MENTAL HEALTH & ADDICTION
This article looks at the necessary features for a bipolar diagnosis and is useful if you or a family member have confusion about having this condition.
Bipolar disorder, historically called “manic-depressive,” is a primary mood disorder characterized by robust and often destructive emotional states over different periods of time. This condition is commonly diagnosed to our patients at CeDAR prior to admission and it is sometimes accurately given and sometimes in error. How do we know the difference?
It is important to remember that bipolar disorder is primarily a biological condition in that it involves disruptions in brain chemistry. This also means that it responds to medication approaches. The most studied psychotherapy for bipolar disorder emphasizes good self-care, medication adherence and attention to sleep patterns and stimulation. This therapy is very different than other forms of treatment that focus on insight-building and coping skills.
Bipolar disorder can exist in 3 overall phases:
A manic phase involves excessive dopamine in the brain, not unlike that experienced by cocaine or amphetamine use. This dopamine surge leads to symptoms of increased energy, distractibility, emotional volatility, euphoria, prolonged insomnia, and distorted judgment. A manic person may exhaust his or her savings account quickly or may get arrested for strange conflicts at the grocery store.
The depressive phase of bipolar disorder is similar to that of classical depression. The only difference in this condition is our approach to treatment. We are likely to use different medications to help someone experiencing bipolar-depression as compared to standard ‘major depressive disorder.’
The maintenance phase of bipolar disorder is where the symptoms have settled down. We prescribe certain medications during this phase that are protective against either mania or depression returning.
It is also important to know that bipolar disorder tends to be a diagnosis of the 20’s. If someone does not experience a severe depressive or manic period over these years and instead encounters problems in the late 30’s or 40’s, the diagnosis can likely be something other than bipolar disorder.
We try to make a bipolar diagnosis during periods of general sobriety. This is because severe drug use can often present similarly to that of mania. This does get more complicated, though, in that patients who have actual bipolar disorder are about 11 times more likely to also have an addiction than the general population.
It is important to be cautious and sensible when working with your doctor around the prospect of having bipolar disorder because the medications are strong with serious potential side effects. It would be a mistake to make a bipolar diagnosis in haste without a detailed overall history. At CeDAR, we recommend taking a thoughtful approach around bipolar, using effective medications while paying good attention to side effects, and integrating recovery from bipolar with overall substance recovery.