A Patient's Guide to Bipolar Disorder

What is Bipolar Depression?

Bipolar is a serious medical illness. To receive a diagnosis of Bipolar Disorder Type I, an individual must have a history of at least one episode of mania; and to receive a diagnosis of Type II, the individual must have had at least one episode of hypomania.

Common Symptoms Include:

  • Mania: Decreased need for sleep, increased activity, elevated or grandiose mood, irritability, often accompanied by impulsivity and engagement in behaviors with a high potential for harm (extreme excessive spending, risky sexual behavior), rapid or pressured speech, distractibility, and racing thoughts. Psychotic symptoms can be present.
  • Hypomania: Similar symptoms but they are not severe enough to result in marked impairment; do not require hospitalization and there are no psychotic symptoms.
  • Depression: Sadness, loss of pleasure in almost all activities, sleep and appetite disturbances, feelings of hopelessness or worthlessness, crying spells, impairments in concentration and focus. May be accompanied by thoughts of self-harm.

 Bipolar Disorder can cause significant impairment in areas such as:

  • Work & Academic Performance
  • Relationships
  • Social Activities

Bipolar is commonly associated with other disorders including:

  • Anxiety Disorders
  • Substance Use Disorders
  • ADHD
  • Eating Disorders
  • Many physical disorders are commonly associated with Bipolar Disorder including: Diabetes, Cardiovascular Diseases, and Endocrine Disorders. When these disorders are co-existing, both illnesses may have a worse outcome.

Individuals with Bipolar Disorder may experience both types of mood disturbances. Some may have a picture that is predominately depressive episodes with one or rare episodes of mania. For those with Type II, depression tends to be the more common mood state.

What is Bipolar Depression?

Bipolar is a serious medical illness. To receive a diagnosis of Bipolar Disorder Type I, an individual must have a history of at least one episode of mania; and to receive a diagnosis of Type II, the individual must have had at least one episode of hypomania.

Common Symptoms Include:

  • Mania: Decreased need for sleep, increased activity, elevated or grandiose mood, irritability, often accompanied by impulsivity and engagement in behaviors with a high potential for harm (extreme excessive spending, risky sexual behavior), rapid or pressured speech, distractibility, and racing thoughts. Psychotic symptoms can be present.
  • Hypomania: Similar symptoms but they are not severe enough to result in marked impairment; do not require hospitalization and there are no psychotic symptoms.
  • Depression: Sadness, loss of pleasure in almost all activities, sleep and appetite disturbances, feelings of hopelessness or worthlessness, crying spells, impairments in concentration and focus. May be accompanied by thoughts of self-harm.

Individuals with Bipolar Disorder may experience both types of mood disturbances. Some may have a picture that is predominately depressive episodes with one or rare episodes of mania. For those with Type II, depression tends to be the more common mood state.

 Bipolar Disorder can cause significant impairment in areas such as:

  • Work & Academic Performance
  • Relationships
  • Social Activities

Bipolar is commonly associated with other disorders including:

  • Anxiety Disorders
  • Substance Use Disorders
  • ADHD
  • Eating Disorders
  • Many physical disorders are commonly associated with Bipolar Disorder including: Diabetes, Cardiovascular Diseases, and Endocrine Disorders. When these disorders are co-existing, both illnesses may have a worse outcome.

Bipolar Testing & Assessments

In order to develop the right treatment plan for you, your provider will need a better understanding of you, the symptoms you experience, the course of the illness, stresses in your life, and your questions or concerns. This is through an evaluation interview and a variety of tests/assessments. Your provider will work with you to develop your individualized treatment plan and to make any changes over the course of treatment.

Doctor reviewing test results.

Standard Assessments for Bipolar

  • Physical Exam: If you have not had a physical exam within the last year, you will be requested to see your PCP. If you do not have one, you may schedule with one of our providers for assessment

  • Lab Work: Lab testing is important, both to rule out physical disorders that could be masquerading as Bipolar Disorder and as a baseline before starting medications. A number of the medications used for this disorder will require ongoing lab monitoring.

  • ECG: An electrocardiogram (ECG) may be necessary in some patients.

Bipolar Testing & Assessments

In order to develop the right treatment plan for you, your provider will need a better understanding of you, the symptoms you experience, the course of the illness, stresses in your life, and your questions or concerns. This is through an evaluation interview and a variety of tests/assessments. Your provider will work with you to develop your individualized treatment plan and to make any changes over the course of treatment.

Doctor reviewing test results.

Standard Assessments for Bipolar

  • Physical Exam: If you have not had a physical exam within the last year, you will be requested to see your PCP. If you do not have one, you may schedule with one of our providers for assessment

  • Lab Work: Lab testing is important, both to rule out physical disorders that could be masquerading as Bipolar Disorder and as a baseline before starting medications. A number of the medications used for this disorder will require ongoing lab monitoring.

  • ECG: An electrocardiogram (ECG) may be necessary in some patients.

Innovative Testing Available at Salience

CNS Vital Signs Neurocognitive Testing: A Computerized Neurocognitive Screening (CNS) is an assessment that tells us how well your brain is managing tasks, such as working memory, concentration, processing speed, and executive functioning. These results can provide insight into how you may perform in your daily life at work and at home, and help your provider identify levels of impairment. The overall duration takes about one hour to complete. 

Brainview: We know that behavioral health and physical health go hand-in-hand, and this assessment helps us see how they are impacting each other. The Brainview test is a cognitive assessment that provides information on your brain's functionality related to stress, memory, and cognition, while also tracking physical functions such as heart rate and metabolic rates. This test will help your provider develop a more informed treatment plan for you and better coordinate your overall care.

Girl in a gradient circle
Girl in a gradient circle

Innovative Testing Available at Salience

CNS Vital Signs Neurocognitive Testing: A Computerized Neurocognitive Screening (CNS) is an assessment that tells us how well your brain is managing tasks, such as working memory, concentration, processing speed, and executive functioning. These results can provide insight into how you may perform in your daily life at work and at home, and help your provider identify levels of impairment. The overall duration takes about one hour to complete. 

Brainview: We know that behavioral health and physical health go hand-in-hand, and this assessment helps us see how they are impacting each other. The Brainview test is a cognitive assessment that provides information on your brain's functionality related to stress, memory, and cognition, while also tracking physical functions such as heart rate and metabolic rates. This test will help your provider develop a more informed treatment plan for you and better coordinate your overall care.

Current Treatment Options for Bipolar

Treatment will often be determined by the type of mood episode that is present. For many patients who have this disorder, the treatment plan will need to be multidimensional and will need to address both the current episode as well as a strategy to prevent future episodes. 

Interventions will likely include medications, therapy, management of any co-occurring medical illnesses as well as monitoring for any medical side-effects of your medication, and at times may require other interventions such as hospitalizations, intensive outpatient, and care management of co-occurring psychiatric illnesses. 

When mood symptoms persist and cause impairment, but have not responded to medication and usual treatments, Salience Health clinicians can assist you in finding some alternative treatment options such as TMS or ECT. You will play an important role in managing your illness and should partner with your provider to create the best treatment plan to manage your illness. Below is a general overview of treatment options.

Salience Health Logo Mark With White Star

Medication

  • Mood Stabilizers: These medications are an important part of the treatment of Bipolar Disorder, both to address current symptoms and to prevent recurrent episodes. Common medications include lithium, anticonvulsant medications, and atypical antipsychotic medications.
  • Antipsychotic medications: These drugs can have mood stabilizing properties and are often used in non-psychotic episodes of Bipolar Disorder. Common medications include: Latuda, Seroquel/quetiapine, olanzapine, and cariprazine.
  • Anti-anxiety medications may be used short-term for symptom management.
  • Antidepressant medications should not be used alone in Bipolar Disorder as a switch into mania is possible. Little evidence supports the effectiveness for Bipolar Depression, but at times they may be used in conjunction with mood stabilizing medications.
  • A significant number of patients will require a combination of medications to manage their symptoms.
  • Patients who have been treated for an acute episode will need ongoing medications to try to prevent future episodes. Common medications may include lithium, lamotrigine, or atypical antipsychotic medication
Black pensive woman wearing warm scarf looking up to the autumn trees at the park.

Side-Effects: Side-effects should be reported to your provider. Common side-effects may vary from one medication to another. Common ones include:Lithium: tremor, inability to concentrate urine, need to monitor thyroid function.

  • Antipsychotic medications: weight gain, metabolic disturbances, sedation, tremor, and long-term risk for irreversible movement disorders.
  • Valproic acid: liver function must be monitored.
  • Lamotrigine: monitor for rashes early in treatment, as these may indicate development of a serious skin condition.
  • There are many other possible side-effects so consult your provider should you experience any.

Current Treatment Options for Bipolar

Treatment will often be determined by the type of mood episode that is present. For many patients who have this disorder, the treatment plan will need to be multidimensional and will need to address both the current episode as well as a strategy to prevent future episodes. 

Interventions will likely include medications, therapy, management of any co-occurring medical illnesses as well as monitoring for any medical side-effects of your medication, and at times may require other interventions such as hospitalizations, intensive outpatient, and care management of co-occurring psychiatric illnesses. 

When mood symptoms persist and cause impairment, but have not responded to medication and usual treatments, Salience Health clinicians can assist you in finding some alternative treatment options such as TMS or ECT. You will play an important role in managing your illness and should partner with your provider to create the best treatment plan to manage your illness. Below is a general overview of treatment options.

Black pensive woman wearing warm scarf looking up to the autumn trees at the park.
Salience Health Logo Mark With White Star

Medication

  • Mood Stabilizers: These medications are an important part of the treatment of Bipolar Disorder, both to address current symptoms and to prevent recurrent episodes. Common medications include lithium, anticonvulsant medications, and atypical antipsychotic medications.
  • Antipsychotic medications: These drugs can have mood stabilizing properties and are often used in non-psychotic episodes of Bipolar Disorder. Common medications include: Latuda, Seroquel/quetiapine, olanzapine, and cariprazine.
  • Anti-anxiety medications may be used short-term for symptom management.
  • Antidepressant medications should not be used alone in Bipolar Disorder as a switch into mania is possible. Little evidence supports the effectiveness for Bipolar Depression, but at times they may be used in conjunction with mood stabilizing medications.
  • A significant number of patients will require a combination of medications to manage their symptoms.
  • Patients who have been treated for an acute episode will need ongoing medications to try to prevent future episodes. Common medications may include lithium, lamotrigine, or atypical antipsychotic medication

Side-Effects: Side-effects should be reported to your provider. Common side-effects may vary from one medication to another. Common ones include:Lithium: tremor, inability to concentrate urine, need to monitor thyroid function.

  • Antipsychotic medications: weight gain, metabolic disturbances, sedation, tremor, and long-term risk for irreversible movement disorders.
  • Valproic acid: liver function must be monitored.
  • Lamotrigine: monitor for rashes early in treatment, as these may indicate development of a serious skin condition.
  • There are many other possible side-effects so consult your provider should you experience any.
Salience Health Logo Mark With White Star

Exercise

  • Regular exercise is strongly encouraged. This activity can help with stress management and weight control. If you have other health conditions, check with you PCP or see one of our primary care providers, if needed, to discuss your health and exercise tolerance.
  • Getting regular sleep is especially important for those with Bipolar Disorder as irregular sleep and sleep deprivation can be associated with mood cycling. Establish a bedtime and wake-up time and try to stick with it.
Patient Education Exercise Tablet
Salience Health Logo Mark With White Star

Exercise

  • Regular exercise is strongly encouraged. This activity can help with stress management and weight control. If you have other health conditions, check with you PCP or see one of our primary care providers, if needed, to discuss your health and exercise tolerance.
  • Getting regular sleep is especially important for those with Bipolar Disorder as irregular sleep and sleep deprivation can be associated with mood cycling. Establish a bedtime and wake-up time and try to stick with it.
Salience Health Logo Mark With White Star

Therapy

Mature businessman working on laptop. Handsome mature business leader sitting in a modern office with large windows
  • Therapy can assist in many ways including: improving stress management skills, improving your commitment to maintaining treatment, and learning more about your illness.
  • Families can become very stressed about their loved one’s illness and may benefit from family therapy.
  • Salience Health Clinics have Cognitive-Behavioral educational and therapeutic classes available within our clinic.
  • Therapy may assist in developing skills to manage the depressed phase of illness. While therapy alone will not cure the disorder, it can demonstrate a positive benefit.
  • NAMI has family and patient support and educational materials available on their website.
Mature businessman working on laptop. Handsome mature business leader sitting in a modern office with large windows
Salience Health Logo Mark With White Star

Therapy

  • Therapy can assist in many ways including: improving stress management skills, improving your commitment to maintaining treatment, and learning more about your illness.
  • Families can become very stressed about their loved one’s illness and may benefit from family therapy.
  • Salience Health Clinics have Cognitive-Behavioral educational and therapeutic classes available within our clinic.
  • Therapy may assist in developing skills to manage the depressed phase of illness. While therapy alone will not cure the disorder, it can demonstrate a positive benefit.
  • NAMI has family and patient support and educational materials available on their website.

Future Treatment Options for Bipolar

Salience Health Logo Mark With White Star

Transcranial Magnetic Stimulation

  • TMS is a form of neuromodulation therapy. TMS is not currently FDA-approved for Bipolar Depression, but has been used in the U.S., Europe, and Asia with good results. There has been a low rate of treatment-emergent mania described with TMS.
  • TMS is a safe and effective outpatient treatment option. Side-effects are minimal for most patients: scalp discomfort, fatigue after treatment, occasional headaches, and nausea. You may drive yourself to-and-from treatment. Many protocols are short and treatment time can be under thirty minutes, daily for a couple of weeks, for most patients.
Salience Health Logo Mark With White Star

ECT

Salience Health Logo Mark With White Star

Bright Light Therapy

  • For patients in severe episodes of mania or depression that either do not respond to medications, or represent a serious threat to safety, ECT may be considered.
  • This treatment is usually started within the hospital but may be completed on an outpatient basis once the crisis has been stabilized.
  • Although studies are limited, initial results suggest this can be an effective strategy for some depressed patients with Bipolar Disorder.
  • This does require the purchase of a light device.

Future Treatment Options for Bipolar

Salience Health Logo Mark With White Star

Transcranial Magnetic Stimulation

  • TMS is a form of neuromodulation therapy. TMS is not currently FDA-approved for Bipolar Depression, but has been used in the U.S., Europe, and Asia with good results. There has been a low rate of treatment-emergent mania described with TMS.
  • TMS is a safe and effective outpatient treatment option. Side-effects are minimal for most patients: scalp discomfort, fatigue after treatment, occasional headaches, and nausea. You may drive yourself to-and-from treatment. Many protocols are short and treatment time can be under thirty minutes, daily for a couple of weeks, for most patients.
Salience Health Logo Mark With White Star

ECT

  • For patients in severe episodes of mania or depression that either do not respond to medications, or represent a serious threat to safety, ECT may be considered.
  • This treatment is usually started within the hospital but may be completed on an outpatient basis once the crisis has been stabilized.
Salience Health Logo Mark With White Star

Bright Light Therapy

  • Although studies are limited, initial results suggest this can be an effective strategy for some depressed patients with Bipolar Disorder.
  • This does require the purchase of a light device.

How to Get Better Outcomes with Treatment For Bipolar?

Things to Avoid to Achieve Better Outcomes

  • Avoid stopping your medications. If you are unhappy with the side-effects you are experiencing, please talk to your provider. Stopping medications can have very negative consequences, including the need for hospitalization. Work with your provider to find a medication regimen that you can tolerate.
  • Avoid using drugs and alcohol to manage stress. Alcohol is a depressant and can disrupt mood. A number of recreational drugs can have serious effects on mood and may lead to cycling or disruption of mood.
  • Inform your provider of any new prescriptions. Some drugs may interact with your medications (e.g., lithium and anti-inflammatory medications; lithium and certain antihypertensive medications). Other medications may have effects on mood (e.g., steroids). Keep your provider up-to-date on all medications and over-the-counter products that you may be using.
  • Staying up all night or sleeping at different times.
  • Do not isolate yourself. Work to establish a support system and have regular contact with the people you have identified.
  • Do not harm yourself. Report any thoughts or urges to harm yourself to your provider. Work with your provider to create a safety plan. If at any point you feel you cannot remain safe, call 911 or go to the nearest Emergency Room and notify your provider. It is best to have a trusted family member or friend aware of who to call or where to take you if at any point you cannot be well enough to recognize your need of treatment.
  • Avoid tobacco. Smoking can worsen anxiety and depressive symptoms and is associated with serious medical risks.
  • If you are a parent of a child or teen who suffers from Bipolar Disorder, you will need to be actively involved in their care. This includes attending appointments, reporting on symptoms, and monitoring for safety and behavioral clues to impending crisis. Family therapy may be recommended to improve communication and to assist the family in managing the illness.
  • Bipolar Disorder is a chronic illness for which there is not currently a known cure. However, there are treatments that can vastly improve symptoms and reduce impairments. Work with your provider to stabilize your mood and to have a plan to maintain your health over time.

Achieving Better Outcomes

Become Education About Bipolar Disorder

  • Learn all you can about your illness. Educated patients are more likely to follow through on treatment and engage in activities that foster wellness.
  • At every visit you will be asked to complete clinical scales. These measurements are important and help your provider track your progress over time. Please assist your provider by filling out these scales every time you come to the clinic.
  • Take every dose of medication every day. Failure to take medications as prescribed is one of the leading causes of relapse and hospitalization.
  • Be a partner in your care. You and your provider should agree on your goals for treatment and should work together to achieve them. Your participation and cooperation are essential to achieving the best outcomes.
  • Remember that it may take more than one trial of medication or another intervention to feel better. Give treatment a fair chance. Give your provider accurate information about your progress, the stresses, and other medical problems that might impact your course of illness. Work with your provider to identify triggers that you might need to avoid, as well as strategies that support your health
Man in suit

How to Get Better Outcomes with Treatment For Bipolar?

Things to Avoid to Achieve Better Outcomes

  • Avoid stopping your medications. If you are unhappy with the side-effects you are experiencing, please talk to your provider. Stopping medications can have very negative consequences, including the need for hospitalization. Work with your provider to find a medication regimen that you can tolerate.
  • Avoid using drugs and alcohol to manage stress. Alcohol is a depressant and can disrupt mood. A number of recreational drugs can have serious effects on mood and may lead to cycling or disruption of mood.
  • Inform your provider of any new prescriptions. Some drugs may interact with your medications (e.g., lithium and anti-inflammatory medications; lithium and certain antihypertensive medications). Other medications may have effects on mood (e.g., steroids). Keep your provider up-to-date on all medications and over-the-counter products that you may be using.
  • Staying up all night or sleeping at different times.
  • Do not isolate yourself. Work to establish a support system and have regular contact with the people you have identified.
  • Do not harm yourself. Report any thoughts or urges to harm yourself to your provider. Work with your provider to create a safety plan. If at any point you feel you cannot remain safe, call 911 or go to the nearest Emergency Room and notify your provider. It is best to have a trusted family member or friend aware of who to call or where to take you if at any point you cannot be well enough to recognize your need of treatment.
  • Avoid tobacco. Smoking can worsen anxiety and depressive symptoms and is associated with serious medical risks.
  • If you are a parent of a child or teen who suffers from Bipolar Disorder, you will need to be actively involved in their care. This includes attending appointments, reporting on symptoms, and monitoring for safety and behavioral clues to impending crisis. Family therapy may be recommended to improve communication and to assist the family in managing the illness.
  • Bipolar Disorder is a chronic illness for which there is not currently a known cure. However, there are treatments that can vastly improve symptoms and reduce impairments. Work with your provider to stabilize your mood and to have a plan to maintain your health over time.

Achieving Better Outcomes

Become Education About Bipolar Disorder

  • Learn all you can about your illness. Educated patients are more likely to follow through on treatment and engage in activities that foster wellness.
  • At every visit you will be asked to complete clinical scales. These measurements are important and help your provider track your progress over time. Please assist your provider by filling out these scales every time you come to the clinic.
  • Take every dose of medication every day. Failure to take medications as prescribed is one of the leading causes of relapse and hospitalization.
  • Be a partner in your care. You and your provider should agree on your goals for treatment and should work together to achieve them. Your participation and cooperation are essential to achieving the best outcomes.
  • Remember that it may take more than one trial of medication or another intervention to feel better. Give treatment a fair chance. Give your provider accurate information about your progress, the stresses, and other medical problems that might impact your course of illness. Work with your provider to identify triggers that you might need to avoid, as well as strategies that support your health
Man in suit