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Section 11
Psychotherapy for Bipolar II Disorder

Question 11 | Test | Table of Contents

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In the last section, we discussed the role childhood and upbringing play in a bipolar client’s life:  characteristics of functions and dysfunctional families; types of dysfunctional families; and family communication.

Depending on your home state, you may or may not be licensed to prescribe medications for your bipolar disorder clients. Whether or not you are certified to do so, I find that it is helpful to understand the basics of bipolar medications to help those clients who are indeed prescribed
medications.

In this section, we will examine the three types of treatments that clients may take in addition to therapy:  psychotropic medications; non-medicinal treatments; and hospitalization.

3 Types of Treatment in Addition to Therapy

♦ 1. Psychotropic Medications
The first topic we will discuss are the psychotropic medications and their effect on bipolar clients. The first are, of course, mood-stabilizers such as lithium. Lithium has been the only pure mood stabilizer available with other mood stabilizers such as anticonvulsants and calcium channel blockers also being used. I have found in some cases, bipolar clients find that they only need to take one mood stabilizer to control their disorder. 

However, most of the time, I have found that many bipolar clients take more than two or three psychotropic drugs to stabilize their mood.  Much of these combinations include antipsychotics or neuroleptics to control psychotic episodes, antianxiety agents, hypnotics, and antidepressants. 

As you know, to prevent the mood swings of bipolar disorders, many doctors and psychiatrists generally prescribe anti-depressants with a mood stabilizer.  However, as you are aware, there is a danger if a client is diagnosed with unipolar disorder and is in fact bipolar.  Without a mood stabilizer, an antidepressant can induce a manic or hypomanic episode.

Other Considerations
Other considerations to take into account when prescribing medications or treating a client on medications include the following. You are familiar with these but I felt a review of these four points would be helpful to make sure we are all on the same page.
a. MAOIs require many dietary restrictions, and some other medications do as well. Check with your client regularly to be sure that they are not on a diet that conflicts with their medication.
b. Mood-stabilizing agents often require monitoring to ensure that they’re not damaging the client’s thyroid, kidneys, or liver. I ask my clients that are currently taking mood stabilizers such as lithium and valproic acid to get blood tests regularly.
c. Many psychotropic medications can cause birth defects or pass chemicals through breast milk. If a client is pregnant or wants to become pregnant, this is a serious issue to discuss with her before taking such a step.
d. Many clients during a manic or hypomanic episode doubt their need for medications because they experience such a euphoria. I find it helpful to explain to them the risks of stopping certain medications "cold turkey". Gradually reducing dosage should be discussed thoroughly between you and the client or the client and the prescribing doctor.

Are you certified to prescribe psychotropic medications in your state, but you are not certain which medications to prescribe?  I have found that if a client has a history of bipolar disorder in the family and the other member has taken medication, that the same medication might also work for the client due to genetic parallels.

♦ 2. Non-Medicinal Treatments
The second topic we will discuss are non-medicinal treatments that have proved successful when treating bipolar clients in the past.  The first is the controversial electroconvulsive therapy, otherwise infamously known as electroshock therapy (ECT). There is a certain stigma surrounding this type of treatment which in some cases does not apply today.  Due to movies and literature portraying the ECT of the past as cruel and debilitating, many clients are resistant. However, it might be noted there have been some improvements in anesthesia, dosage levels, and equipments that reduce the risk of side effects. 

Clearly, there is a risk of short-term memory loss around the time of treatment and in some cases will remain with the client long after the treatment is finished.  Dr. Martha Manning found ECT an efficient substitute when her depression medications would not suffice. 

A second treatment is vagal nerve stimulation which was originally created to treat epilepsy.  This is a small, pacemaker-like device that is placed under the left-side of the client’s collarbone and sends electrical pulses to the brain.  Every five minutes, the VNS device stimulates the vagus nerve for thirty seconds. About one-third of mood disorder clients reported an improvement in their symptoms, with a slight side effect of hoarseness when the device is on.

♦ 3. Hospitalization
In addition to psychotropic medication and non-medicinal treatments, hospitalization may be a third course of action when treating clients under the influence of medications.  Many times, bipolar clients do not require hospitalization when being treated with medications properly and when they keep up with their prescriptions.  Even when hospitalization is necessary, I often emphasize to my clients that their stay is not permanent, but merely a means to get stabilized and back on their feet. 

Louis was a bipolar client of mine who, in the past, had required some hospitalization when he refused to take his medications. Clients like Louis are extremely resistant to such a measure as hospitalization because they do not understand the reasoning behind this decision. 

7 Circumstances under which Hospitalization is Necessary
To help Louis, I gave him a "List of Circumstances" under which hospitalization would most definitely be necessary.  These included the following:
1. When suicidal, homicidal, or aggressive impulses or actions threaten yours or others’ safety.
2. When you’re severely and dangerously agitated or psychotic.
3. When you have another dangerous medical condition such as diabetes, and are no longer managing it properly.
4. When your distress or dysfunction is so severe that it requires round-the-clock care your loved ones can’t provide.
5. When you’re so apathetic or depressed that you won’t eat.
6. When you have an ongoing substance abuse problem.
7. When doctors need to closely observe your reactions to medications.
By giving Louis a list of circumstances he can refer to, he was less suspicious of being hospitalized.

In this section, we discussed the three types of treatments that clients may take in addition to therapy:  psychotropic medications; non-medicinal treatments; and hospitalization.

In the next section, we will examine how stress affects those with bipolar disorder and how clients can monitor their stress:  kindling; short-term and chronic stress; and stress symptoms.
Reviewed 2023

Peer-Reviewed Journal Article Reference:
Cassidy, C., & Erdal, K. (2020). Assessing and addressing stigma in bipolar disorder: The impact of cause and treatment information on stigma. Stigma and Health, 5(1), 104–113.

Hunsley, J., Elliott, K., & Therrien, Z. (2014). The efficacy and effectiveness of psychological treatments for mood, anxiety, and related disorders. Canadian Psychology/Psychologie canadienne, 55(3), 161–176.

Mneimne, M., Fleeson, W., Arnold, E. M., & Furr, R. M. (2018). Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personality Disorders: Theory, Research, and Treatment, 9(2), 192–196.

Montiel, C., Newmark, R. L., & Clark, C. T. (2021). Perinatal use of lurasidone for the treatment of bipolar disorder. Experimental and Clinical Psychopharmacology. Advance online publication.

Swartz, H. A., Levenson, J. C., & Frank, E. (2012). Psychotherapy for bipolar II disorder: The role of interpersonal and social rhythm therapy. Professional Psychology: Research and Practice, 43(2), 145–153.

QUESTION 11
What are three types of treatments that clients may take in addition to therapy? To select and enter your answer, go to Test.

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