Research into new treatments for bipolar disorder include magnetic therapy, rTMS, and the Step-BD program to determine the best treatment practices for bipolar disorder.

Gold Standard for Treating Bipolar Disorder (part 21)

Magnetic Therapy: A new treatment called Repetitive Transcranial Magnetic Stimulation (rTMS) uses powerful electro-magnets put next to the frontal part of the skull to change underlying brain activity. This change in metabolic activity has been shown to alter mood. This magnet therapy has helped some people with bipolar disorder with few reported side-effects. This is a new technique and will need more studies to determine its efficacy and safety. 

Step- BD: The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is a large, national research program to determine the best treatment practices for bipolar disorder. This study, which began in 1998 and concluded in September 2005, included a total of 4,360 participants with bipolar disorder who were followed long-term to determine which treatment(s), or combination of treatments are most effective for treating the episodes of depression and mania in bipolar disorder and for preventing recurrence. The results are pending.

next: What are Some of the Bipolar Disorder Treatment Challenges? (part 22)

ECT is an effective procedure for treating severe mania as well as serious depression. Learn how ECT works and the side-effects of ECT.

Gold Standard for Treating Bipolar Disorder (part 20)

If you have exhausted the more traditional bipolar disorder treatments, there are alternative treatments that may offer some relief.

ECT (Electroconvulsive Therapy)

Before you read the following section, you may need to let go of the overwhelmingly negative portrayal of ECT seen in movies or sensationalized in books. In reality, ECT is a proven and often used treatment for serious depression and manic episodes as well as for bipolar disorder that has not responded to the more traditional treatments. ECT is a procedure where a short application of electric current to the brain induces a seizure. The patient awakens minutes later, does not remember the treatment or events surrounding the treatment, and is often confused. Some statistics state that this confusion typically lasts for only a short period of time while others show that some people given ECT have persistent short-term memory loss.

How Does ECT Work and What are the Concerns?

It's thought that ECT and antidepressants work in the same way. Antidepressants normalize neurotransmitters and ECT does the same, but much quicker. In terms of safety, ECT is considered very safe by many in the medical community, while others consider ECT treatment very risky because of the chance of severe memory loss (though this is rare). This does not mean that ECT is necessarily dangerous or should not be used. It means that if you're considering ECT, you should carefully read all that you can and know the benefits as well as the risks. Recent research suggests that ECT along with certain drugs may be effective for treatment-resistant bipolar disorder depression. ECT is certainly a treatment to explore with an ECT specialist if you feel you've exhausted all of your options.

What is Vagus Nerve Stimulation?

Vagus nerve stimulation (VNS) was originally used for hard to treat epilepsy. In 2005, the FDA approved a VNS device to treat adult patients with long-term or recurrent major depression that has not had an adequate response to four or more adequate antidepressant treatments and/or ECT treatment regimes. At this time, there is no FDA approval for use as a bipolar disorder treatment. As with any treatment, researching the procedure and then talking with a healthcare professional is your best option.

next: Current Research (part 21)

There's still a lot of stigma associated with going to a psychiatric hospital, but if you are severely manic or depressed, it can save your life.

Gold Standard for Treating Bipolar Disorder (part 19)

It's very common for people with bipolar disorder to spend time in the hospital. This is especially true of people with Bipolar I who have significant problems with full blown mania. Despite the lifesaving benefits, hospitalization for bipolar disorder is often seen as something to be ashamed of. It may be kept secret and the wards in the hospitals are often unmarked. And yet, for many people, the hospital is one of the safest and more effective ways to treat a serious bipolar disorder mood swing.

Hospitals save lives, especially for suicidal or severely manic patients. If you can see the hospital as a safe place that helped you get better, your outlook can hopefully change to one of thankfulness instead of resentment. Of course, there can be complications. Many people who were too sick to remember why they originally went into the hospital may be very resentful if they were strapped down or committed unwillingly, even when the evidence shows that the hospital saves lives. If you had this experience, you can ask yourself, "If I didn't go into the hospital then, where would I be now?"

If you just got home from the hospital, especially if you tried to commit suicide or had a severe manic/psychotic episode, it's very important to remember that it can take up to a year to recover from a major bipolar disorder episode that required hospitalization. Things can and do get better, but hospital stays are a sign that your mood swings were severe and it may take a considerable time for you to become more stable. You will need to give yourself time to heal.

next: What if I Need More Help? (part 20)

Discover the types of therapy that work for bipolar disorder and what makes a good bipolar disorder therapist.

Gold Standard for Treating Bipolar Disorder (part 18)

Psychotherapy can play an integral role in any bipolar disorder treatment plan. When considering therapy, it's important that you know the specific types of therapy that have been shown to have success in treating bipolar disorder. Unlike with depression, psychotherapy alone does not have a good track record in treating the illness, but as an addition to your medication and other comprehensive treatments, it can be invaluable.

What Kind of Therapy Works for Bipolar Disorder?

All therapy is not created equally, so it's important that you know the statistics on what has proven the most effective treatment for bipolar disorder. When you look for a therapist, you can ask if they have experience in one or more of the following therapies:

1. Individual or family psycho-educational therapy: This therapy educates the patient and his or her family members regarding the basics of bipolar disorder treatment and prevention. This is especially helpful as family members can often see the signs of a mood swing before the person with bipolar disorder is aware that it's starting.

2. Interpersonal and Social Rhythm Therapy: This family therapy approach helps the patient and his or her family members communicate more effectively through conflict resolution and problem solving skills. It's thought that involving family members in therapy is often more effective than seeing a patient alone. This approach to therapy also emphasizes lifestyle management issues.

3. Cognitive therapy: This therapy helps a patient recognize and respond to the unreasonable, painful and often out-of-control bipolar disorder thoughts. When the patient experiences the thought, he or she is taught to realistically examine the thought and whether it's valid. The patient can then substitute the unreasonable thoughts with more realistic and reasonable thoughts.

What Should I Look for In a Bipolar Disorder Therapist?

Many therapists offer support and help to people with bipolar disorder. Simply being able to talk with a sympathetic listener can make a large difference in your mood and outlook on life. Knowing that there is a safe place for you to talk, cry, get angry and ultimately work together to manage the illness can be a comfort for many people with bipolar disorder.

Therapy can play an essential role in your bipolar disorder treatment plan. It can often feel like there is no one to talk to when you're sick. A therapist can often be there to help you deal with the emotions caused by bipolar disorder and then work with you to find ways to minimize mood swings.

Practicing lifestyle changes and watching for thoughts that can make the illness spiral out of control will help you mange the illness more successfully. When combined with medications and psychotherapy, your chances of truly reducing symptoms and leading a more stable life are increased significantly.

next: Do I Need to Go to the Hospital? (part 19)

How to cope with those scary and dangerous thoughts that are part of bipolar disorder PLUS what to do about suicidal thoughts (thoughts of suicide).

Gold Standard for Treating Bipolar Disorder (part 17)

Bipolar disorder creates some terrible, scary and often dangerous thoughts. The first thing to remember when you experience these thoughts is that they are a normal part of this illness. People with bipolar disorder all over the world have similar thoughts. Once you recognize the specific thoughts you have when you're ill, you can remember them, realize it's bipolar disorder speaking and then counteract them with realistic thoughts.

This can be very hard to do at first, especially if these thoughts have been in your life for years, but a change can be made. For example, if you have the thought, "I have no friends. I'll be lonely forever.' You can do the following: remind yourself that you may feel this way when you're depressed as it's a normal part of depression. You can then look at the thought realistically and break the hold the thought has on your brain. You can say to yourself:

"Wait a minute. I have friends and I have always had friends. And truthfully, there is no way that I will be alone forever. If I make even just a few changes in my life by taking meds and doing what I can to deal with the depression naturally, there is a good chance I can get better and make more friends. I will not listen to this thought. I will keep trying to manage depression."

You can then get on with your day. And when the next mood swing starts, you can do the same technique. This may sound simplistic, but it works.

What if I Have Suicidal Thoughts?

Suicidal thoughts are scary and overwhelming, but they are a normal part of bipolar disorder. It helps if you can see suicidal thoughts as a sign that you want to end the pain caused by bipolar disorder mood swings-not that you want to end your life. Treating bipolar disorder more effectively and comprehensively can reduce suicidal thoughts significantly. There are two kinds of suicidal thoughts:

The first are passive thoughts. These include thoughts such as, I wish I were dead. Things would be better if I were dead. What is the point to my life? I wish I could just walk in front of that bus and die. These thoughts express a wish to die but not a personal method.

Though passive suicidal thoughts must be addressed and talked about with a healthcare professional, they are not as severe as the active suicidal thoughts that come with a specific plan for suicide. Active suicidal thoughts are dangerous and need immediate and professional attention. They include thoughts such as I'm going to kill myself tomorrow. I'm going to buy a gun. There is no point to life. I'm going to end it now. It really can't be said enough that active suicidal thoughts must be taken very, very seriously and treated immediately. It helps to somehow remind yourself, even when the thoughts are at their most desperate and you really do feel it would be much better if you were dead, that it's bipolar disorder talking. Talk to someone and treat your thoughts as a sign of an illness.

If you had serious pneumonia and were scared you were going to die, you would get help. You need to do the same for suicidal thoughts. Call your doctor, ask for help and take care of yourself. You can prevent yourself from killing yourself by having a plan in place that you create now that can be used as soon as you have the first thoughts of suicide.

next: Do I Need a Therapist? (part 18)

A list of bipolar triggers and how triggers affect mood stability associated with bipolar disorder.

Gold Standard for Treating Bipolar Disorder (part 16)

Bipolar triggers are behaviors and outside events that lead to bipolar disorder symptoms. As you probably know from experience, these triggers can be positive or negative. You often have control of them, but some are just part of everyday life.

The more you control your bipolar triggers, the greater chance you have of finding stability. This can lead to a significant reduction in medications as well as more of an ability to work and maintain stable relationships. It can't be stressed enough that triggers are the main environmental cause of bipolar disorder mood swings and must be monitored and reduced as much as possible. You can note all triggers on your mood swing chart as related to a particular mood swing.

Triggers come in many forms- from the positive, such as:

• a new relationship
• the birth of a child
• a promotion at work
• graduating from college
• an exciting vacation

to the negative:

• sleep changes due to work schedules
• troublesome relationships
• a death in the family
• or most significantly, drug and alcohol abuse. Of all of the triggers, these two are the most detrimental.

Common Bipolar Disorder Triggers

• Alcohol and drug abuse
• Argumentative, negative and aggressive people (if this describes you, reducing your bipolar disorder symptoms can help with the problem)
• Stressful work- especially work with constantly changing hours
• Travel - especially travel with time zone changes
• Relationship problems
• Non-supportive family members and friends
• Excessive media exposure to stressful world events
• Social isolation
• Medication side-effects

You can create your own list once you monitor your mood swings more carefully. If you continually walk into the triggers you know affect bipolar disorder, success in managing and hopefully ending symptoms is less likely than if you avoid the triggers, no matter how difficult this may be. Think of one thing from the above list that you can change today. Or maybe you have one of your own that you have wanted to avoid. You do have choices when it comes to ending mood swings. Looking for, and managing the triggers that cause stress and unhappiness, can significantly reduce your symptoms. This an especially powerful tool if you currently get less than optimal relief from medications.

next: My Thoughts are Terrible. What Can I Do? (part 17)

Be careful! For people with bipolar disorder, too much bright light exposure can induce mania and rapid-cycling.

Gold Standard for Treating Bipolar Disorder (part 15)

As with many questions regarding bipolar disorder, the answer can be complicated. Bright light exposure can be helpful or harmful. When bright light hits the retina, it activates a nerve pathway, the retinal-hypothalamic nerve, which goes to the hypothalamus, a brain structure that significantly influences mood states, sleep cycles, appetite, and sex drive. In other words, bright light exposure, like deep sleep, helps regulate brain chemicals for optimum stability.

On the other hand, too much light can stimulate mania and rapid-cycling. Because of this dual action, hospitalizations for mania peak in the summer while those for depression peak in the later fall or winter. People with full-blown mania have to be especially careful as the weather changes from winter to spring.

One point to keep in mind: fresh air alone can help a person with depression feel better.

next: What are Triggers and How Do They Affect Bipolar Disorder? (part 16)

For people with bipolar disorder, exercise can help manage moods, possibly reduce the amount of medications you need and end social isolation.

Gold Standard for Treating Bipolar Disorder (part 14)

The most important fact to know about exercise and bipolar disorder is that regular exercise can change brain chemicals. This means that there is a direct correlation between how much exercise you get and how many mood swings you have. Technically, even something as easy and inexpensive as walking can increase serotonin, the neurotransmitter that affects moods, release endorphins and improve your physical health so that your body is better able to deal with medications side-effects. For some people, regular exercise can significantly change the amount of medications needed to manage the illness by either reducing doses or eliminating the need for medications such as anti-anxiety medications. Because of all of this, it's important not to take exercise lightly. For example, you may think that walking twenty minutes a day could not possibly help with severe depression, but well-documented research shows that it can.

What if I Feel Too Sick to Exercise?

As anyone with bipolar disorder knows, the illness can feel so debilitating that any extra effort feels impossible. The important thing to realize is that feeling that something is impossible is not the same thing as something being truly impossible. Just as mania makes you feel you can do anything (and that you may even hurt yourself trying), depression makes you feel you can't do anything. You will have to override these feelings to get started in order to reap the benefits of exercise. The first step is deciding you want to get better, even when depression is telling you that you that you can't.

Exercise Can End Social Isolation

Many people with depression tend to isolate themselves from the world. This is a problem as isolation can dramatically increase depression symptoms. Exercising with a partner or group can positively impact your depression by getting you out in public where there is light, fresh air and positive company. It helps if you create a particular time to either walk with someone or attend a class. When someone else is depending on you to meet them, this increases your chances of making the appointment.

As with anything you do when you're depressed, it's important to remember that you probably may not want to see people when you're sick. If you wanted to get out and be with people and have fun, you wouldn't be depressed! The fact is that when isolation is caused by depression, it's up to you to break the cycle and force yourself to take action no matter how you feel. The only way to get better is to work at it and exercising with a partner or group is an excellent way to start. Remember, you don't have to want to do it. You just have to do it. You can then praise yourself and focus on the rewards the next time you have to go out.

next: Is Bright Light Exposure Good For Bipolar Disorder? (part 15)

Alcohol, drugs, certain foods, caffeine can all have a negative impact on your bipolar disorder symptoms.

What you put in your body whether it be food, caffeine, alcohol or street drugs can strongly and negatively affect your bipolar disorder symptoms. Changes in blood sugar due to a diet of highly processed foods, such as white sugar and white flour, can affect your daily stability. Coffee, often seen as a treatment for low energy depression, can significantly increase anxiety and lead to sleep problems. Think carefully of what you eat and drink and then monitor how certain things affect your moods. It must be stressed that caffeine is one of the major causes of anxiety and agitation. Try to limit caffeine to less than 250 mg a day. A cup of coffee has 125 mg. For some people though, even decaffeinated coffee is too strong and coffee may have to be stopped completely.

Can I Use Marijuana and Alcohol to Calm Down?

Here are the facts. Pot and alcohol seem to help bipolar disorder symptoms for some people. They can be perceived as calming and harmless, but there is one significant way that pot and alcohol negatively impact bipolar disorder: they affect deep sleep. As you read previously, structured sleep is essential for mood management. Pot and alcohol may put you to sleep to the point of passing out, but it's not deep sleep. Anyone who uses these substances in this way knows that no amount of pot or alcohol can actually end or even greatly improve bipolar disorder symptoms. Alcohol is ultimately a depressant and pot can numb a person to a point where they cannot participate fully in life. In a perfect world, simply stopping alcohol and drugs is, of course, the optimum way to help manage bipolar disorder. There are also relationship and work problems that can be caused by alcohol and pot use. This then leads to more bipolar disorder symptoms and a vicious circle begins.

What If I Have a Problem with Substance Abuse?

Drug and alcohol abuse is a very common problem for people with bipolar disorder and yet drugs and alcohol are two of the most detrimental substances you can put in the body. There is no doubt that it will be very difficult to treat bipolar disorder successfully if you have a substance abuse problem, but changes will have to be made. If you're looking for help on this website, there is a good chance you can then look for help with any substance abuse problem you have. Don't take substance abuse lightly. Get help so that you can more effectively manage bipolar disorder.

next: Does Exercise Really Make a Difference? (part 14)

Controlling and monitoring your sleep is one of the best ways to manage mood swings associated with bipolar disorder.

Gold Standard for Treating Bipolar Disorder (part 12)

Bipolar disorder is an illness that can respond greatly to lifestyle and behavioral changes. A person with bipolar disorder who knows how to make the choices that lead to fewer mood swings has a much better chance of finding stability. There are a variety of areas where mood swings can be significantly lessened. How you monitor and control your sleep, diet, exercise and bright light exposure as well as how you recognize and modify your bipolar disorder triggers can significantly reduce your bipolar disorder symptoms. This can lead to a much higher quality of life and often makes it possible for you to take lower doses of your medications and even get off of some altogether.

Does Regulated Sleep Really Matter?

Of all of the lifestyle choices you can use to manage bipolar disorder more successfully, sleep is the one of the most important. Sleep is also one of the best indicators that a mood swing is starting, especially regarding mania. (Less sleep is often an indicator that a manic cycle is underway. Excessive sleep can be a sign of depression.) Sleep patterns can also let you know if a medication is not the best fit for you.

By finding an optimal sleep schedule, sticking to it and watching for the first signs that your sleep patterns are changing, you can significantly increase your chances of remaining stable.

Can I Use Sleep Patterns as a Diagnostic Tool?

When sleep patterns change dramatically without any outside causes, such as jet lag, you must always ask yourself some important questions from the beginning: sleep can provide so many clues to how well bipolar disorder is being managed as well as let you know when mood swings are starting.

• Am I sleeping less and yet feeling more energy? (check for mania symptoms)
• Am I sleeping all day and still feel tired? ( check for depression or medication side-effects)
• Have I stayed up all night and am still able to function without being tired the next day? (check for mania or medications side-effects)
• Have I had trouble sleeping due to agitation and anxiety? (check for depression and mania or medication side-effects)

There are also certain situations you will need to avoid if they adversely affect your sleep patterns.

• Shift work
• Travel to different time zones
• Arguments later in the day that will disrupt sleep
• Staying up all night on a project
• Partying

The world has become a very busy place and it can be very difficult to reach the goal of getting regular and sufficient sleep. People with bipolar disorder will have to work extra hard to reach this goal as sleep is one of the most important parts of managing bipolar disorder successfully.

next: Does My Diet Have Anything to Do with Bipolar Disorder? (part 13)