Treatments for Bipolar Disorder

Treatments for Bipolar Disorder
After Medication

A Brewster Smythe

Abstract
The objective of this paper will be to overview treatments other than medication -which is believed to be a prelude and basic to other therapies for bipolar disorder. In order to accomplish this goal the paper will follow this sequence. First, it will define bipolar disorder. Secondly, there will be a brief review of the life of Dr. Kay Redfield Jamison and her dual interests in manic depressive illness. And, finally, the paper will provide definitions of interpersonal and social rhythm therapy, cognitive therapy, and family-focused therapy.

Defining Bipolar Disorder
“Summer, a lack of sleep, a deluge of work, and exquisitely vulnerable genes took me to the back of beyond, past my familiar levels of exuberance and into florid madness.” (Jamison, 1995).

Over 2 million American adults are afflicted with bipolar disorder-also known as manic-depressive illness. While depression alone afflicts more women than men, bipolar disorder finds sufferers equally in both men and women. Men, though, are more prone to the manic phase upon first coming into contact with the illness, while woman are more prone to depression. Mania presents itself with the following symptoms: elevated or irritable mood, decreased sleep, high energy, impulsive behavior and increased goal-directed behavior. Depression is characterized with: sadness or irritability, low energy, thoughts of death and suicide and lack of interest in formerly pleasurable activities (Suppes, M.D. Ph.D. et al, 2005).

There is a wide bipolar disorder spectrum ranging from Bipolar 1 and 2 to cyclothymia, which is, “a type of bipolar disorder that is characterized by mood changes with symptoms of mania and depression. Symptoms do not meet the full criteria for Major Depression or Hypomania, either because they are fewer than the required number or their duration is shorter than required.” (Mountain, M.D., 2003)

However, knowing what bipolar disorder is clinically cannot begin to encompass having lived it. Nor, can it adequately describe those people who love and often leave those who come in contact with persons who suffer with it. Broken relationships, lost jobs, interrupted careers; poor financial judgments and emotional unavailability are earmarks of the illness. It often takes years for a correct diagnosis and when the diagnosis does arrive treatment is met with resistance because of what is often perceived as “normal” living.

Kay Redfield Jamison and Treatment
Kay Redfield Jamison is a professor of psychiatry at the John Hopkins University School of Medicine. Jamison is a member of the National Advisory Council for Human Genome Research and clinical director of the Dana Consortium on the Genetic Basis of Manic Depressive Illness (Jamison, 2006, p.90). She is the author of such books as Touched by Fire: Manic-Depressive Illness and the Artistic Temperament and An Unquiet Mind: a Memoir of Moods and Madness. In Unquiet Mind she came forth with her own struggles with bipolar disorder, (a term she finds offensive) and her own resistance against compliance with taking the medication, lithium. “Lithium prevents my seductive but disastrous highs, diminishes my depressions, clears out the wool and webbing from my disordered thinking, slows me down, gentles me out, keeps me from ruining my career and relationships, keeps me out of the hospital, alive, and makes psychotherapy possible.” “That I owed my life to pills, however, was not obvious to me for a long time; my lack of judgment about the necessity to take lithium proved to be an exceedingly costly one.” (Jamison, 1995).

This paper is setting forth to describe three therapies that can be used in conjunction with medication. Whether it is lithium, anticonvulsants-or any number of new mood stabilizers now prescribed-no psychotherapy will work without the basic of compliance with medication.

Interpersonal and Social Rhythm Therapy
Interpersonal and social rhythm therapy encompasses three areas of approach with the individual who suffers with bipolar disorder.

First, the therapy recognizes the relationship problems that begin to occur upon diagnosis of bipolar disorder. The therapy helps the client foster better relationships or teaches them to terminate relationships that have become toxic. Secondly, it helps the client recognize the impact that bipolar disorder has upon biologic rhythms which include: sleep patterns, energy levels, and appetite. And finally, it helps the client deal with the grief that commonly results from any kind of chronic illness-the loss of the “healthy self”(Mountain M.D., 2003). “In standard IPT, the problem of grief is selected only when an important person in the patient’s life has died. Individuals with bipolar disorder, however, often experience the symbolic loss of the person they would have become had they not been afflicted with bipolar disorder.” (Frank, 2004, p.171).
This is a practical approach to the illness of bipolar disorder. The client can learn how to build better relationships, something that needs to happen in order to enjoy recovery. The client also needs to terminate relationships that can trigger mania or depression. This approach also looks at the biologic rhythms of the illness helping the client to set in motion a regular routine that helps maintain recovery. And lastly, this approach helps the clients deal with the sadness that takes place upon diagnosis of an illness that will be lifelong and will require lifelong maintenance.

Cognitive-Behavioral Therapy
Cognitive-Behavioral Therapy or CBT is a therapy that helps the client consider the impact of thinking styles upon mood. CBT has been around for years in the treatment of depression -and in the past decade has found use in the treatment of mania. For example this kind of therapy will help the client identify automatic thoughts that are destructive and teaches the client to use thought-stopping techniques. A client experiencing depression may find themselves in a vicious cycle whereas their thoughts of helplessness promote their behavior. However, with CBT, the client can learn to stop this thinking and recognize it before it becomes engrained. In mania, the client may set up a technique with a close friend whereas the client will call upon that friend when they find themselves starting to begin too many tasks at once (Mountain, Jane et al, 2003). “For patients with other manic outlets, precommitment strategies might include promising not to drive, not to call prostitutes, or to review unconventional decisions with the therapist and two friends before taking any action. The therapist and the patient can refer back to the precommitment agreement when the patient enters a manic phase.” (Leahy, 2004, p.144).

This approach fosters a sense of control for the client whereas the client finds a method to stop wrong thinking or put in place agreements before they get out of control. This way of handling the illness makes long range decisions concerning the maintenance of the recovery phase more practical.

Family Focused Therapy
Family Focused Therapy or FFT is a therapy that was initially developed in the hospital setting for those people who had a family member with bipolar disorder. This therapy helps families learn to understand the illness. The therapist educates the families about the illness of bipolar disorder, examines relational patterns and teaches communication skills in the family so they better work in helping their family member with bipolar disorder decrease time between episodes (Mountain, Jane, et al, 2003)

“The overriding goals of FFT are to assist patients and their relatives to (1) make sense of the current episode of illness and its precipitants; (2) recognize and plan for the likelihood that the illness will recur; (3) accept the need for an ongoing program of medication to maintain stability; (4) distinguish the disorder from the patient’s premorbid personality;(5) learn to cope with stressors that provoke episodes of the illness; and (6) maximize the functionality of family or marital relationships in the aftermath of an illness episode.” (Miklowitz, 2004m p.188)

This therapy is so comprehensive that it takes in all the varied areas of the illness. However the negative area of the therapy is the likelihood that some family members will not involve themselves or will themselves be a trigger for a future episode.

Summary
The objective of this paper was to bring forth a working definition of bipolar disorder. It was also to show through the words and life of Kay Redfield Jamison where medication ends and psychotherapy can begin. And, finally, to define three different therapies currently in use that can clarify a life after medication. Most people who suffer with bipolar disorder know that without compliance with medication no amount of psychotherapy will take hold. Resistance is one of the biggest problems for people with this illness. And ignorance from the public and the patient, themselves is the other.

References
Frank, E., and Swartz, H. (2004). Interpersonal and Social Rhythm Therapy. In S. L.
Johnson , and Leahy, R. L. (Eds.), Psychological Treatment for Bipolar Disorder
(pp.171) . New York, NY: Guilford Press

Jamison, K.R. (Ed). (1995). An unquiet mind. 2nd ed. New York: Vintage.
Jamison, K.R. (2006). Manic Depressive Illness and Creativity. In D.G. Myers
(Eds.), Scientific American (pp.90). London, UK: Worth Publishing
Leahy, R.L. (2004) .Cognitive Therapy. In S.L. Johnson and Leahy, R.L. (Eds.),
Psychological Treatment for Bipolar Disorder (pp. 147). New York, NY:
Guilford Press

Miklowitz, D. J. (2004). Family Therapy, In S. L. Johnson and Leahy, R.L. (Eds.)
Psychological Treatment for Bipolar Disorder (pp.188). New York, NY:
Guilford Press

Mountain, M.D., J. (2003). Bipolar disorder: insights for recovery. 2nd edition. Denver,
Co: Chapter One Press

Suppes, M.D. Ph.D. T, and Dennehy, Ph.D., E. (2005). Bipolar disorder: the latest
Assessment and treatment strategies. 10th ed. Kansas City, MO: Compact Clinicals