Treatment for bipolar disorder for you or your family member begins with a thorough physical and psychiatric examination by a doctor that includes a careful assessment of the symptoms the individual is experiencing. The doctor will ask questions about medical conditions you may have, family history to detect the presence of the illness in other family members, as well as history of any past or current medications that may have been given to you by other doctors or clinicians for this condition, as well as what strategies that have or have not worked for you so far.
Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year's time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks.
However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state. If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse. Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.
Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person's response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication.
Bipolar Disorder Medications
Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.
Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.
Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.
Three types of medications are used to treat the different phases of bipolar disorder. They are:
- Mood Stabilizers
- Antidepressents
- Antipsychotic Medication
Mood stabilizers are typically prescribed for people with feeling "high", talkativeness, irritability, accelerated speech and other manic symptoms as well as depression that interfere with a person's functioning. These medications commonly reduce the intensity of mood swings and usually restore the person to a more normal level of functioning. Lithium, depakote and carbamazepine are common medications in this group. They also are particularly important to help people prevent symptoms from coming back after they are controlled.
Antidepressants are prescribed for persons with the symptoms of depression. These may include feelings of sadness and depression as well as slowed, sluggish behavior. These medications help the body regain its energy so that the person has more interest in daily life. It is important to note that antidepressants may worsen manic symptoms and should be used after careful consultation with your doctor.
Antipsychotic medications are sometimes used for people with bipolar disorder who may have hallucinations or delusions. Hallucinations are perceptual experiences that are not actually occurring, such as hearing voices telling one to harm oneself. Delusions are fixed false beliefs about the self, such as "Everyone is out to get me." Antipsychotic medications can be very helpful in these cases and your or your loved one's doctor will have several to choose from, including newer medicines such as olanzapine, quietiapine, risperidol and ziprasidone.
Decades of research has shown that medications are an important treatment intervention with good results. The range of medications available allows your doctor to select the type most suitable for your or your family member's needs. When prescribing medication, doctors often think in terms of how the medication might affect different phases of the illness. The phases of bipolar disorder includes an initial manic and/or depressed stage, known as the ACUTE PHASE. The next is the early and initial recovery stage, known as the CONTINUATION OR EARLY STABLE PHASE. The third is the maintenance stage, or PROPHYLACTIC PHASE. Medicines may be changed as the course of recovery continues. It is important to know that all medications have benefits, risks and potential side effects. It is equally important to know that there are also risks in NOT taking medications. You should discuss all of these issues carefully with your doctor.
Side effects will be discussed between you and your doctor. Individuals who are using these medications will be carefully monitored in order to minimize these effects. Sometimes, changing medications will eliminate some side effects. Elderly patients, pregnant patients and mothers who are nursing should take particular care in discussing side effects in detail with their doctors.
Common Bipolar Disorder Medications and Generic Names
Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits. In some cases, side effects may not appear until a person has taken a medication for some time.
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.
Other Treatments for Bipolar Disorder
- Electroconvulsive Therapy (ECT) - For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.
Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30-90 seconds. People who have ECT usually recover after 5-15 minutes and are able to go home the same day.
Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.
ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.
- Sleep Medications - People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.
People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.
Further Reading