Treating Bipolar and Bipolar Spectrum Holistically and Integratively

What is bipolar disorder and the bipolar spectrum? 

Traditional psychiatry defines people who struggle with manic/hypomanic or depressive episodes by putting them into two main buckets – depression or bipolar. There is some further nuance – for example, you can be bipolar 1 or bipolar 2, you could have a mixed episode. An emerging view (though not fully accepted by all psychiatrists and not present in the DSM which defines psychiatric diagnosis currently) is that rather than there being two buckets of depression or bipolar it’s more helpful to think about mood disorders as a spectrum. 

On the one side of the spectrum there is classic major depressive disorder (low mood, low energy, disrupted sleep, low motivation, hopelessness). On the other side of the spectrum there is the classic bipolar 1 defined by at least one manic episode (high energy, low sleep, racing thoughts, increased impulsivity, grandiosity so severe that it lasts for at least a week or you end up in the psychiatric hospital). And in the middle is where things get interesting. Maybe you have only experienced depression before but you have other markers (like chronicity, early onset of depression, severe depression, high anxiety while depressed) that hint towards you being closer to the bipolar side of the spectrum than the depressive one. Maybe you only have mixed or seasonal episodes. Where you fit on the spectrum is an important distinction because it can quite drastically change your treatment options.   

What is Traditional Treatment for Bipolar? 

Traditional treatment starts with a DSM diagnosis of bipolar 1 or 2 with additional clarification of the most recent mood episode, if you are in remission and severity of the symptoms you are having. There may also be some ‘modifiers’ that further describe your symptoms like mixed features or with catatonia. Then based upon this diagnosis you are given a treatment usually consisting of a mood stabilizer medication +/- psychotherapy. Mood stabilizers aim to decrease the symptoms during depressive or manic episodes and limit future episodes and their severity. Examples include lithium, lamictal, seroquel, depakote and carbamazepine. Some people diagnosed with bipolar 2 may also be put on an antidepressant like zoloft, lexapro, effexor or prozac.

What are the Reasons and Risks for Untreated Bipolar Disorder?

The challenges many people diagnosed with bipolar disorder face are side effects from medications or the effectiveness of medications wearing off over time. Additionally, some enjoy the feeling of being manic or hypomanic, however, don’t enjoy as much the depressive crash that often comes afterwards. Factors like this can lead to discontinuation of treatment and medications. While understandable given limitations of treatment options in traditional psychiatry (some medications can have brutal side effects), this approach comes with significant future risks including future depressive/manic episodes that became more severe, frequent, and harder to treat as time goes on, increased risk of suicide and increased risk of cognitive issues further down the road.

What is an Integrative and Holistic Approach to Bipolar and Bipolar Spectrum Disorder?

A holistic and integrative approach to bipolar spectrum disorder views medication management as only one part of treatment. In fact, using other holistic approaches often allows people to decrease the dose of medication they are taking. Careful analysis and modification of factors like diet, sleep, sunlight exposure, stress, travel, physical activity, substance use are key as people with bipolar tendencies are very sensitive to changes in the rhythm of their day and lifestyle. Using supplements and botanicals or lab testing to look at factors like inflammation help address symptoms and underlying root causes without using medications. Finding psychotherapy with evidence in bipolar disorder can be helpful as well. Additionally and also very importantly bipolar disorder or bipolar spectrum isn’t all doom and gloom. People who have experienced (hypo)mania often at baseline may have higher creativity, empathy and resiliency.  Personalizing care including limiting medications when possible, addressing holistic factors and making space for hope are key parts of an integrative approach to bipolar disorder. 

Warmly,

Dr Amy

Short disclaimer: This information is for educational purposes only. It is not intended as medical advice, diagnosis, treatment or consultation.