What are bipolar disorder medications and other treatments? Are there any home remedies or alternative treatments for bipolar disorder?
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 there is no cure for bipolar disorder, medications and psychotherapies remain the mainstays of treatment of this illness.
Also, 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 the ability to pay attention, that is associated with bipolar disorder and other mental health problems.
While some home remedies or alternative/over-the-counter 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.
Medications that treat bipolar disorder
In terms of the overall approach to treatment, people with bipolar disorder can expect their mental health professionals to consider several medical interventions in the form of medications, psychotherapies, and lifestyle advice.
Treatment of bipolar disorder with medications (psychopharmacology) tends to address two aspects:
- Relieving already existing symptoms of the manic or depressive phases of the illness
- Preventing symptoms from returning
Antipsychotic medications that are thought to be particularly effective in treating manic and mixed symptoms include:
Antipsychotic drugs belong to a group of medications called neuroleptics and are known for having the ability to work quickly (in 1-2 weeks) 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 drugs in this class, like haloperidol (Haldol), Thorazine (Chlorpromazine), and thioridazine (Mellaril), are more likely to cause muscle stiffness, shakiness, and very rarely uncoordinated muscle twitches (tardive dyskinesia) that can be permanent, healthcare professionals appropriately monitor the people they treat for these potential side effects on a long-term basis, as well.
Mood-stabilizer medications like lithium (Lithobid), as well as antiseizure (anticonvulsant) medications like 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:
- There are also combination serotonergic/adrenergic medications (SNRIs) like:
While antidepressant medication remains a mainstay of treatment for the sadness of bipolar disorder, the prescribing physician will remain watchful since there is some risk that antidepressants can induce a manic or near-manic (hypomanic) episode or the rapid mood-cycling pattern of symptoms.
When using medicines to prevent symptoms of manic or mixed episodes, mood-stabilizer medications like lithium or lamotrigine (Lamictal) are often used. Healthcare professionals who prescribe lithium monitor blood levels of the medication to be sure it is within a therapeutic, safe range of levels.
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 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 of 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) is sometimes 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 is severe and has inadequately responded to psychotherapies and several drug trials. Transmagnetic stimulation (TMS) has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of mildly resistant depression and is thought to be a helpful addition to medication in the treatment of bipolar disorder in individuals who have not responded to at least one trial of medication. However, it is not yet considered to be an adequate treatment for this illness by itself.
Talk therapy (psychotherapy) is an important part of helping individuals who are living with bipolar disorder achieve the highest level of functioning possible by improving ways of coping with the illness from day to day, as well as on a long-term basis. 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, at 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 are effective in treating bipolar disorder include:
- Family-focused therapy
- Cognitive behavioral therapy
- Interpersonal therapy
- Social rhythm therapy
Family-focused therapy involves the education of family members about the disorder and how to provide appropriate support (psycho-education) to their loved ones. This intervention also includes communication-enhancement training and problem-solving skills training for family members.
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, feeling sad, change in sleep pattern or appetite, general discontent, change in activity level, or increased irritability) that the person is beginning to experience either a mood episode or the triggers for mood episodes (like lack of sleep, use of alcohol or other drugs, exposure to severe stress).
In cognitive behavioral therapy, the clinician works to help the person with bipolar disorder identify, challenge, and decrease negative thinking and otherwise dysfunctional belief systems that may impair their functioning relationships and self-esteem.
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 the stability of sleep-wake cycles, to prevent or alleviate the sleep disturbances often associated with this disorder.