We are continuing to learn more and more about how brain cells behave. We know now that neurons can respond to change. This is what we mean by neuroplasticity. And neuroplasticity may be involved in maintaining a normal mood in response to experiences in our relationships and our lives. Bipolar disorder may involve difficulties with these processes of neuroplasticity.
Antidepressant medications, lithium, and mood stabilizers may work in different ways to help with neuroplasticity. But while these medications may be especially helpful with mania, depression continues to be a significant problem for about two-thirds of individuals with bipolar disorder. Symptoms of bipolar depression occur more often and last longer. And they are associated with a higher risk of suicide.
Depression in general often includes negativity and pessimism. And cognitive therapy can be very effective in helping to replace immediate negative reactions with more realistic ones. But where “unipolar” depression is particularly associated with automatic negative thoughts, bipolar depression more often includes hypersomnia, lethargy, and apathy which are more responsive to behavioral therapy focused on activation.
Two models which focus on treatment for individuals with bipolar disorder are Behavioral Family Management for Bipolar Disorder (BFM-BP) and Interpersonal and Social Rhythm Therapy (IP/SRT).
BFM-BP focuses on education and family support. The fact that bipolar disorder has an organic basis and is not easily controlled is emphasized. Healthy communication, conflict resolution, and problem-solving techniques with which to address stressors and difficulties within the family are developed and practiced.
IP/SRT focuses on individual stress management. The individual works with their therapist to identify physical factors and emotional stressors that upset daily rhythms and affective stability.
Behavior modification which includes a reduction in sleeping time, an increase in activity and exercise, and restructuring of daily activities to cope with apathy and lack of energy is often a very helpful approach with bipolar depression.
Individuals with bipolar disorder have often experienced many stressors which may include accepting the diagnosis, economic losses, wavering support from others, feelings of guilt, and significant problems with self-esteem. Having bipolar disorder can make every day decisions more difficult. And larger, more important decisions can be overwhelming. Distress associated with these stressors can be activated during the depressive phase of bipolar disorder and it is extremely important that these be addressed in counseling with a knowledgeable and trusted therapist.