How Bipolar Is Treated

There is currently no cure for bipolar disorder.  Bipolar disorder is a lifelong and recurrent illness. People with the disorder need long-term treatment to maintain control of bipolar symptoms.  Proper treatment helps most people gain better control of their mood swings and related symptoms.  An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

 

Medications

• Bipolar disorder can be diagnosed and medications prescribed by people with an M.D.
• Usually, bipolar medications are prescribed by a psychiatrist.
• In many states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications.
• Not everyone responds to medications in the same way. 
• Sometimes many different medications may need to be tried before the best course of treatment is found.
• Keeping a daily tracker that tracks mood symptoms, medication compliance, sleep patterns, nutrition information, and life events can help the doctor track and treat the illness most effectively. 
• A daily journal can also be a great source for helping doctor track and treat the illness most effectively.
•  Before starting a new medication, people with bipolar disorder should talk to their doctor or pharmacist about the possible risks and benefits.
•  If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible.
• The doctor may change the dose or prescribe a different medication.
• People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first.
• Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

Mood Stabilizers And Anticonvulsants

• Mood stabilizing medications are usually the first choice to treat bipolar disorder.
• In general, people with bipolar disorder continue treatment with mood stabilizers for years. 
• Except for lithium, many of these medications are anticonvulsants.
• Anticonvulsant medications are usually used to treat seizures, but they also help control moods.

Lithium Carbonate (sometimes known as Eskalith or Lithobid)

• Lithium was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania.
• It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
• Lithium treatment may also cause low thyroid levels in some people.
• Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
• Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully.
• A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.
• Lithium is the only true mood stabilizer.

Depakote (valproic acid or divalproex sodium)

• Depakote was approved by the FDA in 1995 for treating mania and is a popular alternative to lithium for bipolar disorder.
• It is generally as effective as lithium for treating bipolar disorder.
• Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20 which causes a woman's eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods.
• This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms.
• Most of these symptoms will improve after stopping treatment with valproic acid.

Lamotrigine (Lamictal)

• In recent years this anticonvulsant received FDA approval for maintenance treatment of bipolar disorder and had proved to be a good choice for many people. 

Other Anticonvulsant Medications

• Including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed.
• There are no definitive studies that show that these medications are as effective as mood stabilizers.

 Atypical Antipsychotic Medications

• They are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.

 Olanzapine (Zyprexa)

• When given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.
• Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode.
• Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms.
• However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease.
• These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.

Aripiprazole (Abilify)

• Like olanzapine, aripiprazole is approved for treatment of a manic or mixed episode.
• Aripiprazole is also used for maintenance treatment after a severe or sudden episode.
• As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.

Quetiapine (Seroquel)

• Relieves the symptoms of severe and sudden manic episodes.
• In that way, quetiapine is like almost all antipsychotics.
• In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.

Risperidone (Risperdal) and ziprasidone (Geodon)

• These are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.

Antidepressant Medications

• Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. 
• However, people with bipolar disorder who take antidepressants should take a mood stabilizer as well.
• Taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms.
• Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

Benzodiazapines

 

Benzodiazepines are a class of drugs primarily used for treating anxiety, seizures, and insomnia.  Benzodiazapines are also commonly used for general anesthesia, sedation prior to surgery, muscle relaxation, alcohol withdrawal, nausea, vomiting, depression, and panic attacks.  Benzodiazepines affect gamma-aminobutyric acid (GABA), a neurotransmitter chemical that nerves use to communicate with one another.  Scientists believe that excessive activity of nerves in the brain may be the cause of anxiety and other psychological disorders, and GABA reduces the activity of nerves in the brain, benzodiazepines may be working by increasing the effects of GABA in the brain and spinal cord.  Benzodiazepines are not meant for long term use and should be closely monitored by a doctor.

•  Alprazolam (Xanax), chlordiazepoxide (Librium), chlorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and midazolam are used for anxiety disorders.
• Clonazepam (Klonopin), clorazepate (Tranxene), and diazepam (Valium) are used for seizure disorders.
• Estazolam, flurazepam, quazepam (Doral), temazepam (Restoril), and triazolam (Halcion) are used for insomnia.
• Midazolam, lorazepam (Ativan), and diazepam (Valium) are used in anesthesia.
• Diazepam (Valium) also is used for muscle relaxation.
• Chlordiazepoxide (Librium) is used for alcohol withdrawal.

All benzodiazepines will cause physical dependence if used for long periods of time. Suddenly stopping therapy after a few months of daily therapy is not recommended as it will cause withdrawal symptoms which include a feeling of loss of self-worth, agitation, insomnia as well as the possibility of seizures, tremors, muscle cramping, vomiting, and sweating.  It's highly suggested to taper down the dosage over time under the supervision of a doctor when stopping a benzodiazepine especially if you've been using these drugs over a period of years.

 Psychotherapy

•  In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder.
• It can provide support, education, and guidance to people with bipolar disorder as well as their families.
•  A licensed psychologist, social worker, or counselor typically provides these therapies.

Cognitive behavioral therapy (CBT)

• Helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.

Family-focused therapy (includes family members)

• This peer to peer approach helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one.
• This therapy also improves communication and problem-solving.

Interpersonal and social rhythm therapy

• This form of therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines.
• Having regular daily routines and sleep schedules may help protect against manic episodes.

Psychoeducation

• This peer to peer approach of therapy teaches people with bipolar disorder about the illness and its treatment.
• This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs.
• Usually done in a group, psychoeducation may also be helpful for family members and caregivers.