Finding the Best Complex Bipolar Disorder Treatment in California
Living with bipolar disorder can be complicated. The complexity of the illness means that there is no single best treatment for the condition and many people feel lost as they try to navigate the recovery process. By learning what to look for in complex bipolar disorder treatment, you can gain a better understanding of what you need in order to create durable healing and regain control over your life. With this knowledge, you’ll be well on your way to finding the best care for your unique needs.
In many ways, bipolar disorder is an inherently complex illness. Rather than experiencing a constant state of illness, the condition is episodic and may require various forms of treatment for acute episodes and ongoing management. As such, treatment often takes time to refine, and treatment providers must stay responsive to the fluctuations and wide-ranging symptomatologies that define the illness. At the same time, those living with bipolar disorder often experience comorbid conditions that can produce significant distress in themselves and interact with bipolar disorder in a way that complicates the treatment process, further compromising outcomes and overall quality of life.
Luckily, there is now greater recognition of the many factors that must be taken into account when designing complex bipolar disorder treatment plans, as well as more available treatment options, than ever before. Particularly in California, we are lucky to have some of the best mental health care professionals and treatment resources in the world available to help guide clients toward recovery and restored functionality. However, with so many options to choose from, it can be difficult to know where to begin. Whether you are just beginning your healing journey or treatment has failed to produce lasting alleviation from symptoms, taking the next steps can feel overwhelming. By exploring the factors clinicians should take into account when creating your treatment plan and understanding the features to look for when selecting a provider, you can improve your chances of finding the complex bipolar disorder treatment best suited to your individual needs.
The Complexity of Bipolar Disorder
Bipolar disorder is not a single illness, but a collection of conditions with unique features that define each subtype. However, even within each subtype, there is a multitude of variations that affect how each person experiences the condition. Some people with bipolar I will experience only mania, while others oscillate between mania and depression. Some people with bipolar II experience hypomania as a euphoric state, while it throws others into irritability. Some will never experience a mixed episode, while mixed episodes are the primary symptom of bipolar disorder for others. This vast range of both symptom presentation and symptom severity means that there is no single symptom cluster that is universally present in experiences of bipolar disorder and that can be consistently targeted by treatment.
In fact, our understanding of bipolar experiences is still evolving; last year, for example, a remarkable study was published showing that people with bipolar I are just as likely to experience anxiety following a manic episode as they are to experience depression, opening up a new area of potential intervention. “For years we may have missed opportunities to evaluate the effects of treatments for bipolar disorder on anxiety,” says Dr. Mark Olfson, lead author of the study. “The results of our study suggest that researchers should begin to ask whether, and to what extent, treatments for bipolar disorder relieve anxiety as well as mania and depression.”
Of course, bipolar symptoms don’t exist in isolation. Rather, they can be deeply impacted by a range of environmental and biological factors as well as comorbidities that further complicate the illness. For example, in women, hormonal fluctuations throughout the reproductive cycle can greatly impact symptom presentation and severity, particularly during the luteal phase of the menstrual cycle, in the postpartum period, and during menopause. Meanwhile, both men and women may have seasonal aspects to their mood episodes, with depressive episodes often tied to winter months. Comorbid psychiatric and physical conditions can also greatly impact experiences of bipolar disorder, potentially interfering with both diagnosis and treatment. Of particular concern are co-occurring substance use disorders, which are experienced by up to 59% of people with bipolar disorder. This extraordinary overlap which has led many to theorize that the two disorders have shared roots. It is also widely accepted that people with bipolar disorder may develop substance use disorders in attempts to self-medicate, ultimately compromising psychological and physical health further.
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What to Look for in Complex Bipolar Disorder Treatment
While there are common threads throughout experiences of bipolar disorder, the multitude of variations and complicating factors means that each person’s experience is largely unique. Healing from bipolar disorder thus requires treatment that acknowledges the challenges faced by each individual and tailors care to meet those challenges in a way that is meaningful and effective. Often, the best treatment will be comprised of three components that can be modulated with your needs in mind:
Medication is typically a cornerstone of bipolar disorder treatment. Today, there exists a full range of empirically-supported pharmacological therapies, including mood stabilizers and antipsychotics, that may be used either on-label or off-label to target various symptoms of the condition. However, there is no single treatment that is suitable for all clients; rather, your medication plan must be designed around your individual symptom presentation and severity, which may change over time.
Unfortunately, finding the right medication protocol can be a complicated process. “While a specific treatment may be effective for the management of a specific cluster of symptoms, it may not be effective for the management of other clusters,” Dr. Konstantinos Fountoulakis points out in a study published in Annals of General Psychiatry. “Thus, treatment has to be regarded separately for each type of episode (manic, hypomanic, bipolar depression) and phase of the disease (acute, long-term and maintenance.” This means that few people with bipolar disorder are treated with a single medication or a single medication plan during their course of treatment. Rather, most receive combination therapy, with 50% of bipolar patients taking three or more drugs, and the exact combination and dosages may vary according to the state of the illness.
Due to the intricacy of pharmacotherapy for bipolar disorder, it is essential to work with a treatment provider with an in-depth understanding of the challenges presented by the illness and any comorbid conditions. This includes not only expertise in the potential efficacy of medications and medication combinations, but also an awareness of the risks presented by these therapies and a keen ability to weigh such risks against potential benefits. They should work closely with you to continuously monitor whether the medication protocol effectively addressing your symptoms, particularly as efficacy may vary over time, and evaluate tolerability. If side effects arise, they should support you in coping with these side effects or make medication changes to avoid them. Pharmacotherapy should never be a purely technical endeavor; it must applied with compassion and an acknowledgment of your own preferences, experiences, and, indeed, your humanity.
Psychotherapy and Experiential Therapies
While medication often takes center stage when it comes to complex bipolar treatment, psychotherapy plays a critical role in both acute and ongoing management of the illness. As Dr. Holly Swartz and Joshua Swanson point out, “Treatment with pharmacological interventions alone is associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment.” Combining medication with psychotherapy, however, drastically improves outcomes and overall quality of life.
There are a variety of psychotherapeutic modalities that may be used in the treatment of bipolar disorder and in recent decades, cognitive behavioral therapy (CBT) has emerged as a particularly promising treatment method. By guiding you through a process of identifying damaging patterns of thought and behavior and using evidence-based techniques to replace them with healthier alternatives, CBT can help address a variety of bipolar symptoms, symptoms of comorbid conditions, as well as negative beliefs you hold about yourself and the world around you. Research shows that “patients undergoing CBT showed improvements in quality of life, with a reduction in both frequency and duration of mood episodes, as well as higher degrees of compliance and fewer hospitalizations.”
Of course, CBT is not the only option for psychotherapy; insight-oriented therapy, motivational interviewing, mindfulness-based therapy, and a variety of other modalities may be applied to address your unique symptoms. Experiential therapies are also increasingly being integrated into complex bipolar treatment plans owing to their ability to target symptoms in novel ways that go beyond traditional therapeutic settings, allowing you to engage in treatment from a fresh perspective. The usefulness of all of these therapies, however, goes beyond a focus on symptomatology; they can help you explore the impact of mental illness on your life, gain greater self-awareness, enhance overall emotional regulation, recapture a sense of control over your life, and empower you to imagine a richer future for yourself.
As with medication, psychotherapy and experiential modalities are often best used in combination. Your treatment provider should tailor a curriculum of therapies to suit your individual needs, allowing each modality to complement the others and opening up multiple avenues toward healing. If you are struggling with a co-occurring substance use disorder, it is also critical that your therapists work with you to explore your drug or alcohol use in order to facilitate recovery and prevent relapse. 12-step programs can also play an important role in these cases.
Independent Living Skill Development
Some people with bipolar disorder remain relatively high-functioning throughout the course of their illness. Often, however, bipolar disorder presents serious functional challenges that interfere with independent living to various extents. As such, recovery depends on overcoming these challenges in order to foster greater confidence, aptitude, and self-reliance. What exactly independent living skill development looks like will depend on your individual situation and your treatment provider should focus on the specific areas in which you need support. This may include vocational supports, social skills training, conflict resolution, and a variety of other supports to help you transition toward successful independence.
A key area of this development will include the ability to manage your own psychiatric care. Unfortunately, bipolar disorder and comorbid conditions can significantly interfere with your ability to adhere to treatment, compromising outcomes and leaving you vulnerable to recurrence. By giving you the tools to participate in treatment at your own volition, including adhering to medication protocols, making appointments, and attending relevant peer support meetings, you can take charge of your own healing and set yourself up for treatment success.
Finding the Best Bipolar Disorder Treatment in California
For some, bipolar disorder can be treated successfully on an outpatient basis. However, the best treatment plans are multifaceted and often require a significant time commitment. At the same time, severe articulations of the illness may be beyond the scope of outpatient care, in part due to compromised adherence. As such, the best bipolar disorder treatment may be found in a residential treatment program. In California, there are a variety of residential treatment programs to choose from, most of which are relatively short-term with stays ranging from 1-3 months. While this timeframe can give some patients a promising start toward recovery, others need a longer duration of care to make significant progress, particularly in the presence of co-morbid conditions such as substance use disorders. In these cases, programs with stays of 12 months or longer are often ideal settings in which to begin the healing process.
In high-quality long-term treatment programs, you can fully immerse yourself in the work of recovery in a warm, supportive environment, surrounded by compassionate clinicians and peers who understand what you are going through. The duration of care means that you can work closely with your treating psychiatrist in order to rapidly develop a medication plan. Due to the continuous monitoring afforded by the residential milieu, the efficacy and tolerability of this plan can be carefully assessed and tailored as needed throughout your stay, ensuring that you receive the best pharmacotherapy experience possible. Simultaneously, you can participate in a comprehensive range of therapeutic modalities designed to address your specific needs. Thanks to the frequency of therapy, you will be able to quickly develop positive therapeutic alliances and delve deeply into the healing process. This allows you to more fully integrate new learning and practice new skills in a safe environment in order to nurture lasting recovery at every stage of your illness. The nature of these programs also means that you can focus on not just immediate containment of acute symptoms, but on long-term goals such as independent living, allowing you to gradually gain greater self-sufficiency at a pace that makes sense for you.
One of the greatest benefits of long-term programs for complex bipolar disorder treatment is the opportunity for clinicians to fully witness your condition. They do not just see you in a moment of crisis, but are able to observe you over time. This allows them to discover any complicating factors impacting your illness, whether it’s hormonal fluctuations, seasonal affects, comorbid mental health conditions, or co-occurring substance use disorders. By having a fuller picture of your symptoms and their origins, they can work with you to create a complete treatment plan that addresses the full scope of your needs, taking into account the unique features of your disorder. As such, your treatment experiences can be truly transformative and your ability to heal fortified.
Creating recovery from bipolar disorder means more than just alleviating symptoms. It means creating a future beyond your mental illness and enhancing your overall quality of life. It means opening up the door to recaptured joy, healthier relationships, enhanced confidence, and greater independence. With the right care, all of this is possible.
Hanbleceya offers long-term treatment for people struggling with mental health disorders, co-occurring substance use disorders and process addictions. Contact us to learn more about our renowned San Diego-based program and how we can help you or your loved one start the journey toward recovery.