Treating Bipolar Disorder

No one knows exactly what causes bipolar disorder. While genetic vulnerability and life stress are involved in triggering it, experts believe that an underlying imbalance of brain chemicals produces the symptoms. When levels of these chemicals are too high, mania occurs. When levels are low, there is depression.

This biological understanding of the disorder has opened doors for targeted treatments.

The best treatment is a combination of medication and counseling, although electroconvulsive therapy (ECT) is often successful for people who don’t respond to traditional therapy or who can’t take the medications.

Doctors often treat the mania symptoms with one set of drugs, and use other drugs to treat depression. Certain drugs are also used for “maintenance” -- to maintain a steady mood over time. Antidepressants are not often used alone, because they may cause rapid cycling between depression and mania.

Most people respond well to medications for bipolar disorder. For many others, the symptoms do not completely disappear despite therapy. The moods may become less intense and more manageable, however.

Remember, getting your diagnosis should come as a relief. Now you know what the problem has been and you're on the road to getting the right treatment.

Mania

If you are suffering from mania, your doctor initially may treat you with an antipsychotic drug and/or a benzodiazepine to quickly control hyperactivity, sleeplessness, hostility, and irritability.

Your doctor will also likely prescribe a mood stabilizer. Mood stabilizers help control mood swings, prevent recurrences of mood swings, and reduce the risk of suicide. They are usually taken for a long time, sometimes years. Examples include lithium and certain anticonvulsant drugs.

Treatment of mania often requires hospitalization because there is high risk for unpredictable, reckless behavior and noncompliance with treatment. For people with extreme mania, pregnant women with mania, or those people whose mania can’t be controlled with mood stabilizers, doctors sometimes also recommend electroconvulsive therapy (ECT).

If mania occurs while on maintenance therapy, your doctor may simply change your medication dose. Or you may start taking an antipsychotic drug to lessen symptoms.

Nondrug treatments, such as psychotherapy, and establishing a well-ordered routine may help patients in their maintenance phase. This is often suggested along with medication.

Depression

Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania and then another episode of depression.

Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.

In April 2002, the American Psychiatric Association suggested using lithium or the anticonvulsant drug Lamictal as an initial treatment for people in the acute depressive phase of bipolar disorder who were not already taking a mood stabilizing medication. Sometimes Lamictal is added to lithium as well.

For more severely ill patients, some doctors may prescribe lithium and an antidepressant -- usually either Wellbutrin or Paxil, though other drugs can be used.

There are other options for treating bipolar depression.

The antipsychotic drug Zyprexa is also approved to treat bipolar depression when used with the antidepressant Zoloft. Other antipsychotic medications have also been studied and found effective in varying degrees.

If all else fails, doctors may recommend electroconvulsive therapy (ECT). It helps nearly 75% of the patients who try it.

Nondrug treatments -- such as psychotherapy and establishing a well-ordered routine -- may help patients in their maintenance phase. They are often suggested along with medication. Psychotherapy alone is not considered sufficient to treat bipolar depression.

continue: Lithium for Mood Stabilization

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Reviewed: 04/2006