A collection of how-to articles from Psychiatric Times and the Carlat Report
Making the Diagnosis
Mixed States. Anxious energy, restless drive, destructive impulsivity. Mixed states happen when mania and depression overlaps, but they look very different from mania and feel like a more intense depression.
The (other) Two Types of Bipolar. DSM focuses on bipolar I vs. II, but there’s another way to divide the illness that is just as informative about treatment.
Anxiety is common in bipolar disorder, but the word means many things, from phobia to distress. First, figure out what is causing the anxiety. Next, look for ways to treat it that don’t make the bipolar worse.
ADHD can occur with bipolar disorder, but the symptoms of bipolar can also be mistaken for ADHD. Here’s a brief overview of the differences, and an overview of the cognitive problems bipolar can cause. For more detail, the Carlat Report has a review of how to diagnose ADHD in bipolar disorder and how to treat it.
Borderline Personality Disorder. There’s a lot of debate about the overlap between borderline and bipolar disorders, but there’s a simple truth behind all that controversy. Bipolar and borderline have nothing in common, but cyclothymia and borderline have a lot in common. For further reading, this unique study paints a colorful portrait of the personal lives of people with bipolar.
Light and Darkness
Lightbox for Depression. A how-to podcast.
Jim Phelps interview on light and darkness.
Podcasts on light and darkness. From Finding Genius.
Ultraprocessed Foods (podcast).
Lifestyle Tips for Depression and Bipolar (podcast).
How to Stabilize Circadian Rhythms (podcast).
Pocket Psychiatrist. Patient guides to sleep, memory, and rebuilding life after bipolar (podcast).
Pramipexole. Branded Mirapex, this treatment for restless leg syndrome has a largest effect size in bipolar depression – and the studies that tested it enrolled treatment-resistant cases.
Antipsychotics. Start with the ones that treat depression, also available as a graphic slide show (that review is only missing the newest, lumateperone/Caplyta, also in podcast version). Podcast on choosing them. Quetiapine podcast.
Antipsychotics for Mania. Not long ago psychiatrists went out of their way to avoid antipsychotics in bipolar. This podcast series explains how that changed, whether the change was justified, and how to choose among them (parts one, two, and three)
Antidepressants. Who gets worse on them (also as Podcast). Should you ever use them in bipolar (also as Podcast and another Podcast)? Bupropion is the most favorable – but it’s riddled with myths. Seven common mistakes with antidepressants.
The Modafinils. How armodafinil (Nuvigil) and modafinil (Provigil) work in bipolar disorder and how to choose between them.
Thyroid augmentation. High dose thyroid (T3) may work in treatment-resistant bipolar depression and rapid cycling.
Cognition. Treatments that sharpen the mind in bipolar disorder (it’s a 2017 article, but little has changed since then, except lurasidone/Latuda improved cognition in a randomized controlled trial of euthymic bipolar disorder, and we know a lot more about how cognition gets better when metabolic health improves.).
History, Humanity, and More Fun
Hagop Akiskal. Paradox and passion marked the life of the man who rediscovered the bipolar spectrum.
Existential Despair in Bipolar. Nassir Ghaemi reflects on the personal impacts of the illness.
Bipolar and Punk Rock. Lou Reed, The Beach Boys, and Joy Division.
Cover image: Pablo Picasso, Harlequin and his Companion (Les deux saltimbanques), 1901