Bipolar Disorder (cont.)
Roxanne Dryden-Edwards, MD
Roxanne Dryden-Edwards, MD
Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
What illnesses coexist with bipolar disorder?
In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental illnesses that may co-occur (be co-morbid) with bipolar disorder is important in preventing bad outcomes. For example, people with bipolar disorder are at increased risk of committing suicide, particularly after engaging in previous episodes of cutting or other self-harm. Therefore, mental health care professionals will take care to examine for any warning signs that the person with bipolar disorder is thinking of harming himself or herself or others. Individuals who suffer from this illness, in addition to either alcohol or substance abuse problems or borderline personality disorder, are also at particular risk of committing suicide. People with bipolar disorder are at higher risk of having an anxiety disorder like panic disorder, phobias, generalized anxiety disorder, or obsessive compulsive disorder (OCD).
What are bipolar disorder medications and other treatments? Are there any home remedies or alternative treatments for bipolar disorder?
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Many people, whether they suffer from bipolar disorder or any medical or other mental illness, understandably wonder how they might help themselves to have the best outcome of treatment. While medications and psychotherapies remain mainstays of treatment of bipolar disorder, lifestyle improvements can be important complementary measures to care for this population. For example, aerobic exercise has been found to help alleviate some of the thinking problems, like memory and ability to pay attention, that are associated with bipolar disorder and other mental health problems. While some home remedies or alternative treatments like St. John's wort have been found to help mild depression, they may induce a manic episode. There remains insufficient evidence that such treatments successfully treat manic symptoms. Although alternative medicine treatments for bipolar disorder like St. John's wort or ginkgo biloba are not recognized as standard care for bipolar disorder, as many as one-third of some patient groups being treated for this disorder report using them.
In terms of the overall approach to treatment, people with bipolar disorder can expect their mental health professionals to utilize several medical interventions in the form of medications, psychotherapies, and lifestyle advice. Treatment of bipolar disorder with medications tends to address two aspects: relieving already existing symptoms of mania or depression and preventing symptoms from returning. Medications that are thought to be particularly effective in treating manic and mixed symptoms include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify), paliperidone (Invega), asenapine (Saphris), and iloperidone (Fanapt). These medications belong to a group of medications called neuroleptics and are known for having the ability to work quickly compared to many other psychiatric medications. For this group of medications, side effects that occur most often include sleepiness, dizziness, and increased appetite. Weight gain, which may be associated with elevated blood sugar, elevated lipid levels, and sometimes increased levels of a hormone called prolactin, may also occur. Although older medications in this class that were not mentioned here are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, health care professionals appropriately monitor the people they treat for these potential side effects as well.
Mood-stabilizer medications like lithium (Lithobid), divalproex (Depakote), carbamazepine (Tegretol, Tegretol XR, Equetro, Carbatrol), and lamotrigine (Lamictal) can be useful in treating active (acute) symptoms of manic or mixed episodes, as well as preventing the return of such symptoms. These medications may take a bit longer to work compared to the neuroleptic medications, some (for example, lithium, divalproex, and carbamazepine) require monitoring of medication blood levels, and some can be associated with birth defects when taken by pregnant women.
Antidepressant medications are the primary medical treatment for the depressive symptoms of bipolar disorder. Examples of antidepressants that are commonly prescribed for that purpose include serotonergic (selective serotonin reuptake inhibitor or SSRI) medications like fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro); there are also combination serotonergic/adrenergic medications (SNRIs) like venlafaxine (Effexor), duloxetine (Cymbalta), and desvenlafaxine (Pristiq), as well as bupropion (Wellbutrin), which is a dopaminergic antidepressant. While antidepressant medication remains a mainstay of treatment for the depression of bipolar disorder, the prescribing physician will remain watchful since there is some concern that antidepressants can induce a manic or near-manic (hypomanic) episode or rapid mood cycling.
When using medicines to prevent symptoms of manic or mixed episodes, mood-stabilizer medications like lithium or lamotrigine (Lamictal) are often used. Health care professionals who prescribe lithium monitor blood levels of the medication to be sure it is within a therapeutic, safe level. The functioning of other body systems is frequently followed to quickly address any abnormal changes that may be associated with the medication. When a neuroleptic like olanzapine is used in combination with lithium, symptoms of relapse may be prevented for a longer period of time compared to when lithium is used alone. While lamotrigine tends to cause few side effects, practitioners tend to question the people they treat closely about symptoms of persistent fever, rash, or sore throat that may be warning signs for a rare but potentially fatal side effect. Depakote is also associated with that rare but potentially dangerous side effect. Medications like topiramate (Topamax) are being researched as a potential treatment for people with bipolar disorder who engage in pedophilia, sexual addiction, or are otherwise considered sexually deviant. While oxcarbazepine (Trileptal) continues to be used by many in an attempt to manage the mood swings of both adult and pediatric bipolar disorder, its effectiveness remains a matter of debate.
Despite its stigmatized history, electroconvulsive therapy (ECT) can be a viable treatment for people whose bipolar disorder has inadequately responded to psychotherapies and a number of medication trials.
Talk therapy (psychotherapy) is an important part of helping individuals with bipolar disorder achieve the highest level of functioning possible by improving ways of coping with the illness. These interventions are therefore seen by some as being forms of occupational therapy for people with bipolar disorder. Psychotherapy may also engage people with bipolar disorder who prefer to receive treatment without medication. While medications can be quite helpful in alleviating and preventing overt symptoms, they do not address the many complex social and psychological issues that can play a major role in how the person with this disease functions at work, home, and in his or her relationships. Since about 60% of people with bipolar disorder take less than 30% of their medications as prescribed, any supports that can promote compliance with treatment and otherwise promote the health of individuals in this population are valuable.
Psychotherapies that have been found to be effective in treating bipolar disorder include family focused therapy, psycho-education, cognitive therapy, interpersonal therapy, and social rhythm therapy. Family focused therapy involves education of family members about the disorder and how to provide appropriate support (psycho-education) to their loved one. This intervention also includes communication-enhancement training, and teaching family members problem-solving skills training. Psycho-education involves teaching the person with bipolar disorder and their family members about the symptoms of full-blown depressive and manic symptoms, as well as warning signs (for example, change in sleep pattern or appetite, change in activity level or increased irritability) that the person is beginning to experience either mood episode. In cognitive behavioral therapy, the mental health professional works to help the person with bipolar disorder identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems. The goal of interpersonal therapy tends to be identifying and managing problems the sufferers of bipolar disorder may have in their relationships with others. Social rhythm therapy encourages stability of sleep-wake cycles, with the goal of preventing or alleviating the sleep disturbances often associated with this disorder.
Reviewed by Melissa Conrad Stöppler, MD on 6/12/2012
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