Bipolar Disorder

Treatment Overview

Although there is no cure for bipolar disorder, it can be effectively treated with a combination of medicines and counselling. It is important to take your medicines exactly as prescribed, even when you feel well. Your doctor may have to try different combinations of medicines to find what's right for you.

Initial treatment

The first treatment for bipolar disorder often happens in the acute phase, when a person may have his or her first manic episode. In the acute phase, you may be suicidal or psychotic or using such poor judgment that you are in danger of harming yourself. Your doctor may decide you should be hospitalized for your own safety, especially if he or she believes you are suicidal. Medicines that may be used for initial treatment include:

• Mood stabilizers, such as lithium carbonate (for example, Carbolith, Duralith, and Lithane). Experts believe lithium may affect certain brain chemicals (neurotransmitters) that cause mood changes, but how the medicine works is not completely understood.
• Anticonvulsant mood stabilizers, such as valproate sodium (Depakene Syrup), divalproex (Epival), and carbamazepine (Tegretol) are also mood stabilizers. Valproate and divalproex are used to treat manic episodes. The anticonvulsant lamotrigine (Lamictal) was approved for the long-term maintenance treatment of bipolar I disorder and may be helpful for bipolar depression. Anticonvulsants can be helpful in hard-to-treat bipolar episodes. A mood stabilizer and an antipsychotic are often used as the first medicines for acute manic episodes.
• Antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), and quetiapine (Seroquel). Antipsychotics can help improve symptoms in both manic and depressive episodes. They may be used in combination with mood stabilizers and anticonvulsants.
• Benzodiazepines, such as diazepam (Valium). These may be used instead of antipsychotics or as an additional medicine during a manic phase.

Managing a manic episode

Ongoing treatment

Ongoing treatment for bipolar disorder includes counselling and adjusting medicines with the goal of preventing manic and depressive episodes. It may take months for your symptoms to go away and for you to be able to function normally.

Mood stabilizers are generally used long-term, and other medicines are prescribed for episodes of mania or depression that happen even though you are taking the mood stabilizers. If you've had more than one manic episode, or one severe manic episode, you may benefit by taking medicines for the rest of your life. Counselling may help you deal with troubled relationships and enable you to function at work.

Atypical antipsychotic medicines are now being used for long-term treatment, but their effectiveness is still being studied.

Antidepressants, such as fluoxetine (for example, Prozac), are used very carefully to treat depression because they can trigger a manic episode. Experts now recommend that antidepressants only be used for short periods of time during severe episodes of depression and that they be combined with mood stabilizers.¹⁰

Managing a manic episode

Treatment if the condition gets worse

In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.

If you also have anxiety symptoms, such as worrying and not sleeping, panic attacks, or symptoms of psychosis, you may need additional medicines.

Managing a manic episode

What To Think About

When you and your doctor are discussing your medicines, think about whether your lifestyle allows you to take medicines on time every day. A medicine you only take once a day may work best for you if you have a hard time remembering to take your medicines.

The side effects of the medicines should also be considered. You may be able to tolerate some side effects better than others. Discuss the side effects of each medicine with your doctor as you consider your treatment options.

The use of antidepressants alone has been linked to an increase in manic episodes.⁸ Antidepressant treatment needs to be monitored closely to avoid causing a manic episode.

Unfortunately, many people don't seek treatment for bipolar disorder. You may not seek treatment because you think the symptoms are not bad enough or that you can work things out on your own. But getting treatment is important.

If you need help deciding whether to see your doctor, see some reasons why people don't get help and how to overcome them.

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Author:	Jeannette Curtis Ralph Poore	Last Updated: May 2, 2008
Medical Review:	Kathleen Romito, MD - Family Medicine Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine Lisa S. Weinstock, MD - Psychiatry
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