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Nichole Davis
English 2010
Professor Tyler
2/21/16
Bi-Polar Treatments
Many individuals will suffer with a mild form of depression at some point during their life, while
others suffer with extreme forms of depression called bi-polar. The National Institute of Mental
Health website describes the disorder as:
Bi-polar disorder, also known as manic-depressive illness, is a brain disorder that causes
unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day
tasks. Symptoms of bi-polar disorder are severe. They are different from the normal ups
and downs that everyone goes through from time to time. Bi-polar disorder symptoms
can result in damaged relationships, poor job or school performance, and even suicide.
But bipolar disorder can be treated, and people with this illness can lead full and
productive lives (Bipolar Disorder).
Exactly how many individuals suffering with bi-polar is unknown, but according to the National
Alliance of Mental Illness, it is estimated that approximately 2.6 percent of American adults, that
is 6.1 million people, will suffer with bi-polar at some point in their lives (Duckworth). Because
so many individuals suffer with bi-polar disorder, there is continually new information and
ongoing research to find a more effective way of treating the disorder in the hope that one day,
there could be a cure.

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The treatment of bi-polar disorder has a long and varied history, ranging from
medications, to therapy, to the more extreme treatments such as shock therapy. The purpose of
this paper is to detail the major treatments of bipolar disorder and to show how those who are
affected by it can receive treatment in order to live a better life.
To fully understand bi-polar disorder, one must know that the disorder is not a one size
fits all illness, but one which there are different versions of the disorder itself, each requiring
different methodology of treatments. Doctors and Phycologist use the DSM-5, which serves as
the universal authority for psychiatric diagnosis. The DSM-5 helps to classify and diagnose
mental health disorders.
According to the DSM-5, there are seven diagnostic groups for bi-polar disorder, these
include: 1) Bi-polar I disorder, which is at least one manic or depressive episode. 2) Bi-polar II
disorder, which is listed to be least one hypomanic episode plus at least one major depressive
episode (both ups and downs). 3) Cyclothymic disorder, which has repeated mood swings, but is
not severe enough to be a major depressive episode or manic episode. 4) Substance or
medication induced bipolar is stated to be a related disorder, and has to do with alcohol or other
substances (intoxication or withdrawals). 5) Bi-polar and related disorders may sometimes
present due to another medical condition. This instance may vary depending on medical or
neurological conditions which might produce manic or hypomanic episodes. 6) Other specified
bipolar and related disorders and unspecified bipolar and related disorders involves a diagnosis
in one of these categories when a patient has bipolar symptoms that do not meet the criteria for
the bipolar diagnoses as the others would provide. 7) Lastly, the DSM-5 also states that some
individuals may experience a type of rapid cycling bi-polar disorder, where within a one year
time frame, the patient has had at least four episodes or in any combination thereof (123-165).

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Now that we have discussed the various forms of bi-polar disorder, this next section
intends to show there are multiple forms of treatment available to combat the disruptions that
those with bipolar face. One of the most common forms of treatment is via drug use, both in
legal prescribed form and conversely, through illicit drug use.
Some patients, either due to lack of access to proper medical treatment, or by their own
choice, turn to illegal drug use as a form of treatment. Dr. Sherrie McGregor, an expert in
substance abuse and bipolar disorder, believes the individuals who are diagnosed with bi-polar
disorder should also be screened for drug addiction; as many individuals will often present a dual
diagnosis. McGregor also states that individuals suffering with bi-polar disorder who choose
illicit drugs in order to self-regulate due to the chaotic and uncomfortable mood swings
associated with the disorder, can often time exacerbate the illness (McGregor).
Patients with bipolar disorder have high rates of psychiatric, medical and substance abuse
disorders, which contribute to a reduced life expectancy, and lower quality of life. According to a
study done by the Stanley Foundation Bipolar Treatment Outcome Network, Department of
Psychiatry, University of Cincinnati College of Medicine, 65% of individuals meeting the DSM5 definition of bi-polar disorder also suffered with at least one other mental disorder including:
anxiety, eating disorders and substance abuse (McElroy et al., Altshuler, Suppes). Another study
that was completed by Frederick Cassidy, Eileen Ahearn, and Bernard Carroll on substance
abuse in bi-polar disorder found that 43.9 % of individuals suffering with bi-polar disorder also
suffered with drug and or alcohol addiction for most of their life. The study also revealed that it
was more common for men to abuse drugs and alcohol than women. However, regardless of
gender, drug and alcohol abuse declined as an individual aged (Cassidy, Ahearn and Carroll 181).

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While some individuals turn to drugs or alcohol, others find another way to treat
themselves. The legal forms of therapeutic drug treatment involve a basic protocol as described
in the DSM-5. It states that when a depressive episode occurs in a patient with bipolar disorder,
the first step in the acute phase of treatment is to ensure that the patient is taking a mood
stabilizer drug, such as lithium, valproate, or carbamazepine (802) and/or an antipsychotic such
as olanzapine, risperidone, aripiprazole, quetiapine or ziprasidone, in a dose that would be
effective in the acute treatment phase of mania (709). The DSM-5 also states that when
depressive symptoms persist or when they are so severe to begin with that one cannot wait, one
may add an antidepressant. Traditionally, an antidepressant has been used; however, though
effective, all the antidepressants entail the risk of precipitating a manic episode (124).
While medication is great for some individuals, others suffer serious side effects.
According to a study that was done by Dawn Velligan et al on Doctors Adherence Problems in
Patients with Serious and Persistent Mental Illness states that only 51%70% take the
prescribed medication due to the side effects (Velligan et al.). As some individuals choose not to
take prescribed medication, they start seeking out other alternatives which may be more natural.
While it is true that some doctors choose to medicate their patients, others simply believe,
as Pfeiffers laws states, For every drug that benefits a patient, there are natural substances that
can produce the same effect (qtd. in Walsh). This law has led many medical professionals to
think outside the box of medication, giving way to research and provide proof of other options.
One example is that of PhD. William Walsh, who is the founder of the Walsh Research Institute,
Naperville, Ill., which is a nonprofit organization that studies nutrient therapies in mental
disorders (Walsh).

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Other individuals such as Lisa Turner, who is a food psychology coach and author of
Healthy BALANCE, also agrees that there are other options besides just medication. Turner
has documented several types of natural options ranging from using distilled flower blossoms to
help balance emotions, to meditating to control anxiety, which often is exhibited in bi-polar
patients. She also has suggested that individuals cut out sugars and caffeine. She suggests that
individuals increase the amount of fish they consume, while taking supplements such as St.
Johns Wart. She believes that if individual do these combinations, it can help to control nutrient
imbalance which some believe to be the primary classifications of bipolar disorder (Turner 3336).
Even though the previous methods are affective there are still a few more options to be
examined, such as a combination of medication and therapy. In the article Effectiveness of
Psychosocial Treatments in Bipolar Disorder: State of the Evidence by Dr. Huxley, Dr. Parikh,
and Dr. Baldessarini, stated that group therapy, family psychotherapy, and individual
psychosocial interventions were effective feasible forms to treat patients, this in combination,
along with medication, helped reduce hospitalization than other treatments alone (Huxley,
Parikh, and Baldessarini).
Another affective treatment according to the DSM-5 is cognitive-behavioral therapy. It is
suggested that in mild cases of depression, one may also consider the use of cognitive-behavioral
therapy (807). This also proves true according to the study of A Randomized Controlled Study
of Cognitive Therapy for Relapse Prevention for Bipolar Affective Disorder: Outcome of the
First by Year-Lam DH et al, which states that the basic elements of cognitive therapy is
desirable and can be a successful treatment because it includes acceptance of the illness,

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educating the patient and their family about the illness, and self-monitoring of the illness and
medication (Lam et al.,).
There have been other additional studies on the benefits of therapy and according the
American Journal of Psychotherapy an article on Group Therapy in Manic-Depressive Illness
written by Dr. Wulsin, Lawson, Michael Bachop, and Dr. David Hoffman States that individuals
suffering with bi-polar who are involved with therapy have less hospitalization and increased
adherence to medication, along with improved economic status and social functioning. They also
claim that patients in group therapy also report fewer episodes of mania, and less episodes of
depression. Family therapy also provided similar results, with a noted increase in family or
spousal attitudes in acceptance of the disorders. They state that individual psychotherapy, is
possibly the most common form of treatment, has noticeable improvements in various aspects for
patients participating in this modality. The study also shows that patients participate in various
aspects, including coping strategies, relapse prevention, and efforts to stabilize both sleep
schedules and activity levels (Lawson, Bachon and Hoffman 263-271).
Kevin R Connolly and Michael E. Thase, the authors of the Clinical Management of
Bipolar Disorder gave a review of Evidence-Based Guidelines also support the theory from
Lawson, Bachop and Hoffman, stating that, More intensive psychotherapies (cognitivebehavioral therapy, family focused therapy, interpersonal and social rhythm therapy) have also
demonstrated benefit as adjuncts to improve both symptoms and function and should be
considered when available and financially feasible (Connolly and Thase). Even though therapy
is effective in most cases there are some that are resistant to most other treatments.
Some individuals have treatment resistant bi-polar, which they do not respond to
traditional methods of treatment such as medication or therapy. Some turn to what used to be

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viewed as more controversial or extreme forms of treatment called electroconvulsive treatment

(ECT) previously referred to as shock therapy. Even though ECT is considered controversial and
it often times has a negative stigma, proponents believe that the benefits outweigh the side
effects. No longer is it the same treatment that has been dramatized in Hollywood movies such
as One Flew Over the Cuckoos Nest, but is a more directed approach as stated in the study
Effects of Stimulus Intensity and Electrode Placement On the Efficacy and Cognitive Effects of
Electroconvulsive Therapy by Sackeim, Harold A., et al., they detail that they use general
anesthesia and target specific parts of the brain in order to archive the desired results (839
Harold). This is also reiterated in a study completed by Dr. Stan Kutcher and M.A. Heather
Robertson, titled Treatment-Resistant Bi-polar Youth, they found that the individuals who
participated in the ECT were significantly better and were released much faster than the
individuals who chose not to participate. This showing that as a last resort ECT is affective in the
rare cases were individuals are treatment resistant (Kutcher and Robertson). This information on
ECT is also corroborated in the book Manic-Depressive Illness: Bipolar Disorders and
Recurrent Depression 2 by Frederick K Goodwin and Kay R. Jamison (782-784 Goodwin and
Jamison).
While living with mental illness such as bi-polar can be extremely challenging, there is
hope. Just as there are many forms of bi-polar disorder there are also forms of treatment
available for those who suffer from this illness. And while it is a devastating disorder, those
afflicted by it can, with proper treatment, have a decent opportunity at living a normal life and
can successfully manage the disorder through the multiple means of treatment available to them.

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Work Cited
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders:
DSM-5 5th ed:1-897 Washington: American Psychiatric Association, (2013) Print. 01
Mar. 2016.
Bipolar disorder. National Institute of Mental Health. NIMH. 2016. Web. 01 March, 2016.
<https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml>
Cassidy, Frederick. Ahearn, Eileen and Carroll, Bernard. (2001), Substance abuse in bipolar
Disorder. Bipolar Disorders, 3: 181188. (2001) doi: 10.1034/j.1399-5618.2001.30403.
Web. 01 Mar. 2016.
Connolly, Kevin R, and Michael E Thase. The Clinical Management of Bipolar Disorder: A
Review of Evidence-Based Guidelines. The Primary Care Companion to CNS
Disorders 13.4 (2011): PCC.10r01097. PMC. Web. 29 Feb. 2016.
Duckworth, Ken. Mental Illness FACTS AND NUMBERS:
Numbers of Americans Affected by Mental Illness. National Alliance of Mental illness
(2013). Web. 01 Mar. 2016.
<http://www2.nami.org/factsheets/mentalillness_factsheet.pdf>
Goodwin, Frederick K, Jamison, Kay R. Manic-Depressive Illness: Bipolar Disorders and
Recurrent Depression, 2: New York. Oxford University Press. (2007) 782-784. Print. 01

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Mar. 2016.Huxley, Nancy A., Sagar V. Parikh, and Ross J. Baldessarini. "Effectiveness
Of Psychosocial Treatments In Bipolar Disorder: State Of The Evidence." Harvard
Review Of Psychiatry (Taylor & Francis Ltd) 8.3 (2000): 126. Academic Search Premier.
Web. 28 Feb. 2016.
Kutcher, Stan and Robertson Heather, A. Electroconvulsive Therapy in Treatment-Resistant
Bipolar Youth Journal of Child and Adolescent Psychopharmacology.
(2009) 5(3): 167-175. doi:10.1089/cap.1995.5.167. Web. 01. March. 2015.
Lam DH et al, Watkins ER, and Hayward P. A Randomized Controlled Study of Cognitive
Therapy for Relapse Prevention for Bipolar Affective Disorder: Outcome of the First
Year. Arch Gen Psychiatry. (2003);60(2):145-152. doi:10.1001/archpsyc.60.2.145.
Web. 29 Feb. 2016.
McElroy, Susan L et al, Altshuler, Lori L and Suppes Trisha, Axis I psychiatric comorbidity
and its relationship to Historical illness variables in 288 patients with bipolar disorder.
Am J Psychiatry. 2001;158(3):420426. PubMed. Web. 01 March 2016.
Mcgregor, Sherrie. Substance Abuse and Bipolar Disorder. Psych Central. (2013). Web.
29 Feb. 2016, <from http://psychcentral.com/lib/substance-abuse-and-bipolar-disorder/>
Sackeim, Harold A., et al. "Effects of stimulus intensity and electrode placement on the efficacy
and cognitive effects of electroconvulsive therapy." New England Journal of Medicine

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328.12 (1993): 839-846. Print. 1 Mar. 2016.

Turner, Lisa. "Healthy BALANCE." Better Nutrition 76.12 (2014): 32-36. Academic Search
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Velligan, Dawn I. et al., Weiden, Peter J. and Sajatovic, Martha. Adherence Problems in
Patients with Serious and Persistent Mental Illness. Journal of Clinical Psychiatry.
(2009);70(suppl 4):1-48. 10.4088/JCP.7090su1cj. Web. 1. Mar. 2016.
Walsh, William. Bipolar: Advanced Nutrient Therapies for Bipolar
Disorder Walsh Research Institute. (2014). Web. 01 March, 2016.
<http://www.walshinstitute.org/uploads/1/7/9/9/17997321/wri_bipolar_webinar_03-202014.pdf>
Wulsin, Lawson, Michael Bachop, and David Hoffman. "Group Therapy In ManicDepressive Illness." American Journal Of Psychotherapy 42.2 (1988): 263. Academic
Search Premier. Web. 1 Mar. 2016.