Treating Dysphoric Bipolar Disorder
The exact meaning of the phrase “treating dysphoric bipolar disorder” is often unclear and not everyone has a clear idea of what the term means. Dysphoria in relation to bipolar disorder has many people stumped. Some people believe dysphoria to mean the ‘angry’ side of mania, whilst others think that dysphoria, being the opposite to euphoria means depression. None of these definitions properly describe the way dysphoria applies to the mood swings and cycles of bipolar disorder. In actual fact, dysphoria can be valid as a description for either mania OR depression.
Dysphoric mania is described in the Merck Manual as “prominent depressive symptoms superimposed on manic psychosis.” These symptoms include:
• emotional weeping
• difficulty sleeping
• racing ideas and confused thoughts
• grandiose feelings
• mental agitation
• physical restlessness and agitation
• suicidal thoughts
• groundless sense of persecution
• hearing things that are not there
• difficulty reaching decisions
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The Merck Manual describes Dysphoric depression as “intrusions of hypomanic symptoms or hyperthymic traits into a retarded major depressive episode”. In lay terms, this means that characteristics of hypomania or overactivity occur during a depressive phase when a patient is generally listless and dull. Symptoms include:• irritability and irrational anger
• having pressured speech in spite of slowed thinking
• extreme overtiredness and fatigue
• dwelling unnecessarily on guilt feelings
• general feeling of anxiousness
• difficulty sleeping
• extra high sex drive
• being melodramatic about the depression
The most important characteristic to monitor with dysphoria is the greatly increased risk of suicide. Treating dysphoric bipolar disorder is a serious business and should always be brought to the attention of a medical professional.
Treating dysphoric bipolar disorder
In the view of most mood experts, the three most important principles for treating dysphoric bipolar disorder are: relying on mood stabilizers, consider using specialized psychotherapies, and avoiding antidepressants (you must work with your doctor however, DO NOT stop yours now!)
Mood stabilizers
First, start with the mood stabilizers that aren’t medications! Approaches that have proved crucial for some patients with bipolar disorder are maintaining a regular daily schedule, especially regular patterns of sleep, the use of blue light and darkness, and the importance of regular exercise.
In addition to non-medication approaches, most bipolar sufferers also need to use medications, called “mood stabilizers”. There are several options which your doctor will choose, based on what will work best for your set of symptoms looking at the potential side effects and risks
Specialized Psychotherapies For Bipolar
Compared to medications alone, several psychotherapy approaches for bipolar disorder have been shown to be of benefit when added to medications for the treatment of bipolar disorder. In April 2007 a major research program published their results showing that when the three psychotherapies listed below were added to mood stabilizer treatment for bipolar patients experiencing significant depression, the patients recovered more quickly and more were likely to stay well.
• Bipolar-specific cognitive behavioral therapy
• Interpersonal therapy with social rhythm therapy
• Family-focused therapy (for patients with family who could join in treatment)
The problem is finding a therapist who can provide one of these treatments. Currently, these psychotherapies are primarily found in large treatment programs that have adopted one or more of the new methods. However, the internet is a good source for finding links to resources that will allow you to help direct your therapist to these new tools.
Avoiding Anti-depressants
This approach is still controversial. There is strong consensus that antidepressants can — in some people — make bipolar disorder worse. It is thought that the depression gets better, but the “manic” side symptoms including sleep problems, anxiety/agitation, difficulty concentrating, etc) get worse. This can cause more frequent “cycling”, even though the depression is better. In many people, eventually a full depression episode occurs again, despite being on an antidepressant, even one that “worked” before!
Some thoughts to take into account when discussing this option with your doctor:
• If you’re doing well, leave your medication as-is.
• If you’ve just been diagnosed as bipolar, most doctors will add a mood stabilizer to your antidepressant. Talk to your doctor about tapering off the anti-depressant
• If you’re currently on a mood stabilizer and not doing well, then get your doctor’s assessment of the risk involved in tapering off the antidepressant.
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Treating dysphoric bipolar disorder should be done with a psychiatrist who knows something about this particular type of bipolar, even if it means traveling a long way. If it is impossible for you to find a psychiatrist, try approaching your primary care provider with some of the information you have learned here with a view to trying some of the treatments under medical supervision.
References: Excerpts from information provided by Jim Phelps MD at www.PsychEducation.org. (Quality Mental Health Information On Specific Topics)
