Bipolar Disorder (cont.)
How is bipolar disorder treated?
Most people with bipolar disorder—even those with the most severe forms—can
achieve substantial stabilization of their mood swings and related symptoms with
proper treatment.
Because bipolar disorder is a recurrent illness, long-term preventive treatment
is strongly recommended and almost always indicated. A strategy that combines
medication and psychosocial treatment is optimal for managing the disorder over
time.
In most cases, bipolar disorder is much better controlled if treatment is
continuous than if it is on and off. But even when there are no breaks in
treatment, mood changes can occur and should be reported immediately to your
doctor. The doctor may be able to prevent a full-blown episode by making
adjustments to the treatment plan. Working closely with the doctor and
communicating openly about treatment concerns and options can make a difference
in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms,
treatments, sleep
patterns, and life events may help people with bipolar disorder and their
families to better understand the illness. This chart also can help the doctor
track and treat the illness most effectively.
Medications
Medications for bipolar disorder are prescribed by psychiatrists—medical
doctors (M.D.) with expertise in the diagnosis and treatment of mental
disorders. While primary care physicians who do not specialize in psychiatry
also may prescribe these medications, it is recommended that people with bipolar
disorder see a psychiatrist for treatment.
Medications known as "mood stabilizers" usually are prescribed to help
control bipolar disorder. Several different
types of mood stabilizers are available. In general, people with bipolar
disorder continue treatment with mood stabilizers for extended periods of time
(years). Other medications are added when necessary, typically for shorter
periods, to treat episodes of mania or depression that break through despite the
mood stabilizer.
- Lithium, the first mood-stabilizing medication approved by the U.S. Food
and Drug Administration (FDA) for treatment of mania, is often very
effective in controlling mania and preventing the recurrence of both manic
and depressive episodes.
- Anticonvulsant medications, such as valproate (Depakote®) or
carbamazepine (Tegretol®), also can have mood-stabilizing effects and may
be especially useful for difficult-to-treat bipolar episodes. Valproate was
FDA-approved in 1995 for treatment of mania.
- Newer anticonvulsant medications, including lamotrigine (Lamictal®),
gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to
determine how well they work in stabilizing mood cycles.
- Anticonvulsant medications may be combined with
lithium, or with each
other, for maximum effect.
- Children and adolescents with bipolar disorder
generally are treated with lithium, but valproate and carbamazepine
also are used. Researchers are evaluating the safety and efficacy of these
and other psychotropic medications in children and adolescents. There is
some evidence that valproate may lead to adverse hormone changes in teenage
girls and polycystic ovary syndrome in women who began taking the medication
before age 20. Therefore, young
female patients taking valproate should be monitored carefully by a
physician.
- Women with bipolar disorder who wish to conceive, or who become pregnant,
face special challenges due to the possible harmful effects of existing mood
stabilizing medications on the developing fetus and the nursing infant.
Therefore, the benefits and risks of all available treatment options should
be discussed with a clinician skilled in this area. New treatments with
reduced risks during pregnancy and lactation are under study.
Treatment of bipolar depression
Research has shown that people with bipolar
disorder are at risk of switching into mania or
hypomania, or of developing rapid cycling, during
treatment with antidepressant medication.
Therefore, "mood-stabilizing" medications
generally are required, alone or in combination with
antidepressants, to protect people with bipolar
disorder from this switch. Lithium and
valproate are the most commonly used
mood-stabilizing drugs today. However, research
studies continue to evaluate the potential
mood-stabilizing effects of newer medications.
- Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine
(Zyprexa®), risperidone (Risperdal®),
quetiapine (Seroquel®), and ziprasidone (Geodon®), are
being studied as possible treatments for bipolar disorder. Evidence suggests
clozapine may be helpful as a mood stabilizer for people who do not respond
to lithium or anticonvulsants. Other research has
supported the efficacy of olanzapine for acute mania, an
indication that has recently received FDA approval.
Olanzapine may also help relieve psychotic depression.
- If insomnia is a problem, a high-potency benzodiazepine medication such as
clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote
better sleep. However, since these medications may be habit-forming, they
are best prescribed on a short-term basis. Other types of sedative
medications, such as zolpidem (Ambien®), are sometimes used instead.
- Changes to the treatment plan may be needed at various times during the
course of bipolar disorder to manage the illness most effectively. A
psychiatrist should guide any changes in type or dose of medication.
- Be sure to tell the psychiatrist about all other prescription drugs,
over-the-counter medications, or natural supplements you may be taking. This
is important because certain medications and supplements taken together may
cause adverse reactions.
- To reduce the chance of relapse or of developing a new episode, it is
important to stick to the treatment plan. Talk to your doctor if you have
any concerns about the medications.
Thyroid function
People with bipolar disorder often have abnormal thyroid gland function.
Because too much or too little thyroid hormone alone can lead to mood and energy
changes, it is important that thyroid levels are carefully monitored by a
physician.
People with rapid cycling tend to have co-occurring thyroid problems and may
need to take thyroid pills in addition to their medications for bipolar
disorder. Also, lithium treatment may cause low thyroid levels in some people,
resulting in the need for thyroid supplementation.
Medication side effects
Before starting a new medication for bipolar disorder, always talk with your
psychiatrist and/or pharmacist about possible side effects. Depending on the
medication, side effects may include weight gain, nausea, tremor, reduced sexual
drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be
sure to tell the doctor about all side effects you notice during treatment. He
or she may be able to change the dose or offer a different medication to relieve
them. Your medication should not be changed or stopped without the
psychiatrist's guidance.
Psychosocial treatments
As an addition to medication, psychosocial treatments—including certain forms of
psychotherapy (or "talk" therapy)—are helpful in providing support, education,
and guidance to people with bipolar disorder and their families. Studies have
shown that psychosocial interventions can lead to increased mood stability,
fewer hospitalizations, and improved functioning in several areas.
A licensed psychologist, social worker, or counselor typically provides these
therapies and often works together with the psychiatrist to monitor a patient's
progress. The number, frequency, and type of sessions should be based on the
treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder are cognitive
behavioral therapy, psychoeducation, family therapy, and a newer technique,
interpersonal and social rhythm therapy. NIMH (National Institute of Mental
Health) researchers are studying how these interventions compare to one another
when added to medication treatment for bipolar disorder.
- Cognitive behavioral therapy helps people with bipolar disorder learn to
change inappropriate or negative thought patterns and behaviors associated
with the illness.
- Psychoeducation involves teaching people with bipolar disorder about the
illness and its treatment, and how to recognize signs of relapse so that
early intervention can be sought before a full-blown illness episode occurs.
Psychoeducation also may be helpful for family members.
- Family therapy uses strategies to reduce the level of distress within the
family that may either contribute to or result from the ill person's
symptoms.
- Interpersonal and social rhythm therapy helps people with bipolar disorder
both to improve interpersonal relationships and to regularize their daily
routines. Regular daily routines and sleep schedules may help protect
against manic episodes.
- As with medication, it is important to follow the treatment plan for any
psychosocial intervention to achieve the greatest benefit.
Other treatments
- In situations where medication, psychosocial treatment, and the
combination of these interventions prove ineffective, or work too slowly to
relieve severe symptoms such as psychosis or suicidality, electroconvulsive
therapy (ECT) may be considered. ECT may also be considered to treat acute
episodes when medical conditions, including pregnancy, make the use of
medications too risky. ECT is a highly effective treatment for severe
depressive, manic, and/or mixed episodes. The possibility of long-lasting
memory problems, although a concern in the past, has been significantly
reduced with modern ECT techniques. However, the potential benefits and
risks of ECT, and of available alternative interventions, should be
carefully reviewed and discussed with individuals considering this treatment
and, where appropriate, with family or friends.
- Herbal or natural supplements, such as St. John's wort (Hypericum
perforatum), have not been well studied, and little is known about their
effects on bipolar disorder. Because the FDA does not regulate their
production, different brands of these supplements can contain different
amounts of active ingredient. Before trying herbal or natural
supplements, it is important to discuss them with your doctor. There is
evidence that St. John's wort can reduce the effectiveness of certain
medications. In addition, like
prescription antidepressants, St. John's wort may cause a switch into mania
in some individuals with bipolar disorder, especially if no mood stabilizer
is being taken.
- Omega-3 fatty acids found in fish oil are being studied to determine their
usefulness, alone and when added to conventional medications, for long-term
treatment of bipolar disorder.
A long-term illness that can be effectively treated
Even though episodes of mania and depression naturally come and go, it
is important to understand that bipolar disorder is a long-term illness that
currently has no cure. Staying on treatment, even during well times, can help
keep the disease under control and reduce the chance of having recurrent,
worsening episodes.
- lithium, Eskalith, Lithobid - Learn more about lithium (Eskalith, Lithobid), including a description, generic and brand names, drug class and mechanism, preparations, storage, reasons for prescription, dosing, drug interactions, and common side effects.
- Depression - Read about depression causes, symptoms, diagnosis, treatment and types, including manic depression (bipolar disorder), postpartum depression and clinical depression.
- risperidone, Risperdal - Information about the drug risperidone (Risperdal) prescribed for mania, schizophrenia, stuttering, Tourette syndrome, and OCD (obsessive compulsive disorder).
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