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Elevating Psychiatric care What We Treat

Bipolar Disorder

What is bipolar disorder?

Bipolar disorder, also known as manic-depressive illness, is a chronic brain disorder that is characterized by recurrent episodes of dramatic mood shifts, extreme highs and lows in mood, energy, and the ability to think clearly. It negatively impacts quality of life and the ability to perform day-to-day tasks. It affects men and women equally and most cases are severe. The average age of onset is 25.

Mood episodes are intense emotional states, are common and last days to weeks. They are accompanied by extreme behavior changes, difficulty with daily routines and social interactions and can disrupt personal relationships and cause difficulty at work or school. People without bipolar disorder also have episodes of mood fluctuation but they last just hours and they do not cause extreme behavior changes.

There is no single cause of bipolar disorder. Rather, it is a combination of genetic and environmental factors. 80-90% of people with bipolar disorder have a relative with bipolar disorder or depression.

Environmental risk factors include stressful life events (such as the death of a loved one or divorce), sleep disruption, drug and alcohol abuse, and certain medical conditions that can trigger mood episodes.
Some research suggests that brain structure is involved.
Recent research reports that vascular disease is a recognized cause of bipolar disorder that is inherited and is associated with an increased risk of death from stroke later in life. More research is needed, but we know that bipolar disorder is associated with an elevated risk of cardiovascular death.

Bipolar I

Bipolar I is characterized by one or more episodes of mania or mixed mania and depression symptoms. People with this type frequently have other mental disorders such as anxiety and depressions, substance abuse and attention deficit hyperactivity disorder. People with bipolar I have a significantly higher risk for suicide than other diagnoses. They may also experience a major depression. The diagnosis of bipolar I is based on a manic episode that lasts for a week when the person exhibits extreme elation involving intense energy or an uncomfortable irritable mood. Often a manic episode is so severe as to cause dysfunction and require hospitalization to keep the patient safe.

During the manic episode symptoms may include:

  • feeling very happy and energized (euphoria)
  • feeling very angry, irritable, or agitated
  • increased risk taking
  • sleeping less than usual
  • talking more quickly than usual
  • uncontrollable racing thoughts
  • being easily distracted

During the hypomanic episode symptoms include reduced severity and extent that can last just four days in a row and do not interfere with function.

The mainstay treatment is medication and psychotherapy to teach the patient about their illness and how to stick with their medications to prevent future mood swings. Also, peer support and a personal wellness plan are important.

The most common mood stabilizer is lithium. He may also recommend antidepressants. However, Dr. Poulakos treats the individual based on their needs. Sometimes different medications must be tried to find the one that works best for you and can help to prevent mood swings.  When medication and therapy don’t help, he may recommend Electroconvulsive Therapy (ECT), Transcranial Magnetic Stimulation (TMS) or Vagus Nerve Stimulation (VNS), or Cranial Electrotherapy Stimulation (CES). If he recommends these any of these treatments, he will explain the benefits and risks to you. Other options may include biofeedback

Bipolar II

A diagnosis of bipolar II is diagnosed when the person experiences at least one episode of major depression and at least one hypomanic episode with a return to normal functioning between episodes. The highs in bipolar II are called hypomania which is not as extreme as in bipolar type I. Patients often suffer with other mental illnesses like anxiety and substance abuse.

Symptoms of hypomania include feeling unusually confident, social and energetic, unusually talkative, quick to anger, easily distracted, thinking faster and being highly sexual.

Cyclothymic Disorder

This is the mildest form of bipolar disorder that involves mood swings with hypomania and symptoms of depression. Mood swings alternate for at least two years, never stop for more than two months and can worsen over time.

Rapid Cycling

Rapid cycling is a term use to describe when a person diagnosed with bipolar disorder experiences four or more mood episodes within a 12-month period. Changes happen quickly over a few hours or days. Almost half of all bipolar patients experience rapid cycling. Most often it is temporary.

Bipolar disorder can be distressing and disruptive for not only the patient but also for their family, friends, and employers. Bipolar disorder is treatable. There is no cure, but when treated people with this disorder can lead full and productive lives and have successful relationships.

Dr. Poulakos offers evidence-based, individualized treatment using medication and psychotherapy, and state-of-the-art treatments. When people are directly involved in creating their own treatment plan including wellness goals and support services, they experience improved outcomes. He is a caring and compassionate doctor who will work with you to find solutions that meet your unique needs. Contact him at his New York City office to schedule an appointment to receive the correct diagnosis and all your treatment options.

At a Glance

Dr. Paul Poulakos

  • Attending Psychiatrist at Mount Sinai Beth Israel Medical Center
  • Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai
  • Past Clinical Assistant Professor of NYU Langone Medical Center
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