Allenmore Psychological Associates remains OPEN. During this period of concern and anxiety having access to quality behavioral health care is important and our staff is dedicated to ensuring your behavioral health care needs are met. In the unlikely event that the WA Department of Health directs us to close we will notify patients via telephone on the day of their appointment (similar to our Snow Day policy). If you are an existing patient who is demonstrating symptoms associated with the coronavirus or impacted by related closures (e.g. cannot find day care due to a school closure) and need to cancel we ask that you inform our staff as soon as possible, APA will not charge you for a late cancellation.

Bipolar Disorder

We all have many different emotional experiences. It is common over the course of time for us to experience happiness and joy, as well as down periods when we are sad, discouraged, frustrated or angry. These experiences are typically short-lasting, understandable, appropriate for the situation we are in, and often adaptive and life-enhancing. Our emotions are adaptive because they can allow us to understand ourselves and provide us with motivation and energy to take appropriate action in response to the situation. However for some of us, our emotional experiences become extreme, excessive or “out of sync” with the situations in which we find ourselves. We can overact to a situation by becoming excessively angry, sad or even happy or excited. An ongoing pattern of emotions which are excessively intense, extreme, erratic or unpredictably changeable may reveal that we are suffering from Bipolar Disorder. Bipolar Disorder is one class of major mood disorders. It has been estimated that Bipolar Disorder affects almost 6 million people in the United States of America every year.

What is Bipolar Disorder?

Bipolar Disorder, which used to be called manic depressive disorder, is a serious mental disorder which can adversely impact an individual’s health and wellbeing if left untreated. Extreme shifts in mood from depression to manic episodes characterize Bipolar Disorder. Depressive episodes involve experiences of low mood, sadness, sleep and appetite disturbance, fatigue, social withdrawal and low self-esteem (to learn more, please visit our depression page). While depressive episodes on their own cause high levels of suffering and life disruption, people afflicted with Bipolar Disorder also experience manic episodes which can amplify both suffering and life disruption. During manic episodes an individual becomes excessively energized and exhibits an intensely euphoric and happy mood, or a hostile, irritable mood. During manic episodes, individuals often have decreased need for sleep, and feel powerful and invincible. They may engage in risky behaviors involving sex, gambling, excessive spending and drug or alcohol abuse, that they would not do otherwise. At the height of a manic episodes, individuals may experience psychosis, were they temporarily lose touch with reality, sometimes seeing or hearing things that others do not. While many individuals with Bipolar Disorder have normal periods between manic and depressive episodes, other individuals develop Rapid Cycling Bipolar Disorder which involves shifts between manic and depressive episodes, often without periods of normal stable mood.

What are the Subtypes of Bipolar Disorder?

There are several subtypes of Bipolar Disorder and correctly diagnosing which subtype a client is suffering from can be important in creating a treatment plan for the client. Bipolar I Disorder (which is pronounced Bipolar “One” Disorder) is diagnosed when an individual has experienced at least one manic episode during their lifetime. As indicated above, a manic episode is characterized by abnormal mood (intensely euphoric, angry or hostile) and abnormally risky, driven and potentially self-destructive behavior. Clients with Bipolar I Disorder also frequently experience depressive episodes, but a history of depressive episodes is not required to make the diagnosis of Bipolar I Disorder.

Bipolar II Disorder (which is pronounced Bipolar “Two” Disorder) is similar to Bipolar I Disorder in that the client’s moods alternate between high and low episodes over time. However, the client suffering from Bipolar II Disorder never has a full-blown manic episode. Instead, they experience hypomanic (meaning “less than” manic) episodes. During a hypomanic episode, the client also experiences excessive energy, grandiosity or unrealistically inflated self-esteem and involvement in impulsive, high risk behaviors, but they do not exhibit the extreme level of social or occupational impairment, or the psychotic symptoms observed in a manic episode.

Individuals diagnosed with Bipolar II disorder also tend to suffer from depressive episodes. Bipolar Disorder can be challenging to diagnose because clients often present for treatment when they are depressed and may not complain of hypomanic symptoms. In fact, they may experience these hypomanic symptoms as enjoyable and not view them as a problem. It is only after they are in treatment with the same provider over a period of time that the depressive symptoms recede and hypomanic symptoms emerge, that the mental health treatment provider is able to see that the client is not just suffering from a depressive disorder (or what is termed “Unipolar Depression”) but in fact, suffers from a Bipolar Disorder. On the whole individuals with Bipolar II Disorder spend more time in depressive episodes than those with Bipolar I Disorders and these depressions tend to be more debilitating to their functioning.

Bipolar Disorders tend to be chronic and require management over the lifetime of the individual. Without treatment, they can cause significant disruption in an individual’s personal, social and occupational functioning. There is some evidence that left untreated, Bipolar Disorder can progress to Rapid Cycling Bipolar Disorder in which an individual’s mood becomes increasingly unstable and they experience a number of depressive or manic/hypomanic episodes in a year’s time. There is also a tendency for individual’s suffering from Bipolar Disorder to suffer from other mental disorders. It has been estimated that up to 60% of individuals diagnosed with Bipolar Disorder have diagnosable co-occurring mental disorders and 37% have substance abuse disorders.

Treatment for Bipolar Disorder

Effective treatment for Bipolar Disorder begins with a comprehensive assessment establishing the diagnosis of Bipolar Disorder, as well as any other co-existing mental disorders and/or substance abuse disorders. Such a comprehensive assessment is essential to properly tailor treatment for the individual. Once the diagnosis has been made, the individual is often assessed for psychotropic medications. For most clients diagnosed with Bipolar Disorder, psychotropic medications will play a central role in their treatment and they will be on psychotropic medications for the long term. At Allenmore Psychological Associates, our Advanced Registered Nurse Practitioner (ARNP) evaluates and prescribes psychotropic medications for individuals suffering with Bipolar Disorder. The therapists at APA also regularly collaborate with other ARNP’s, physicians and psychiatrists in the community who are prescribing medications for our patients with Bipolar Disorder. APA is a well established practice which has been providing bipolar disorder treatment in Tacoma for nearly three decades, as such our therapists have close working relationships with many local medical providers. Having a solid treatment relationship with a medication prescriber over time is essential for the successful treatment and maintenance management of Bipolar Disorder.

The Role of Psychotropic Medications

There are several classes of psychotropic medications that are used to treat Bipolar Disorder. Usually the first class of medications that is considered in treating Bipolar Disorder is mood stabilizing medications. These medications, as the name implies, have the major effect of helping control moods and reduce mood instability. Lithium was the first recognized mood stabilizing medication. It was discovered in the 1970’s and is still in use today. Valproic acid (Depakote) was initially utilized as an antiseizure medication, but was also found to have mood stabilizing properties. It is also widely used today in the treatment of Bipolar Disorder. Several anticonvalcent medications including lamotragine (Lamictal), gabapentin (Neurontin) and topiramate (Topamax) are also used as mood stabilizers. Atypical antipsychotic medications are also commonly employed in the treatment of Bipolar Disorder. These medications are termed “atypical” to distinguish them from earlier antipsychotic medications which are referred to as conventional antipsychotic medications. These medications include olanzapine (Zyprexa), aripiprazole (Abilify) and quetiapine (Seroquel). Atypical antipsychotic medications are typically used to treat symptoms of extreme mania or psychosis. However, they are also often used as a maintenance medication with Bipolar Disorder. Antidepressant medications can also have a role in treating symptoms during a bipolar depressive episode. Medication prescribers tend to be cautious in their use of antidepressants with Bipolar Disorder because these medications can precipitate abrupt switching from a depressive episode to a hypomanic or manic episode. For this reason a mood stabilizing medication is often prescribed in conjunction with the antidepressant.

Psychotherapy as an Important Ingredient in Successful Treatment

For many people suffering from Bipolar Disorder, psychotherapy or counseling is an important ingredient in the successful treatment of their disorder. There are many positive impacts that working with a therapist trained and experienced in working with Bipolar Disorder can make. One of the first is providing education about Bipolar Disorder and the necessary aspects of effective treatment. After an individual is diagnosed with Bipolar Disorder, progress in therapy is heavily dependent upon the individual understanding that they have a serious mental disorder for which there is no cure, and which will require lifelong treatment and active involvement on their part to manage. This is a lot for most people to come to terms with, especially young people. A common response to receiving this diagnosis is to minimize or deny the diagnosis and not pursue the necessary treatment. Unfortunately this approach does not work out well for most individuals, and can lead to recurring depressive, hypomanic or manic episodes and ultimately to Rapid Cycling Bipolar Disorder. When individuals understand there is a great deal of hope because Bipolar Disorder is highly treatable, they then tend to be motivated get the proper treatment so that they can live a productive, satisfying life.

Beyond providing education and helping patients diagnosed with Bipolar Disorder come to terms with the disorder and commit to treatment, there are a number of specific psychotherapy approaches that have been shown to be useful. Therapists often employ cognitive behavioral therapy (CBT) techniques in working with individuals diagnosed with Bipolar Disorder. In CBT the therapist guides the patient in identifying and learning to change distorted beliefs and patterns of thinking which serve to precipitate or maintain depressive, hypomanic or manic episodes. Helping patient’s learn effective coping and problem solving techniques is common focus in CBT. Interpersonal or family therapy techniques are also commonly utilized in treating Bipolar Disorder. These techniques involve improving communication and problem-solving within the family. Family members can also be taught to become aware of “early warning signs” of the onset of depressive, hypomanic or manic episodes and collaborate with the patient to intervene early to avoid a full-blown episode and to maintain mood stability. Therapists also employ a variety of lifestyle management techniques to help individuals living with Bipolar Disorder. These techniques include helping the patient to establish regular eating, sleeping and exercise routines to promote mood stability. The role of proper diet and abstaining from alcohol abuse and street drug use is also emphasized. Patients are helped to monitor their moods on a daily basis and be on the lookout for early signs that they may be switching moods. One way in which we encourage clients to track their mood, medication use and sleep is by using readily available smartphone applications, described in our resources section. The patient is then empowered to utilize coping and other skills to prevent the onset of another depressive, hypomanic or manic episode.

Getting Started with Treatment for Bipolar Disorder at APA

For over 30 years the counselors at APA have had the privilege of treating many individuals with Bipolar Disorder. What this experience has taught us, is that quality mental health treatment which combines properly prescribed psychotropic medication with targeted, focused psychotherapy can have a powerful impact in the lives of individuals who have Bipolar Disorder. We are proud to provide this comprehensive Bipolar Disorder treatment Tacoma area residents can depend on. We have experienced the satisfaction that comes when we work together collaboratively with clients to help them move toward health and wellbeing. We have been repeatedly impressed with the quality of life that individuals with Bipolar Disorder can experience when they learn to manage their moods, to maintain emotional stability and to channel their energy in constructive directions. If you are suffering from Bipolar Disorder, or if you suspect that you may have Bipolar Disorder, we are here to help. To get started with treatment at Allenmore Psychological Associates, please contact us at (253) 752-7320. One of our highly trained front office staff members will answer the phone and be happy to schedule an initial appointment with one of our providers.

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