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Understanding Bipolar Disorder - Psychotherapy & Other Treatments

Psychotherapy and other treatments

Bipolar disorder is best treated with a combination of medications and psychotherapy. Medications can provide effective treatment during the acute episode and prevent future episodes from occurring. Psychotherapy can help in ways that medications can’t and can be an important adjunct to medication.

Psychotherapy

“I cannot imagine leading a normal life without both taking lithium and having had the benefits of psychotherapy,” writes Kay Redfield Jamison, a psychiatrist who suffers from bipolar disorder, in her book, An Unquiet Mind.
Psychologist, David Miklowitz, points out in his book, The Bipolar Disorder Survival Guide, that psychotherapy can help people with bipolar disorder:

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Understand past episodes of illness

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Make plans to cope with future episodes

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Accept and adapt to a long-term medication regime

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Develop strategies for coping with stress

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Improve academic and workplace functioning

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Deal with the stigma associated with the illness, and

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Improve relationships with family and friends.

A suitable therapist is one who understands and takes into account the biological basis of your illness and your need for psychiatric care. He or she should be able to help you deal with current difficulties and cope better with future problems. One valuable form of individual psychotherapy for people with bipolar disorder is cognitive-behavioral therapy (CBT), which can help you deal with ingrained patterns of negative thinking. Another individual approach is interpersonal therapy which will help you understand the interactions between your illness and important aspects of your life, like your close personal relationships and your workplace, and help you alter these to achieve greater mood stability.

Family and couples therapy can also be valuable for people with bipolar disorder. It is always helpful if people close to you understand your disorder and how you have to cope with it. Family members may also benefit from involvement in a family support . Check with the Depression and Bipolar Support Alliance (800 826 3632; www.ndmda.org) or the National Alliance on Mental Illness (800 950 NAMI; www.nami.org) to see if there is a family support in your area.

Self-help s can also be very beneficial for people with bipolar disorder, providing opportunities to share experiences and strategies for dealing with illness. Check and see if you can locate a bipolar disorder self-help in your area.

Light therapy

Some people with bipolar disorder find that their moods are influenced by the season of the year. As the days get shorter in September and October they begin to get depressed and they don’t emerge from the depression until March or April. They may experience episodes of mania in the spring or summer. These people may benefit from exposing themselves to a source of bright light – at least 10,000 lux – during the hours of darkness in winter for 30 minutes to two hours a day. Bright lights of this type are available commercially, some of them with timers that turn the light off and on automatically. Light treatment can be effective for people with bipolar seasonal affective disorder, but there is a risk that it can lead you to switch into mania or hypomania or interfere with your sleep. Adjusting the “dose” of light often corrects these problems.

Electroconvulsive therapy: yes or no?

Most people who experience a severe episode of depression in bipolar disorder respond to treatment with some combination of the medications described above. A few do not. For those few, electroconvulsive therapy (ECT) may bring welcome relief from the symptoms. The improvement can be dramatic. For patients who are seriously suicidal, it may be life-saving. ECT is also effective in treating mania, but it is rarely needed for this purpose as medications are usually rapidly effective in this phase of the illness.

ECT is the electrical induction of seizures in anesthetized patients. An ECT series may comprise twelve or more treatments conducted at a rate of about three a week. Some people undergoing the procedure may experience memory loss or confusion, but these side effects are almost always transient. The memory loss is most evident for events that occurred during the period of treatment. Patients with bipolar disorder undergoing this procedure must first be withdrawn from anticonvulsant medications, as these are likely to prevent the occurrence of the required seizure. It may also be necessary to stop taking lithium during ECT treatment in order to minimize the possibility of developing confusion.

Sometimes ECT is only effective in producing a remission of symptoms for a few weeks or months. Recurrence of symptoms is much less likely if the patient is taking medications. Medications which were ineffective in getting the person out of a severe depression may prove to be effective, after ECT, in preventing a recurrence. For those few people where medications do not prevent relapse, maintenance ECT – perhaps a treatment every 4 to 6 weeks – is very likely to prevent recurrence.

ECT has gotten a bad name, largely due to the dramatic, negative images in movies such as The Snake Pit and One Flew Over the Cuckoo’s Nest, showing how it was used, decades ago, without anesthesia and without patient consent. In fact, it is a safe and effective treatment which is only used selectively for people who have not responded to treatment with medications.

Much more information about psychotherapy and other aspects of the treatment of bipolar disorder can be found in the comprehensive guide written by David Miklowitz, a professor of psychology at the University of California, Berkeley, The Bipolar Disorder Survival Guide: What You and Your Family Need to Know (Guilford Press, 2002).