardless of the

medication prescribed, one must adhere to dosage instructions and avoid drugs and alcohol.

Medications alone are proven to successfully treat Bipolar Disorder however, combining

medication with some sort of therapy will not only help one adhere to medication and ensure side

effects are discussed and addressed but will also help with the overall treatment of Bipolar

Disorder.

Stress can trigger both mania and depression. Talking to a trained professional can help a

person cope with stress and manage Bipolar Disorder symptoms. There are many types of

therapy for Bipolar Disorder. Cognitive Behavioral Therapy, Family Focused Therapy, and

Interpersonal and Social Rhythm Therapy are three proven treatment options to combat this

mental illness.

Cognitive Behavioral Therapy focuses on identifying and restructuring negative patterns

of thought and behavior. Studies show this type of therapy helps patients avoid relapsing while

improving depression and preventing manic episodes. Cognitive Behavioral Therapy looks to

manage the symptoms of Bipolar Disorder and prevent behaviors which can result in a relapse

into those symptoms. It also helps patients comprehend their emotions and thought processes

involved in influencing their behaviors to better manage them. Cognitive Behavioral Therapy
 Stroker 5

helps patients learn about different coping methods to help control their feeling and stress levels.

One of the difficulties and challenges with this particular therapy is that the patient must talk

openly about their issues with their therapist. This is crucial in ensuring that their therapy

sessions are effective. Just as finding the right medication can be difficult and may require

experimenting with several medications until the best is found. The same can be said for finding

the right therapist. This can be frustrating and take time until the patient finds someone they

connect with. A patient with Bipolar Disorder may require sessions with several different

therapist until they find the right one. They should feel comfortable talking about their past and

present thoughts, feelings and issues.

Interpersonal and Social Rhythm Therapy helps patients create stability in their day to

day life. This form of treatment targets routine aspects of a the patient’s daily life, including

sleeping habits and dealing with interpersonal problems. There are four phases incorporated in

this therapy. During the initial phase, the therapist will work with the patient to collect all history

involving their Bipolar Disorder illness. Once again as in any type of therapy, it is imperative the

patient be open, honest and willing to discuss everything associated with their illness. The

therapist will complete an interpersonal inventory, noting and reviewing critical relations in the

patient’s life and then analyzing the quality of those relationships. The therapist will also provide

education about the disorder because educating the patient on Bipolar Disorder can encourage

the patient to accept their illness and be knowledgeable about making decisions for treatment

options. During Interpersonal and Social Rhythm Therapy, the therapist and patient work

together to find an interpersonal problem area to work on. Following this preliminary meeting is

the intermediate stage of the therapy. This involves the therapist working with the patient to

come up with and implement a social rhythm stabilization strategy. This provides the patient
 Stroker 6

with different ways to manage routine disrupters while working on their interpersonal problem

areas. The next phase in the therapy is the preventative phase. In the preventative phase,

treatment gains are evaluated and discussed with the patient to help point out any possible risks

while continuing to ensure stability. Finally comes the termination phase. During this phase the

patient’s treatment is reviewed; identifying areas of success and potential areas of vulnerability

to a future Bipolar Disorder episode (Frank). Interpersonal and Social Rhythm Therapy help

with medication adherence, management of life’s daily stressors, and reduction of social

rhythmic disruptors.

Bipolar disorder can be stressful to family members and loved ones of those suffering

with this disorder, causing emotional and financial strains. As with any illness, family

involvement in treatment is important. The more aware family members are about the illness and

the more support from family members, the higher the success in treatment. Together Bipolar

Disorder patients and their families can get help. Family Focused Therapy has been around since

the mid-1980s. Since the 80s, there has been significant information collected about families

dealing with a love one suffering from Bipolar Disorder illness (Miklowitz). This type of therapy

recognizes the importance of a patient’s relationship with their family and how this relationship

can help with managing Bipolar Disorder. Family Focused Therapy is a type of therapy where

the sessions incorporates the family members of the patient in the therapy session. These

sessions are completed in order to work to analyze problems among family members that could

possibly be making the patient’s illness worse and can contribute to better treatment plans and

results.

In the case of my sister, it took her two months and three different therapists to find a

therapist she felt comfortable working with. Her first two therapists wanted to talk about more
 Stroker 7

general aspects of her life and keep things casual, which she did not enjoy. Her current therapist

is more formal and structured, having an agenda for every session. This therapist uses a white

board for discussions/illustrations and assigns homework assignments for follow-up sessions.

Through the experience of my sisters different therapist, I have realized that one of the more

important steps for a Bipolar Disorder patient is to find a therapist that they like, trust, and feel

comfortable with. Consistency with a therapist is also critical. My sister sees her therapist once a

week for an hour. Eventually, as things progress, she will see her therapist every other week.

Combining medication and therapy are two vital aspects of treating Bipolar Disorder.

Both of these forms of treatment rely on professionals in their respective areas. Doctors prescribe

proper medication, and trained therapists facilitate effective therapy sessions. Simply living a

healthy lifestyle in combination with medication and therapy can also have a major impact on the

overall success of the Bipolar Disorder treatment plan. Living a healthy lifestyle doesn’t require

doctors prescribing medications or sessions with trained therapist. This form of treatment

encompasses a wide range of positive activities that fall directly on the patient’s responsibility to

adhere to. Healthy habits and routines can help keep one’s moods in check while also helping to

control manic and depressive episodes. Simple lifestyle changes such as good nutrition, proper

sleep, and regular exercise, along with avoiding alcohol and drugs, can make a positive impact

on the success of a treating Bipolar Disorder.

A proper and quality diet can affect a person’s physical and mental wellbeing and reduce

the effects of bipolar disorder. The European College of Neuro psychopharmacology Congress

conducted research that suggests that the effectiveness of treatments for the disorder can be

improved or hindered by one’s diet. This study suggests that a healthy diet can aid in therapy for

depression and manic behavior. On the contrary, an unhealthy diet could advance other medical
 Stroker 8

conditions, which can then have an impact on a person’s Bipolar Disorder symptoms (Cohut).

Fish oil has many benefits, and some experts also believe that it can increase a person’s brain

function and improve behavior as well as keep your heart healthy. The American Heart

Association (AHA) suggest people eat fatty fishes, such as tuna, anchovies, salmon, or trout, at

least two times a week. Fish oil supplements can also be taken if you do not like the taste of fish.

Studies have been done regarding the use of omega-3 fatty acids and bipolar disorder, and

although they were inconclusive, some experts still believe it can be beneficial for people dealing

with Bipolar Disorder. Nuts can have the same effects as fish oil which is great for those who are

vegetarian or vegan. Walnuts, almonds, and flaxseed contain alpha-linolenic, which is processed

into omega-3 by the body (Bhandari). Foods a patient with Bipolar Disorder should avoid

include caffeine, high-fat meals, sugar, and salt.

Proper nutrition is essential to improving mental health, and nutrition with exercise work

together to potentially add to the successful treatment of Bipolar Disorder. Dr. Louisa Sylvia,

from the Bipolar Clinic and Research Program in Boston, is a psychologist that conducts

research on the effects of physical activity and a regimented healthy lifestyle on mental illnesses.

Research on Bipolar patients showed that a consistent exercise program and a regimented

lifestyle averted the ups and downs in moods associated with Bipolar (Wheeler). Exercise may

suppress energy associated with mania; however, more research needs to be conducted to draw

conclusions. Studies done by the American Psychological Association suggest that exercise can

counteract depression. Exercise is also helpful in treating anxiety, self-esteem issues, and

addictions; all issues that could be troubling for a person with Bipolar disorder. Recommended

exercises for bipolar patients include aerobic activities like walking, running, or biking. Exercise

and physical movement stimulate the production and release of the neurotransmitter serotonin.
 Stroker 9

Elevated levels of serotonin have been found to have a positive effect on people with depression.

Along with exercise, proper sleep patterns are important for people with Bipolar disorder. Sleep

difficulties often occur through no fault of the patient, which in turn could cause adverse effects

on day-to- day life and other treatment programs. Medication may be required to help patients

with sleep problems. Therapy and exercise while avoiding caffeine and other foods can help

regulate the patients sleep patterns. Conversely, too much sleep, which can be common during

bipolar depression, is also a challenge. Lastly, in the lifestyle arena, drugs and alcohol tend to

worsen the symptoms of Bipolar Disorder. Drug abuse can also lead to Bipolar Disorder of

people with no history of mental health issues.

Since being diagnosed with Bipolar Disorder, my sister has recognized the need for

lifestyle changes. Damaris acknowledges the fact that medication and therapy can be most

effective when paired with an earnest attempt to alter her daily routine. She has started to

exercise in the morning a few times a week to help get her body and mind ready for the rest of

the day. To enhance her workouts, she has also changed her diet. She has cut back on fatty,

processed, junk food and eats vegetables and fruits with every meal. She also has stopped

consuming caffeine and worked to limit her amount of sugar intake while increasing her water

intake. She has eliminated all alcohol and drugs from her life as well, and so far, she has noted

huge benefits to these changes. She is sleeping better, feeling more energized throughout the day,

and overall feels more positive about herself.

Bipolar Disorder is a frustrating illness and unfortunately there is no known cure.

Treatment options vary, and what works for one patient may not work for another. It may take

some time before someone with Bipolar Disorder finds their ideal treatment plan. Medication is

necessary to treat and stabilize people with this mental illness. However, people diagnosed with
 Stroker 10

Bipolar Disorder must use a variety of treatment strategies to successfully manage their illness.

With a treatment plan that combines medication, therapy and lifestyle changes, people with

Bipolar Disorder can live a successful, healthy, and happy life.

 Stroker 11

Bibliography

Bhandari, Smitha. “Bipolar Diet: Foods to Avoid and Good Foods to Eat.” WebMD, WebMD, 11

June 2019, www.webmd.com/bipolar-disorder/guide/bipolar-diet-foods-to-avoid#2.

Cascade, Elisa F, et al. “Antidepressants in Bipolar Disorder.” Psychiatry (Edgmont (Pa.:

Township)), Matrix Medical Communications, Mar. 2007,

www.ncbi.nlm.nih.gov/pmc/articles/PMC2922360/.

David, director. Ride the Tiger: A Guide Through the Bipolar Brain. PBS, 2016, pbs.org/ride-

the-tiger/home/.

Frank, Ellen, et al. “The Role of Interpersonal and Social Rhythm Therapy in Improving

Occupational Functioning in Patients With Bipolar I Disorder.” American Journal of

Psychiatry, vol. 165, no. 12, 2008, pp. 1559–1565., doi:10.1176/appi.ajp.2008.07121953.

Maria Cohut, Ph.D. “Bipolar Disorder: A Good Diet May Boost Treatment.” Medical News

Today, MediLexicon International, www.medicalnewstoday.com/articles/323291.php#1.

Miklowitz, David J, and Bowen Chung. “Family-Focused Therapy for Bipolar Disorder:

Reflections on 30 Years of Research.” Family Process, U.S. National Library of Medicine,

Sept. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5922774/.

Stroker, Damaris. Telephone interview. 30 November 2019.

 Stroker 12

Won, Eunsoo, and Yong-Ku Kim. “An Oldie but Goodie: Lithium in the Treatment of Bipolar

Disorder through Neuroprotective and Neurotrophic Mechanisms.” International Journal

of Molecular Sciences, vol. 18, no. 12, 2017, p. 2679., doi:10.3390/ijms18122679.