Mathew J. Kosik, CAADC, LMSW

Episodes may be a mixture of both manic and depressive symptoms. In such an episode, individuals with bipolar disorder may feel sad, empty, and hopeless but have a high level of energy at the same time. Sometimes, changes in mood are less dramatic. For example, individuals may feel happy and think everything is fine, but people around them may notice their mood changes. Episodes like this are called hypomania. If an individual is hypomanic and does not receive proper treatment, their condition will likely worsen.

Generally considered a lifetime illness, the disorder begins in the late teen or early adult years. Bipolar disorder has no known cause, but research has shown that it tends to run in families. To diagnose it, a psychiatrist carefully assesses an individual's moods and behavior patterns. They may also be asked to keep a daily record of their moods and other factors that can help with diagnosis and determining the right course of therapy. Counseling is a typical form of treatment, as is a group of medications that can control symptoms, called antipsychotics.

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

• Frequent intense sexual fantasies, urges, and behaviors that feel involuntary or beyond an individual's control
• Numerous unsuccessful attempts to stop or reduce sexual behaviors
• The use of sexual behaviors as an attempt to deal with other problems, such as loneliness or depression
• Feeling guilt or remorse after engaging in repeated sexual behaviors
• The inability to stop engaging in sexual behaviors despite negative consequences such as contracting a sexually transmitted infection, damaging important relationships, losing a job, or developing financial or legal problems
• Continuing to engage in repeated sexual behaviors despite receiving little or no satisfaction from them

Compulsive sexual behavior can occur regardless of an individual's gender or sexual orientation, though it may be more common in men. The risk of compulsive sexual behavior may also be higher for people who have alcohol or drug use disorders, other mental health disorders, or childhood traumas, including sexual abuse.

While the causes of compulsive sexual behavior remain unknown, theories of possible causes include:

• Imbalance of brain chemicals affecting mood: certain chemicals in the brain, such as serotonin, dopamine, and norepinephrine, help control mood. When these chemicals are out of balance, sexual desire and behavior could be affected.
• Altered brain pathways: over time, compulsive sexual behavior might cause changes in the brain's pathways, especially in areas of the brain related to reinforcement. Eventually, more intense sexual content and stimulation are usually needed to obtain satisfaction or relief.
• Conditions that affect the brain: some health conditions, such as dementia, epilepsy, or bipolar disorder, may cause damage to parts of the brain that affect sexual behavior. Also, certain medications used to treat Parkinson's disease may cause compulsive sexual behavior.

There is ongoing debate among mental health experts over how to classify compulsive sexual behavior. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, serves as the predominant guide for diagnosing mental health conditions in the United States and does not include compulsive sexual behavior as a diagnosis. However, the condition may sometimes be diagnosed as part of another mental health condition, such as an impulse control disorder or a behavioral addiction. In contrast, the World Health Organization recently identified compulsive sexual behavior disorder as a diagnosis, which it includes among impulse control disorders.

Determining if sexual behaviors have become a problem is not always straightforward, and more research is required to establish standard guidelines for diagnosis. Nevertheless, whether hypersexual behavior is a compulsion or an addiction, there are individuals engaging in these behaviors who would like to receive help with managing their behavior. There are mental health professionals who specialize in treating addictions, including and compulsive sexual behaviors. Compulsive sexual behavior may be treated with:

• Psychotherapy: essentially, a mental health professional will help individuals identify and manage factors that might trigger compulsive sexual behaviors. Psychotherapy may be provided in individual sessions, as well as sessions with families or couples. These sessions may take place in person or online.
• Medications: while there is currently no medication specifically approved to treat compulsive sexual behavior, some medications used to treat other conditions may be prescribed, such as antidepressants, anti-anxiety medications, or mood stabilizers. These medications act on brain chemicals linked to urges and behaviors. They can lessen sexual urges and brain-chemical rewards that certain behaviors might provide. The medications that are most appropriate for an individual depends on that individual's circumstances, including any other mental health conditions.
• Support groups: these groups can help individuals learn about compulsive sexual behavior, receive support and understanding, identify treatment options and coping techniques, and prevent relapse. Support groups are often modeled after the 12-step program of Alcoholics Anonymous. Mental health professionals may be able to recommend particular groups that meet locally or online.

The principal goal of treatment for compulsive sexual behavior is to help individuals manage urges and reduce problematic behaviors while still enjoying healthy relationships.