By Dr Ananya Mandal, MD
The treatment of bipolar disorder is focused on reducing the severity of manic and depressive episodes and helping sufferers lead an as-near-to-normal life as possible. There is no known cure for the condition and treatment usually involves a combination of medication and counselling or psychotherapy.
If left untreated, manic or depressive phases may last for months and even as long as one year. Depressive phases are particularly harmful as they may lead to suicidal thoughts and urges to act on them. With treatment, symptoms usually subside after around three months and a stable mood is restored.
Mood stabilizers to prevent episodes of mania, hypomania, depression and establish a stable mood. Mood stabilizers may need to be taken daily and over long periods. One of the most commonly used agents of this class, lithium, is usually prescribed for periods of 6 months. The use of lithium may lead to severe side effects including vomiting and diarrhea and therefore requires regular monitoring. In addition, the drug should not be withdrawn or stopped abruptly as this may cause a flare-up of symptoms.
Anticonvulsant drugs can also act as mood stabilizers and include lamotrigine, carbamazepine and valproate.
Antipsychotics for the treatment of psychosis and mania may also be used and include aripiprazole, quetiapine, risperidone and olanzapine. Quetiapine is also suitable for long-term use as an antidepressant and mood stabilizer.
Talking therapy, cognitive behavioural therapy, family and group therapy, and counselling are all useful approaches for treating patients with bipolar disorder.
In individuals who experience a rapid cycling of high and low moods, a combination of lithium and valproate is usually prescribed. An alternative combination therapy is valproate and lamotrigine.
Lifestyle changes including regular exercise, adoption of a healthy and balanced diet, cessation of smoking or substance abuse, and reduction of alcohol and caffeine intake.
Reviewed by Sally Robertson, BSc
Last Updated: Sep 23, 2013