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DIFFERENTIATING BETWEEN BIPOLAR DISORDER I AND BIPOLAR DISORDER II

Many people have heard about the diagnosis Bipolar Disorder. Formerly this diagnosis was named Manic Depression. Today we differentiate between Bipolar Disorder I and Bipolar Disorder II. Bipolar Disorder I is characterized by periods of depression alternating with periods of manic behavior. What is manic behavior? It is discreet periods of high energy which can be either positive or negative in nature. The positive kind would manifest itself by an unusual burst of energy, not needing much sleep, high amounts of goal directed behavior, happy even euphoric behavior, increased amounts of impulsivity, creativity and sometimes grandiosity. Sometimes people in this state talk rapidly and cut others off. Usually, people experiencing this kind of mania like to be there. They enjoy being happy, productive, highly energetic and creative. The problem is that sometimes this mania is highly unpractical and distructive to theirs and their loved ones life. This is particularly true with Bipolar Disorder I which has higher levels of mania. A manic person may suddenly leave a long happy marriage for a random person they met in a bar. They may leave a good job to go explore the world. At the moment the person in a manic state may not understand or consider the implications of his behavior. They may not realize it is a problem. Its usually later when they are out of the manic state and more settled down when they may come to realize the problem. Frequently, family members are the first to mention the problem. Some patients never recognize the problem in themselves and only get help after family insist on it. While positive manic states are sometimes not recognized as being a problem, alternatively, the negative manic states almost always are. If not by the patient himself, certainly by family members, work colleagues or friends.
Negative manic states are high energy states also. There may be problem sleeping. Instead of happy or euphoric mood, in its place is an angry or highly irritable mood. You see these people driving down the road and in response to someone cutting them off they react in a highly explosive way. They may track down the perceived perpetrator and pull a gun on them or start a fist fight. However, this is more common in men. Negative mania is erratic and often scary to the patient and/or those around him. With women, they may report being highly annoyed and easily provoked emotionally. Family members may report they feel like they are “walking on eggshells.”
Bipolar Disorder II is similar to Bipolar Disorder I in that it has periods of depression but it alternates with lower levels of mania. The mania is not as distructive. A person may appear to be a person who is involved in a lot of things and has a lot of projects going at the same time. They seem to exude more energy and creativity than the average person during these times. We sometimes call this type of mania “hypomania” People who have hypomania may not have problems in this state. For them, the problems come when they are in their depressed phase.
Another thing I would like to mention is that sometimes manic states look like anxiety. Be sure to get your anxiety checked out by a specialist if the standard treatments of anxiety, ie. therapy or antidepressants aren’t doing the job. Manic episodes are often missed by the general primary care provider.
How is Bipolar Disorder treated?
If a person has been treated previously with an antidepressant, a mood stabilizer may be added. Some people with Bipolar Disorder( I or II) cannot tolerate antidepressants at all. They may make them too manic. In that case they may need a mood stabilizer or antipsychotic. The other part of treatment is psychotherapy. In my view, they should both be in the treatment plan for best results. Cognitive Behavioral Therapy (CBT), Interpersonal Therapy, Marriage and Family therapy and psychodynamic types of therapy can be useful. Recent research shows that CBT can be done effectively in short periods of time from 8-16 weeks in duration for some. CBT focuses on the present and doesn’t spend large amounts of time with what happened in the past. It is goal focused and skill building in nature. Other treatment modalities that I have found to be helpful is spirituality exploration and developing healthy health habits such as good sleep hygiene and an exercise routine. I have found herbal remedies are not as effective in Bipolar spectrum disorders. Although some people prove to be the exception to the

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