Ketamine Treatment for Bipolar Depression: Does it Help

Is Ketamine treatment for bipolar depression a wonder drug, or is it an irresponsible use of a street drug? For many, ketamine is a miracle treatment breakthrough that helps people facing severe bipolar depression, treatment-resistant bipolar depression, and suicidal thoughts that can accompany these serious bipolar episodes. Others are skeptical and point to myriad problems associated with ketamine. Let’s explore the facts about this substance to understand more about ketamine treatment for bipolar depression.

Ketamine at a glance:

  • It only has FDA approval as an anesthetic
  • Ketamine is an anesthetic in both human and veterinary medicine
  • Ketamine is also a street drug, often taken as a party or club drug
  • Ketamine’s chemical structure and the way it acts on the brain are similar to the street drug PCP
  • It can make people dissociate, or detach from reality
  • It’s used as a date rape drug
  • When misused, ketamine can cause impaired learning, memory, and attention; delirium, amnesia, potentially fatal respiratory problems, agitation…and depression

At first glance, ketamine looks horrible. It’s dangerous and does nasty things, including possibly causing depression. How, then, can people use it to treat bipolar depression? When Ketamine is used to treat bipolar depression under medical care, ketamine is not being used as a street drug or an anesthetic. It’s being used as an antidepressant, and it can be a very effective one.

How Ketamine Treatment for Bipolar Depression Works

Ketamine is different from traditional antidepressants. Traditional antidepressants target the neurotransmitters serotonin, norepinephrine, and dopamine. Ketamine blocks glutamate and enhances the brain’s ability to grow and change.

Ketamine blocks the N-methyl-D-aspartate (NMDA) receptor, which seems to be its depression-reducing kingpin. It rebalances glutamate and GABA as well as facilitates the development of new receptors and synapses.

The ketamine-induced activity in the brain leads to the reduction of severe bipolar depression symptoms. Ketamine treatment can bring a host of benefits.

Advantages and Benefits of Ketamine Treatment for Bipolar Depression

Ketamine has a high success rate, with up to 85 percent of people reporting significant improvements in their mood (Depression Alliance, n.d.). This leaves about 15 percent of people unaffected by ketamine treatment, whereas, with traditional antidepressants, approximately 33 percent of users don’t improve.

Not only does ketamine treatment help bipolar depression, but it also does it quickly. While it can take four- to eight weeks to feel the positive effects of traditional antidepressants, ketamine treatment creates relief in a matter of hours.

While ketamine treatment does offer advantages, it has disadvantages, too.

Drawbacks of Bipolar Depression Ketamine Treatment

Researchers have identified certain problems with ketamine use in bipolar depression.

  • There’s only a small difference between a safe and effective dose and a lethal dose
  • Researchers are still trying to find a dose that’s high enough to be effective and low enough to be safe
  • People can experience distorted vision and hearing
  • Tolerance risk; people will need more to have the same effect on depression symptoms
  • Ketamine carries a risk of abuse
  • It may not be safe (or effective) for long-term use
  • Long-term treatment frequency is unknown
  • May always require treatment in a clinic because, as a street drug, it may not be available in pharmacies

Despite these disadvantages, many people are receiving ketamine treatments for bipolar depression and are so happy with the results that they continue with treatment despite the cost.

Receiving Ketamine Treatment

Some psychiatrists offer ketamine treatment as a trial. If you can’t find a psychiatrist who does this, you could go to a ketamine clinic.

Ketamine clinics have begun to spring up nationwide. Many clinics are located in university medical centers and are reputable. Others may be unsafe or unreliable because there’s no oversight or standard of treatment regulating treatment centers.

Treatment involves a ketamine infusion for bipolar depression, which is ketamine delivered intravenously. Nasal sprays, including esketamine aka Spravato (FDA approved for treatment-resistant depression), and others pending FDA approval, may soon be another ketamine treatment method.  Because ketamine’s bipolar depression-relieving effects are temporary, people undergoing treatment need to return every few weeks for another round of treatment.

Because the FDA hasn’t approved ketamine treatment for bipolar depression, insurance typically doesn’t cover treatments. Most people pay out-of-pocket for the treatment, and the cost is hefty. Infusions cost between $400 and $800 each. With treatments occurring every few weeks, ketamine treatments for severe bipolar depression can be over $10,000 each year.

Ketamine treatment for bipolar depression is promising. Early experiences indicate that the treatment, while expensive, is effective and efficient. There are still many unknowns, however:

  • When used long-term, will it be safe and effective?
  • What is the right dosing schedule, amount?
  • How many treatments will be recommended?

The current recommendation is that ketamine treatment for bipolar depression be used only when all other treatments have been unsuccessful. And even then, ketamine treatment should be short-term only, to augment traditional medication while it begins to work. Cautious use may be the most effective and safest approach.

article references

APA Reference
Peterson, T. (2019, June 12). Ketamine Treatment for Bipolar Depression: Does it Help, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/ketamine-treatment-for-bipolar-depression-does-it-help

Last Updated: June 15, 2019

Are Antidepressants Safe and Effective in Bipolar Depression Treatment?

The effectiveness and safety of antidepressants for bipolar depression treatment has been called into question by psychiatrists, researchers, and people living with bipolar depression. In fact, according to Dr. Nassir Ghaemi, director of the Bipolar Disorders Program at Emory University School of Medicine, “The use of antidepressants in bipolar disorder is perhaps the most controversial topic in the treatment of bipolar disorder” (Cascade, et al., 2007). Here’s a peek into the controversy to arm you with information about the safety and effectiveness of antidepressants for bipolar depression treatment.

Antidepressants in Bipolar Depression: What Changed?

Antidepressants used to be the go-to treatment for bipolar depression. They were typically the first medication prescribed, and often they were the only medication used. Then, in 2002, considering emerging studies and negative patient experiences, the American Psychiatric Association (APA) changed its recommendation: antidepressants should not be the first line of treatment; lithium or Lamictal should be used first.

Professional opinion differs regarding whether to follow the APA’s recommendation. It’s not for lack of research; the problem is that different studies yield conflicting information. One study will find, for example, that antidepressants destabilize someone’s mood and lead to rapid cycling of depression and mania or hypomania. However, another study will show that the use of antidepressants alone (called antidepressant monotherapy) helps depression with little risk of inducing mania.

This ambiguity can be frustrating for people living with bipolar depression who just want to feel better, return to normal functioning, and avoid swinging into a manic episode. A consultation with one psychiatrist might lead to a recommendation of antidepressants, but a psychiatrist giving a second opinion might advise that antidepressants be strictly avoided. By informing yourself of the pros and cons, you can avoid feeling caught in the middle between the two sides of the bipolar depression antidepressant debate.

Do Antidepressants Help or Harm? The Advantages and Disadvantages of Antidepressant Treatment in Bipolar Disorder

Using antidepressants for bipolar depression treatment could produce a few different results:

  • Your depression might improve, but the medication might work too well, leading to a manic or hypomanic episode, or a mixed episode which means the return of depression symptoms
  • Your depression might stay the same, unaffected by the medication
  • Your depression might be unaffected and your mood might destabilize, causing mania, mixed episodes, and rapid cycling

Mental health professionals in favor of using antidepressants in helping people with bipolar depression believe that with continued use, antidepressants lower the risk of relapse. Symptoms will go away and stay away because of the way antidepressants work in the brain.

Those that oppose prescribing antidepressants to people fighting bipolar depression believe that antidepressants:

  • Destabilize mood, inducing manic or mixed episodes
  • When paired with a mood stabilizer as often done, are rendered ineffective because the combination of medications cancels each other out
  • Don’t work well on their own or with mood stabilizers

Who Should (and Shouldn’t) Use Antidepressants to Treat Bipolar Depression?

Sometimes people wonder if there are certain groups who should (or shouldn’t) take antidepressants when they have bipolar depression. Because there are so many individual differences and a variety of variables that apply, there isn’t a straightforward answer to this question. This checklist can help you and your doctor decide if antidepressants are a good idea:

  • Have you successfully used antidepressants for bipolar depression in the past?
  • Have you stopped taking antidepressants only to have your symptoms worsen?
  • Are your mood episodes confined to depression and mania/hypomania without mixed episodes and no instances of rapid cycling between mood episodes?

Generally, “yes” answers can indicate that antidepressants might be safe and effective in your bipolar depression treatment. “No” answers could caution against taking antidepressant medications.

If after careful consideration of your personal history and experience with bipolar disorder and treatment, you and your psychiatrist decide that antidepressants will be safe and effective in your treatment, consider these guidelines recommended by a variety of researchers and mental health professionals:

  • Avoid using antidepressants as your sole form of medication
  • Antidepressants should be paired with mood stabilizers or perhaps other medications such as antipsychotics or anticonvulsants

While it appears that there is more evidence against antidepressant use in bipolar depression than in favor of it, the jury is still out regarding the safety and effectiveness of antidepressants for bipolar depression treatment. Studies have been done, but more are needed. Currently, too little evidence is available to declare with certainty that antidepressants are safe or dangerous, effective or ineffective in treating the depression side of bipolar disorder.
 
Perhaps the best thing to do is to be informed and have open conversations with your doctor. Regardless of what prescription medication you take, know yourself and your symptoms, and alert your doctor when something isn’t right. This is a great way to be active in your treatment so you can manage bipolar depression, with or without antidepressants.

article references

APA Reference
Peterson, T. (2019, June 12). Are Antidepressants Safe and Effective in Bipolar Depression Treatment?, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/are-antidepressants-safe-and-effective-in-bipolar-depression-treatment

Last Updated: June 15, 2019

Bipolar Depression and Light Therapy: Does It Really Work?

Bipolar depression and light therapy are a combination that both mental health professionals and people living with bipolar depression have wondered about for some time. The idea is attractive. Imagine practicing some quiet, relaxing self-care by sitting comfortably in front of a light and almost effortlessly reducing depression. Does it sound too good to be true? Perhaps surprisingly, light therapy for bipolar depression just might be effective, giving you another tool to overcome depressive episodes in bipolar disorder.

Light therapy, also called bright light therapy, involves exposure to a bright, full-spectrum light with a UV filter. Often, people sit in front of a light box, but some people prefer to wear a light visor for mobility. Either way, taking in full-spectrum light can be helpful in reducing bipolar depression.

Despite the need for more studies (existing studies, while promising, are small and thus limited), the American Psychiatric Association has stated that in bipolar depression, bright light therapy is an acceptable alternative or addition to medication and psychotherapy (Nasr, et al., 2018). In order to benefit from light therapy as well as avoid harm, it’s important to know how to properly use it.

Light Therapy and Bipolar Depression: How to Use It and Recommendations

Perhaps because it’s considered to be a medical treatment, lightbox instructions are given in dosages. A dose of light therapy involves a few important factors:

  • The intensity of your light (measured in lux)
  • Your distance from the lightbox
  • Duration of your exposure

A common light therapy dose is between 5,000-7,000 lux for 15 to 60 minutes.  Other doses are used, too, because each person is different. Light intensity and duration of exposure vary greatly, as illustrated by these examples:

  • 400 lux for 2 hours per day
  • 2000 lux for 2 hours per day
  • 7000 lux for 45 to 60 minutes per day
  • 10,000 lux for 45 to 60 minutes per day

Higher doses of intensity or duration may bring greater risks. It’s recommended that people starting bright light therapy for bipolar depression consult with their doctor for guidance on a dose that’s both safe and effective.  Usually, people begin treatments with 15 minutes per day and work their way up to 60 minutes by 15-minute increments over the course of weeks.

Time of day is an important factor, too. The optimal time of day for bipolar depression and light therapy is around noon.

Effective distance and positioning is typically one foot away with your head at an approximately 45-degree angle to the light. It’s not necessary to stare directly into the light box. The light simply should enter your eyes at an angle between 30 and 60 degrees.

Benefits and Risks of Bright Light Therapy for Bipolar Depression

Thus far, researchers have observed more benefits to light therapy for bipolar depression than risks. Some observations in studies and by physicians using light therapy with patients include:

  • Bipolar depression remission; in one study (Watson, 2018), over two-thirds of participants experienced remission
  • Fairly quick response time; typically 4-6 weeks
  • Non-invasive
  • Minimal side effects

Such a positive response in a short time is a positive sign that light therapy can be effective in treating bipolar depression. Still, every treatment carries risks, and knowing the risks can help you make an informed decision about whether bright light therapy is right for you.

Side-effects that have been identified thus far include:

  • Headaches
  • Agitation
  • Eye strain
  • Menstrual irregularities (rare)
  • Insomnia (this is less of a problem when light therapy is done no later than noon)
  • Mania

Among the drawbacks of light therapy:

  • Lightboxes can be expensive and usually aren’t covered by insurance
  • It’s time-consuming
  • Relapse is likely after stopping

Of all side-effects and drawbacks, perhaps the biggest one is the risk of entering a manic episode. Because of this danger, it’s important to consult with your doctor before beginning. Make sure that light therapy is right for you and your unique experience with bipolar disorder. Continue to touch base with your doctor throughout the process so they can monitor how you’re doing and adjust your dose as needed.

Lightbox therapy for bipolar depression has the potential to help people resume living full lives. Indeed, “Evidence suggests that bright light therapy is an effective, well-tolerated, and affordable adjunct treatment for bipolar depression “(Nasr, 2018).

article references

APA Reference
Peterson, T. (2019, June 12). Bipolar Depression and Light Therapy: Does It Really Work?, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/bipolar-depression-and-light-therapy-does-it-really-work

Last Updated: June 15, 2019

Help for Bipolar Depression: Where to Find It

Getting help for bipolar depression can make a positive difference in the quality of life of anyone living with this often-debilitating disorder. Several different types of bipolar depression help and support are available, and what you choose will depend on such factors as current level of mood stability, the nature and intensity of your depression symptoms, the area of your life that’s being impacted the most (relationships, work or school performance, motivation, etc.), and any other concerns you have about what you’re experiencing. When you know you need bipolar treatment help, it can be daunting to know where to begin. Use this resource to learn what sources of help for bipolar depression are available and how to find them.

Types of Help for Bipolar Depression

Because the support you need varies over time, different types of facilities and organizations exist. In general, you might receive treatment or support in these settings:

  • Inpatient hospitals
  • Outpatient programs based in hospitals
  • Outpatient clinics
  • Private psychiatrists
  • Private mental health therapists
  • Mental health organizations in your community

Inpatient treatment involves overnight stays, usually so medication can be monitored closely and adjusted until an effective combination and dosage is determined. While hospital programs vary greatly, many offer individual and group therapy, exercise programs, and other positive treatment experiences in addition to stabilization with medication.

Outpatient programs, no matter where they’re located, provide a focused therapy experience. Many outpatient treatment programs run for several hours each day for a set number of days or weeks. Focus is on helping people develop ways to ensure they follow through with their treatment plan and take medication correctly as well as developing coping skills for dealing with bipolar depression.

Private care providers, like psychiatrists and therapists, have an office that you visit at intervals determined by you and your doctor or therapist.

Community-based organizations are mental health groups that provide information, referrals, classes, and support groups. These can be an excellent source for learning how to create a quality life with bipolar depression.

Numerous sources of help are available, but sometimes they’re hard to find when you’re in the throes of a depressive episode. This collection of resources can help you find what you need to move forward past bipolar depression.

Where to Find Help for Bipolar Depression

You can find information locally, in your community. Common places include:

  • Doctor’s offices and clinics
  • Hospitals
  • Community centers
  • Libraries
  • University or high school health centers

Online sources of help can be useful, too. These organizations have extensive resource pages that include links to more references, informative articles, and bipolar disorder treatment- and support group locators which allow you to search for bipolar depression help by zip code. Among the most reputable and helpful are:

A great source of bipolar depression help for children, teens, college students, and families are

Crisis lines are important to have on hand. If your bipolar depression ever makes you feel so hopeless that you consider harming yourself or taking your own life, these sources of bipolar depression help connect you with people who are there to listen, talk, and provide additional help.

Getting help for bipolar depression can help you not just survive the difficulties it creates but move past those difficulties and thrive. Use the above information to find people, programs, and support groups that fit you, then utilize the processes to start improving your life.

article references

APA Reference
Peterson, T. (2019, June 12). Help for Bipolar Depression: Where to Find It, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/help-for-bipolar-depression-where-to-find-it

Last Updated: June 15, 2019

Negative Habits and Depression

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Having depression can sometimes lead to developing negative habits as we try to cope. Often things that aren't necessarily wise or healthy feel good at the moment. Sometimes it's easier to do what is comfortable rather than that which requires work and sacrifice. Also, depression drains us of our energy, thus making it difficult to take even that first step towards building healthier habits. Does this mean we're stuck? No, we're not; we just need to identify our negative habits and work toward changing them into more positive coping skills.

Negative Habits We May Develop to Cope with Depression

  1. Spending an excessive amount of time online. The Internet can be positive. Obviously, I support Internet use since I'm here. The key word here, though, is positive. The other key word is limited. If we scroll through social media to avoid interacting with others or stay on our phones so much that we neglect things we need to do, such as cook, clean, or shower, then we've developed a negative habit. I realize it feels easy and comfortable at the time, but in the long run, zoning out with social media will only worsen our depression.
  2. Eating only junk food. In my opinion, a splurge or two every now and then on junk food is fine. On the other hand, if you find yourself eating empty calories and unhealthy foods every meal of every day, then you're harming both your body and your mind with a negative habit. I know. I've done this. It's an easy slope to slip on when you have depression. 
  3. Not getting physical activity. I know I feel better both physically and mentally when I take walks every day or almost every day. I find that I need to do it first thing in the morning before the day starts "happening" to me; however, this schedule sometimes gets messed up. Due to my depression, some mornings I wake up and struggle to get out of bed. I lie there too long, and time passes until I have to get up and wake my children. The day starts; I get too busy and make excuses as to why I can't fit my walk in. Once I miss a day, it's easier to miss more and more. A negative habit of inactivity has set in. 

How to Move Back Towards Healthier Habits 

  1. Limit your time online and avoid certain sites. Set a timer. Stay off websites and social media platforms that upset or anger you. Look for more positive sites and social media opportunities. If you're up for it, go out and spend time with friends -- without even looking at your phone. Find other things to do besides scrolling through your phone. You could read, write, paint, draw, garden, start a flower bed, or any other activity that appeals to you. Look, I know how easy it is to stay in the habit of being on your phone all day. I've been doing way too much of that lately myself. Depression makes things so much harder, but we don't have to continue in bad habits.
  2. Take small steps to eat healthier. Don't overwhelm yourself by trying to revamp your entire diet or by attempting to completely clean out your pantry and refrigerator. Change one or two things at a time. Get used to those changes and then make a couple more. Keep at this process, over time, as long as it takes. This is about taking care of ourselves and building healthy habits to help us cope with depression. It's not a race.
  3. Work in physical activity in a way that suits you. Once you've found a way, then stick to it. I'm speaking to myself here, too. I need to get up so I can get out and walk. That's what I enjoy. I love being in nature, so an outdoor walk is a wonderful way for me to be motivated (usually) to break the negative habit of inactivity. Figure out what type of physical movement you enjoy. You could set a goal of getting in that movement three days a week at first, and then you can add in more days as you feel up to it. There will be missed days sometimes, and we need to give ourselves grace when this happens. We have depression. Some days we just can't do it, and that's okay.

Watch this video to learn about some of the triggers that can cause us to turn to negative habits to cope with depression.

Treatment-Resistant Bipolar Depression: What Helps?

Treatment-resistant bipolar depression is the frustrating and exhausting experience of trying to treat and manage your symptoms but seeing no improvement. Depressive episodes of bipolar disorder can be hard to treat, even more so than episodes of mania (Poon, et al., 2015). Different doctors and researchers define this condition slightly differently. One common criterion for treatment resistance is the failure of lithium to improve symptoms. Another definition is that someone has tried two or more different medications without success. In either of these situations, someone is said to have treatment-resistant bipolar depression.

If your bipolar depression is unresponsive to treatment, you might not be concerned about the clinical definition of treatment resistance. You are likely more concerned with the fact that your symptoms aren’t decreasing because nothing you do to treat them helps.

There are approaches that help treatment-resistant bipolar depression. Keep reading to discover what can be done to overcome this exasperating condition.

Treatment-Resistant Bipolar Depression: Why Does It Happen?

Sometimes there are underlying reasons for depression that resists treatment. If you can identify one or more reasons treatment isn’t working, you can work to eliminate those obstacles.

Some common reasons that bipolar depression might not respond to treatment:

  • Taking medications for other illnesses
  • Drinking even small amounts of alcohol or using other substances, including marijuana
  • Frequently missing doses of prescribed medications
  • The presence of other conditions like hypothyroidism, anemia, sleep apnea, substance use disorders, and personality disorders
  • Poor sleep habits (different from insomnia, these are habits we control, such as staying up late watching TV, playing video games, or being on social media)

If any of these factors fit, talk with your doctor about what you’re experiencing. They’re not flaws; they’re just some things in your control that can help you improve your depression. Your doctor can help you identify ways to make changes to improve how your bipolar depression responds to treatment.

Another thing your doctor can help with is medication.

Helping Treatment-Resistant Bipolar Depression with Medication

Medication is the first line of defense in treating bipolar depression. Medication works because it directly treats the brain. Each person responds uniquely to various forms of medication, and finding the right prescription, whether it’s for one type of medication or a combination of medications, is a process that takes patience and time ("What Are the Best Medications, Treatments for Bipolar Depression?").

In some cases, standard bipolar medication doesn’t work; therefore, researchers are searching for other pharmaceutical options. Some medications under review for treatment-resistant bipolar depression include:

  • Glutamatergic agents that affect the neurotransmitter glutamate: ketamine, memantine
  • Psychostimulants: modafinil
  • Dopamine antagonists to enhance dopamine activity: pramipexole, ropinirole
  • Opioids: oxycodone

These may be used to replace certain medications or could be added as adjunct medications. If you don’t like the idea of medications that are newly being used for bipolar depression, or if your doctor doesn’t prescribe them, there are other options available to you.

Brain Stimulation for Treatment-Resistant Bipolar Depression

Treatments that directly stimulate the brain have been successful in helping people break through treatment resistance to overcome bipolar depression.

Many of these treatments are newer treatments for which studies are finding positive results. Brain stimulation treatments that you and your doctor might decide to try, if available in your area, include:

Simpler Options for Ending Treatment-Resistance in Bipolar Depression

While all the above methods can end treatment resistance in bipolar depression, there are other, simpler, things you can do. Regularly seeing a therapist will help you identify and change negative thoughts that are holding you back as well as build a collection of coping skills.

One of the most beneficial things you can do to overcome treatment-resistant bipolar depression is to maintain a healthy lifestyle: nutrition, exercise, proper sleep, and daily routines. Of course, establishing and maintaining a healthy lifestyle is difficult when you live with bipolar depression. That’s why having a therapist can be an asset. Therapists can help you create and follow a healthy routine to decrease depression.

Keep in mind, too, that treatment resistance isn’t treatment failure. Notice positive changes. Embrace even small improvements. An accumulation of tiny changes leads to the realization one day that your bipolar depression is no longer resistant to treatment; in fact, it might not be around at all.

article references

APA Reference
Peterson, T. (2019, June 12). Treatment-Resistant Bipolar Depression: What Helps?, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/treatment-resistant-bipolar-depression-what-helps

Last Updated: June 19, 2019

Bipolar Depression with Anxiety: What Treatments Work

Bipolar depression with anxiety is a common combination. About 75 percent of people with bipolar II disorder have at least one anxiety disorder (American Psychiatric Association, 2013). Anxiety disorders like generalized anxiety disorder (GAD), social anxiety disorder, and panic disorder are the most common disorders that occur alongside bipolar II disorder; further, symptoms of these anxiety disorders are more likely to flare during a period of bipolar depression than an episode of mania. Given that bipolar depression with anxiety occurs quite frequently, it’s important to know more about these conditions, how this combination can affect people, and what treatments work.  

Anxiety greatly influences someone’s experience with bipolar depression, including the symptoms they experience and how they respond to treatment. Both disorders worsen each other. Episodes of depression and anxiety are longer and more severe than when they occur on their own. The long-term outlook is worse, too, largely because it can be harder to treat comorbid anxiety and bipolar depression.

Bipolar Depression with Anxiety: Symptoms and Effects

Anxiety and bipolar depression bring out the worst in each other, making things very difficult if you are dealing with both conditions. As a result, you might experience symptoms like heightened worry and fear, anxiety attacks, and more severe depression.

These two co-occurring disorders create undesirable effects that interfere in life, such as:

  • Avoiding people, situations, and events that increase anxiety
  • Deepened depression due to isolation created by anxious avoidance
  • A dark view of the world because of depression’s negative thought patterns
  • Increased worry, fear, and agitation because of this dark worldview
  • Increased likelihood of substance abuse
  • Decreased quality of life
  • Suicidal ideation, action

Anxiety disorders are difficult to live with. So, too, is bipolar depression. Unfortunately, when they occur together, treatment is more difficult than it is for each one separately. While difficult, it’s not impossible. Treatment is available, and with patience, you can find the right approach for your bipolar depression with anxiety.  

Anxiety and Bipolar Depression: Treatment Options That Work

Each person dealing with bipolar depression and anxiety is unique. A treatment approach that works for one person might not work at all for another. While there isn’t a single treatment that works for everybody, there is something for almost everyone. It’s a matter of knowing and considering your options and working with your doctor to find the most effective approach to your mental health.

Effective treatment options for bipolar depression with anxiety include:

  • Medication, often a combination of different prescriptions
  • Individual therapy
  • Family therapy

Medication for Bipolar Depression with Anxiety

Medication is almost always the starting point. Your doctor might begin by prescribing a mood stabilizer. Next, they might prescribe an antidepressant to treat anxiety, although in bipolar disorder, antidepressants can trigger mania or induce a chronic state of depression. If you do use an antidepressant, your doctor will monitor you carefully and adjust your medications as needed.

As an alternative to antidepressants, your doctor may have you try benzodiazepines to treat your anxiety. Benzodiazepines don’t aggravate depression or mania, but they do carry the risk of tolerance and dependence. Finally, you might also receive a prescription for an atypical antipsychotic.

If one medication doesn’t work, you don’t have to feel defeated. Each class of medication used (from mood stabilizers to antipsychotics and everything in-between) has numerous medications within it. Finding the right combination is often a matter of trial and error.

You might want to talk to your doctor about side effects. Having both disorders can make you more sensitive to medication side effects, especially when the medication is new for you. Being aware and communicating with your doctor will help you find a medication that works without intolerable side effects.

Medication is almost always the first line of treatment for bipolar depression with anxiety. In addition to medication, therapy can be very effective in decreasing symptoms and improving lives.

Therapy for Anxiety and Bipolar Depression

Therapy, both individual and family, is helpful in bipolar depression and anxiety treatment. Individual therapy lets you address challenges and create coping skills. Family therapy does this, too, but it’s done as group therapy with the entire family present. Both help people improve the quality of their lives. Some types of therapy that have been shown to help include:

  • Cognitive behavior therapy
  • Relaxation training
  • Interpersonal and Social Rhythm Therapy (tracking activities, and creating stable, reliable routines)

Medication and therapy are effective treatment approaches for managing bipolar depression with anxiety. While finding the right treatment isn’t always a quick, easy process, it is possible to do so. You can minimize the effects of these disorders and live a quality life.

article references

APA Reference
Peterson, T. (2019, June 12). Bipolar Depression with Anxiety: What Treatments Work, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/bipolar-depression-with-anxiety-what-treatments-work

Last Updated: June 15, 2019

Bipolar Depression in Teens: How Parents Can Help

The idea of bipolar depression in teens often surprises people because bipolar disorder is frequently thought of as a mental disorder of adulthood. However, adolescents (and even children) can and do develop bipolar disorder, which includes bipolar depression.

The illness in adolescents can differ slightly from the illness in adults. Symptoms of bipolar depression in teens can be more intense and occur more frequently than adult symptoms; additionally, teenagers sometimes experience psychotic symptoms during both depressive and manic episodes, whereas adults who experience delusions and hallucinations do so in mania. These differences are due, at least partially, to the nature of adolescence.

Remembering teens’ developmental stages is helpful for parents, family members, and the adolescents themselves.  The adolescent brain is different from an adult’s brain. The brain continues to develop and change through the teen years. Further, their inner world is a sea of raging hormones, wreaking havoc on their emotions. The teen years also involve pulling away from parents and family to find a place among peers as well as to build independence. If bipolar depression sets in during the ups and downs and stress of growing up, the consequences can be crushing.

True to adolescence, teenagers sometimes resist help, especially from parents, even though bipolar depression in teens is treatable. Parents beware, too, that your son or daughter’s symptoms will likely be worse at home than when they’re out in the world. As exasperating as this can be, it’s a compliment. Home is a safe haven where they know they’re loved. They can stop hiding their symptoms when they’re home.

Let’s look at what bipolar depression is like for teens and how parents and family members can help.

Bipolar Depression in Teens: Symptoms

It can sometimes be hard to tell the difference between ordinary teen moodiness and what’s more serious, like bipolar depression. Further complicating the picture is the fact that sometimes depression in teens manifests more as irritability than sadness. If your teen is suddenly more irritable than usual, and is short-tempered for two weeks or longer, they might have bipolar depression. These are some other signs to watch for:

  • Frequent sadness and/or irritability
  • Becoming emotional quickly, including frequent crying
  • Sullenness
  • Problems with decision-making and concentration
  • Unusual fatigue
  • Lethargy, lack of motivation
  • Quitting activities once enjoyed
  • Drop in grades
  • Feeling worthless
  • Sleeping too much or too little
  • Eating too much or too little
  • Preoccupation with death, talk of suicide or wanting to go away and stop being a burden

Bipolar depression in teens can make them feel removed from life. This, of course, perpetuates the depression. It’s possible to disrupt that vicious circle. Here are some ways to help your teen recover.

How Parents Can Help a Teen with Bipolar Depression

Your teen can break free from bipolar depression, and you can help with the process. Family involvement is one of the treatments, along with medication and individual therapy, that has been shown to improve bipolar depression. Your chances of success will likely be higher when you remember the unique developmental stage of adolescence mentioned above.

While doing so might be challenging because of bipolar depression symptoms, sit with your teen and create a plan. Establish some ground rules together before jumping into discussions about treating and managing depression. Perhaps you might agree that you won’t treat your teen like a child or try to control them, and they promise not to shut you out or argue. Create ground rules that are important to you, your teen, and the rest of the family.

Other approaches that many families with a teen struggling with bipolar depression have found helpful include:

  • Keeping stress levels low at home (de-clutter, solve problems respectfully, keep noise levels down, etc.)
  • Creating a routine to increase stability and reduce feelings of unpredictability and chaos
  • Helping your teen track symptoms because when they can spot patterns and triggers, they can start to use coping skills right away to keep bipolar depression to a minimum
  • Developing coping skills
  • Maintaining open communication by giving everyone a chance to be heard and to listen nonjudgmentally
  • Helping your teen identify and describe feelings
  • Talking with your teen to help them separate themselves from the illness
  • Choosing your battles and concentrating on issues that are important to the family while letting other, less important, concepts go
  • Establishing a healthy lifestyle for the whole family: exercise, nutrition, hobbies, and fun

Bipolar depression in teens can be challenging for everyone. With support, your teen has an excellent chance of dealing with it effectively and once again embracing life.

article references

APA Reference
Peterson, T. (2019, June 12). Bipolar Depression in Teens: How Parents Can Help, HealthyPlace. Retrieved on 2019, June 26 from https://www.healthyplace.com/bipolar-disorder/bipolar-depression/bipolar-depression-in-teens-how-parents-can-help

Last Updated: June 15, 2019

Setting Healthy Boundaries After an Abusive Relationship

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Setting healthy boundaries now that my abusive relationship has ended is one of the most difficult things I’ve had to figure out recently. 

It took me a long time to realize how my ex-boyfriend had dismantled the boundaries I did have. He was able to use to his advantage the confusing misconceptions I had adopted about boundaries.

What Are Healthy Boundaries?

Healthy boundaries show our standards for what treatment we expect from others and the behavior that we will not tolerate because it violates our human rights.

For example, healthy boundaries can include the rights to make independent decisions; to have our own thoughts, ideas, desires, and emotions and the freedom to express them; to choose with whom to spend time, how to spend it, and whether to say yes or no; to be treated with dignity and respect.

In a way, if you think about it, the concept behind what constitutes “boundaries” is inalienable. We are all born with inherent personhood worthy of these things.

And yet the idea that healthy boundaries are a concrete thing is not inherent, but culturally ingrained. We grow up learning from the people around us that boundaries are something we have to build and fight for.

We also learn what is okay and what isn’t based on what others tell us we should accept and what we observe. Our own interpretations of what boundaries are, even when we think we have developed healthy boundaries, can help an emotional abuser manipulate us. 

What Healthy Boundaries Are Not

Some people who get into relationships disrespect boundaries on purpose. They may do it overtly through verbal abuse to try to wear down your self-esteem, or they may try to manipulate you into believing you are wrong for having boundaries, or both. 

Before I entered my abusive relationship, I had boundaries, but I also lived in a cultural environment just like everyone else. I hadn’t thought about what healthy boundaries were and I had soaked up some confusing and contradictory ideas about boundaries.  

My ex-boyfriend was both overtly abusive and used verbal abuse and manipulation. Confusion about boundaries made it easy for my boyfriend to bend them around the edges and exploit me in other ways. 

These are some of the falsehoods about boundaries that my ex-boyfriend was able to use to put doubt in my mind about setting and defending boundaries. 

  1. “Boundaries are selfish.”  Having the confidence to set healthy boundaries for yourself is not arrogant or self-absorbed. Setting limits and avoiding things that subvert your human rights only steps on the toes of people who were trying to overstep in the first place. It does not suppress the rights of others. 
  2. “Boundaries are walls.” Healthy boundaries don’t mean you have to stop trusting people or that you’re not a forgiving person. It just means you don’t freely give trust and forgiveness away and they aren’t automatically granted. You’re not “hard” or jaded if you set boundaries and they don’t make you bitter or unavailable. 
  3. “Boundaries are punishments.”  Boundaries are not about getting back at anyone. They are the inverse of punishing—they are about showing respect for myself and others by being assertive. By being straightforward about what I want, I am relieving the other person of the burden to read my mind and freeing myself of resentment.
  4. “Boundaries are about control.” Avoiding things that subvert your human rights is not about teaching other people a lesson. You are only stepping on the toes of people who were trying to overstep in the first place. Setting limits does not suppress the rights of others.
  5. “Only jerks set boundaries.” It’s not outside the boundaries of your sex or gender role to set healthy boundaries. A partner may convince you that you’re not being ladylike or you’re being a misogynist, or something or other. 

If a partner has attempted to make you believe that you are using boundaries in any of these ways or that you are wrong for using boundaries, then you are being manipulated.

Setting Healthy Boundaries After an Abusive Relationship Ends

Even if you had strong boundaries or you thought you knew what healthy boundaries were, after a verbally abusive relationship ends, it can be difficult to rebuild your boundaries due to the doubt an abusive person may have caused you to have about what is appropriate in a relationship if you love someone.

Verbal and emotional abusers seem to hide these truths about boundaries from us by making us give up more and more to get less and less. They cause us slowly over time to believe that the reason the relationship is "not working out" is because we are not doing enough and we slowly lose sight of ourselves and who we used to be.

Re-setting our boundaries involves remembering our core values:

  1. Understand what healthy boundaries are and what they are not. Become aware of any lies the abuser may have tried to make you believe about standing up for yourself.
  2. Decide what your "bare minimum" boundaries are. You are starting over again. Decide what your basic rights are that you will not and should not tolerate. These things are not others "being nice," but things that should be standard in the ways that people treat you. These are your rules for interaction with others.
  3. Once you have determined the "bare minimum" boundaries, think through more complicated boundaries you will have. For example, think through how you will observe when the bare minimum boundaries are being violated. What will you see from others and how will it make you feel?  
  4. Envision what a boundary violation would look like. Imagine a scenario where you remember someone violating your boundary in the past and how it made you feel. It's likely to happen again, so becoming aware of the discomfort and how it sits in your body can help prepare you. 
  5. Decide what you will do when your new healthy boundaries are violated. What are some of the things you would say?  How could you say no or speak up for yourself in a way that you would feel good about yourself and feel that you had protected your boundary?
  6. Practice enforcing your boundaries with people you know.  Assuming most people you know are not people who are out to exploit you, but who will still occasionally ask you to do things you don't want to do, practice your new skill.
  7. Avoid entering into any new relationships until you feel confident that you will be able to maintain your healthy boundaries. A manipulative person can wear down even the most ironclad of boundaries, however, if you enter a relationship with open eyes and the confidence that stronger boundaries can bring you, you may be more aware of any warning signs from a person who doesn't respect those boundaries. 

What healthy boundaries are really about is being assertive, knowing yourself, and being able to stand firm in those two things.

Defending Boundaries and Red Flags After a Verbally Abusive Relationship

Why is it so difficult to defend boundaries? How do we know we've encountered a red flag? Watch this video to hear about what I've learned about defending boundaries in the aftermath of my abusive relationship.

When You Have ADHD, Boredom Is Painful

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Attention-deficit/hyperactivity disorder (ADHD) can often lead to boredom. It can also result in discovering exciting methods to counter that discontent. In certain ways, I get bored less often than friends who do not have the condition, and what someone considers uninteresting is entirely subjective. Still, it appears I am not alone when it comes to ADHDers who absolutely despise being bored.

Boredom Is Very Uncomfortable for ADHDers

It can be hard to explain to others how excruciating boredom can feel. I was often baffled by those who refer to a job as “pretty boring” but still tolerable. A tedious job terrifies me (at least if it lasts a long time). ADHD coach Andrew Lewis puts it well when he compares ADHD boredom to physical pain.1 I have indeed been bored to tears.

Part of this frustration is how people respond. One therapist advised me that work is not fun, and we all have to do things we do not find “fun” to survive. At the time, neither of us thought I had ADHD. He was not exactly wrong, but his advice did not help me in the slightest. I found it incredibly disheartening. It made me feel that all I had to look forward to was a career doing something I hated or, more likely, moving from one unfulfilling job to another. Even wonderful jobs would eventually become intolerable.

ADHD and an Interest-Based Nervous System

Lewis notes that ADHD brains have trouble regulating dopamine, neurotransmitters “responsible for our feelings of reward, interest, and stimulation.”1 It is likely one reason ADHDers are prone to addiction. We must seek stimulation that our brain has issues processing. Interestingly, a stimulated brain also helps our self-control and ability to tolerate boredom, so engaging our brain by doing something enjoyable can actually help us complete banal tasks.

I was shocked when I first realized that many people prioritize projects based on importance (to them and others), rewards, and punishments. ADHDers tend to prioritize based on urgency, novelty, challenge, and personal interest.2 It is not that we lack attention, it is that we struggle to direct our attention at will. It can feel almost physically impossible to something I want or need to do if I find it horribly boring. 

How to Cope with ADHD Boredom

ADHDers, including myself, develop many strategies to avoid being bored. (Not all of those coping methods are feasible or even safe.) When young, I would read cereal boxes, calculate serving sizes, and count things to keep my mind occupied. I also composed stories, made up television episodes, or went over favorite movies in my head.

Sometimes, staving off boredom involves taking breaks and slowing down. I am experimenting with working on projects for longer blocks of time while still breaking up those blocks in order to relax and reset. Checking in on your physical and mental health is also crucial. This might include taking a few minutes to meditate, exercise, and making sure to eat and drink. Counterintuitively, pausing when I want to speed up helps me feel more balanced and less restless.

Taking the right medication, creating something (writing, drawing, singing, etc.), and consciously doing things you enjoy, like reading or dancing, can also ignite those sparks that help with self-control and diminish boredom. Other tips include spending time outside, talking with friends, or trying something new and a little frightening.3

Do you have ADHD and feel the same way about being bored? If so, what challenges do you face and how do you deal with them? Let me know in the comments, and thank you for reading.

Sources

  1. Lewis, A., "I'm bored." SimplyWellBeing, Feb. 2017.
  2. Dodson, W., "Secrets of Your ADHD Brain." ADDitude, Summer 2013.
  3. Sinfield, J., "The Link Between ADHD and Boredom." Verywell Mind, Oct. 2018.