Bipolar disorder

Aug 03, 2025 News

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Continuing from last week…

By Dr. Telford Layne Jr. PsyD, MSc. Postgrad, BSc.
Clinical and Developmental Psychologist – Psychoanalyst
Unwrapping Gift – Clinic

Kaieteur News – Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental illness that causes apparent shifts in a person’s mood, energy, activity levels, and concentration. People with bipolar disorder often experience periods of significantly “up,” elated, irritable, or energized behavior (known as manic episodes) and very “down,” sad, indifferent, or hopeless periods (known as depressive episodes).

Bipolar disorder can affect children, with symptoms sometimes appearing as young as five years old, though it is more commonly diagnosed in adolescence. While the average age of onset is unclear, reported ages range from five to 19 years. Bipolar disorder affects men and women with similar overall prevalence, but the way it manifests can differ.

Bipolar disorder is categorised into three primary types: Bipolar I, Bipolar II, and Cyclothymic disorder.

Today we are looking at Bipolar II, and Cyclothymic disorder.

Bipolar II disorder is a mental health condition characterized by distinct episodes of depression and hypomania, a less severe form of mania. Unlike bipolar I disorder, individuals with bipolar II do not experience full manic episodes. Instead, they cycle between periods of depression and hypomania, which can be less noticeable and disruptive to daily life than full mania.

Hypomanic Episodes: These are periods of elevated mood, increased energy, and activity, but the symptoms are less intense and disruptive than full maniac. People experiencing hypomania may feel unusually happy, confident, or productive, Increased energy, activity, and restlessness. Irritable mood. Inflated self-esteem or grandiosity. Decreased need for sleep. Increased talkativeness. Racing thoughts. Increased, distractibility. Increased goal-directed activity or psychomotor agitation. Excessive involvement in pleasurable activities have a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions, or foolish business investments.

Depressive Episodes: Bipolar II is also characterized by periods of major depression, which can be severe and prolonged. Signs of depressive episodes are Persistent sad, anxious, or “empty” mood. Feelings of hopelessness or pessimism. Feelings of guilt, worthlessness, or helplessness. Loss of interest or pleasure in activities once enjoyed. Decreased energy or fatigue. Difficulty concentrating, remembering, or making decisions. Insomnia, early-morning awakening, or oversleeping. Restlessness or irritability. Thoughts of death or suicide. Appetite and weight changes.

Cyclothymic disorder:

Cyclothymic disorder, also known as cyclothymia, is a mood disorder characterized by fluctuating moods with periods of hypomanic symptoms and periods of depressive symptoms. These fluctuations are less severe than those seen in bipolar I or II disorders, but they are chronic and pervasive, lasting for at least two years in adults.

Characteristics:

Alternating Moods: Cyclothymia involves distinct periods of hypomania and depression, though these episodes are not as severe or prolonged as in bipolar disorders.

Chronic Nature: The mood fluctuations are persistent, with symptoms present for at least two years in adults (one year in children and adolescents).

Onset: Cyclothymia typically begins in adolescence or early adulthood but there are exceptional cases in children with genetic disposition or extensive traumatic experience.

Individuals with Cyclothymia are often associated with other conditions, including anxiety disorders, substance use disorders, and impulse control disorders.

Symptoms of cyclothymia are:

Hypomanic Symptoms: inflated self-esteem, increased energy, racing thoughts, impulsivity, increased talkativeness, and decreased need for sleep.

Depressive Symptoms: Include low mood, feelings of hopelessness, fatigue, sleep problems, changes in appetite or weight, and difficulty concentrating.

Impact

It is always critically important to become self-aware of our thinking, feelings and behavior. They are indicators of normal lifestyle and abnormal lifestyle. It is the presence of disorders and disabilities that disrupt our intrapersonal and interpersonal relationship that goes on to create chaos in our lives making us dysfunctional or hard to work with.

Potential Complications:

Increased Risk of Bipolar Disorder: Cyclothymia can sometimes evolve into bipolar I or II disorder.

Substance Use Disorders: Individuals with cyclothymia may be more vulnerable to developing substance use problems as a way to cope with mood swings.

Relationship Difficulties: The emotional instability associated with cyclothymia can strain interpersonal relationships.

Treatment plan for Bipolar I, Bipolar II, and Cyclothymic disorder

Bipolar disorder (Bipolar I and II) and cyclothymic disorder require an effective treatment plan often combines medication, psychotherapy, psychoeducation, and lifestyle modifications. This is dependent of the severity of the experience. The first and best approach is psychotherapy. However, if there are a presence of psychotic behavior medication is required first. As a clinical psychologist I do not include medication as treatment plan except in no other option cases. Medication triggers other psychological disturbances depending on the side effects of the medication being taken.

1. Medications

Mood Stabilizers: These often serve as the first line of treatment and help regulate mood swings.

Lithium is particularly effective for treating both manic and depressive episodes in bipolar I and II. It may also be beneficial in cyclothymia.

Lamotrigine is often preferred for depressive episodes and maintenance treatment in bipolar I and II. It may also be used in cyclothymia, particularly when there is a prominent anxious-depressive component.

Antipsychotics: These may be used alone or with mood stabilizers to manage manic symptoms or mood instability.

Antipsychotics are sometimes used for short-term treatment of cyclothymia symptoms, but long-term use should be avoided.

Antidepressants: These are used with caution, particularly in Bipolar I, as they can sometimes trigger manic or hypomanic episodes.

If prescribed for bipolar I, they should be used in combination with a mood stabilizer or antipsychotic.

For Bipolar II, they may be used alone in some cases, but caution is still needed.

Antidepressants may also be considered in cyclothymia, but with caution due to the risk of exacerbating symptoms.

2. Psychotherapy

Cognitive Behavioral Therapy (CBT): This therapy helps individuals identify and challenge negative thought patterns and behaviors, and develop coping strategies.

CBT is considered a gold standard and is widely used for all types of bipolar disorder and cyclothymia.

It can help identify triggers for mood episodes and improve emotional regulation skills.

Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT helps individuals establish regular routines (sleep, wake, meals) and improve interpersonal relationships. This can help stabilize moods and prevent episodes.

This therapy can be beneficial for Bipolar I, Bipolar II, and cyclothymia.

Family-Focused Therapy (FFT): FFT involves family members in the treatment process to improve communication, reduce family conflict, and create a supportive environment.

It is particularly helpful when family dynamics may be contributing to or worsening the individual’s symptoms.

Psychoeducation: Learning about the disorder, its symptoms, treatment options, and triggers is essential for self-management.

Psychoeducation can be incorporated into other therapies or delivered in a group setting.

Dialectical Behavioral Therapy (DBT): DBT focuses on mindfulness and emotional regulation skills. This can be particularly helpful for managing intense mood swings.

3. Lifestyle modifications

Consistent Sleep Schedule: Establishing and maintaining a regular sleep schedule is crucial, as sleep disruption can trigger mood episodes.

Regular Exercise: Exercise can help regulate mood and reduce symptoms of depression and anxiety.

Healthy Diet: A balanced diet supports overall well-being and can help manage energy and moods.

Stress Management: Developing healthy ways to manage stress is important to prevent mood episodes.

Avoidance of Substances: Alcohol and recreational drugs can interfere with medications and worsen symptoms.

Strong Support System: Leaning on friends, family, and support groups can provide valuable emotional and practical assistance.

Important considerations

• Individualized Treatment: Treatment plans for Bipolar I, Bipolar II, and cyclothymic disorder should be tailored to the individual’s specific needs, symptom severity, and preferences.
• Monitor for Side Effects: It’s important to monitor for potential side effects from medications .
• Addressing Co-occurring Conditions: Many individuals with bipolar disorder and cyclothymia also have co-occurring conditions, such as anxiety, substance use disorders, or ADHD. These need to be addressed as part of the overall treatment plan.

Any treatment plan must be from a clinical psychologist or a psychiatrist

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• Bipolar Disorder, Dr. Telford Layne Jr., Psychoanalyst, Psychologist

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