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Understanding Bipolar Disorder
the Basics | Symptoms | Treatment
Treatment
This information on bipolar disorder is an overview of treatments for bipolar disorder. At present, treatment for bipolar disorder is most often with a combination of a mood-stabilizing drug and psychotherapy. The main mood-stabilizing drugs used for the treatment of bipolar disorder include lithium carbonate, valproic acid (also known as Depakote) and carbamazepine (Tegretol), Lamictal, Topamax, Gabitril, and many other antiepileptic agents. They also include some newer antipsycohitic agents. While drug treatment is primary, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. In addition, since denial is often a problem, routine psychotherapy helps patients stay on their medications. (Patient compliance is particularly tricky in adolescence.) Almost all forms of psychotherapy can be used -- cognitive, behavioral, or psychodynamic; individual, family, or group therapy.
The family or spouse of a patient should be involved with any treatment. Having full information about the disease and its manifestations is important for both the patient and loved ones.
Lithium carbonate has historically been the principal drug used in treating bipolar disorder. It can be remarkably effective in reducing mania, although doctors still do not know why. Lithium may also prevent recurrence of depression, but it is often given in conjunction with varying combinations of antidepressants. Other mood stabilizers that have proved helpful in treating the manic or mixed phases of the illness include Depakote and carbamazepine. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Neurontin and Lamictal are two of these newer choices and may be used in treatment-resistant cases.
When the depressive phase of bipolar disorder occurs, an antidepressant often needs to be used along with a mood stabilizer. The newly developed selective serotonin reuptake inhibitors (SSRIs) -- specific to the brain chemical serotonin -- are often the antidepressants of choice because they have fewer side effects than older drugs.
Among the SSRIs are Paxil, Prozac, and Zoloft. Other antidepressants include the tricyclics -- such as desipramine, imipramine, and amitriptyline, although these are used infrequently. Wellbutrin is similar to SSRIs but in a different class of drugs. Newer antidepressants include Effexor, Cymbalta and Remeron. In general, your doctor may try to keep the use of antidepressants limited and brief if possible, since prolonged used may actually trigger a manic episode or cause cycles to be more rapid.
Haloperidol, previously a mainstay of treatment in manic patients, or more recently, other newer antipsychotic medications, such as Zyprexa or Risperidal are often given to patients who fail to respond to lithium, or to treat acute symptoms of mania before lithium can take effect (seven to 10 days).
Many of these drugs can be toxic and should be closely monitored through blood tests to see that adequate levels have been reached and to detect any bad reactions early on. Because it is almost impossible to predict which patient will react to what drug or what the dosage should be, the psychiatrist will often need to experiment with several different medications when beginning treatment.
Electroconvulsive therapy (ECT) is sometimes used for severely manic or depressed patients and for those who don't respond to medication or for those women who, while pregnant, experience symptoms. Because it acts quickly, it can also help patients who are considered to be at high risk for committing suicide. ECT fell out of favor in the 1960s, but the procedure has been greatly refined since then. The patient is first anesthetized and a drug to prevent muscle contraction is given. Then an electric current is passed through the brain to produce a grand mal seizure of short duration -- no more than a few seconds. During the course of ECT treatments -- usually two to three weeks -- lithium and other mood stabilizers are discontinued to ensure an adequate response to the electrical stimulation.
Light therapy has proved effective as an additional treatment when bipolar disorder has a connection to the winter depression condition seasonal affective disorder. For those people who usually become depressed in winter, sitting for 20-30 minutes a day in front of a special light box with a full-spectrum light can effectively treat their depression.
At-Home Remedies
Maintain a calm environment, particularly when someone is in a manic phase. Keep to regular routines for daily activities -- sleeping, eating, and exercise. Adequate sleep is very important in preventing the onset of episodes. Avoid excessive stimulation: Parties, animated conversation, and long periods of watching television or videos can exacerbate manic symptoms.
IMPORTANT! Help and Support
In the manic phase, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car. Drinks and foods containing caffeine -- tea, coffee, cola and chocolate -- should be eliminated in the manic phase. Avoid alcohol at all times. It is very important for a patient experiencing manic symptoms to receive prompt psychiatric assessment. Family members may need to contact the doctor since, oftentimes, patients in a manic or hypomanic episode have little insight into their illness and may refuse treatment. But prompt intervention, including possible medication adjustments at an early point in an episode, may prevent further problems and the need for hospitalization.
the Basics | Symptoms | Treatment
