Treatment of Bipolar Disorder

Psychological treatment often focuses on the life adjustment problems that develop because of the manic episodes, and in helping the individual recognize the onset of a manic episode and take corrective action. Supportive counseling is needed, to help the individual accept that he/she has a chronic psychological problem that will have a major impact on life management. Anyone with bipolar disorder should be under the care of a psychiatrist skilled in its diagnosis and treatment, as well as a psychologist. Psychologists provide the individual and his/her family with support, education, coping skills training, They also help monitor the symptoms and encourage the individual to continue medical treatment. The psychiatrist monitors the medication that is usually required with this disorder.

Most people with manic depressive illness can be helped with treatment.

Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.  One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.  Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.

Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.  Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used. Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania.  The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia. Thyroid augmentation may also be of value. For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.  Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.  Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.

Treatment Issues

Symptoms of bipolar disorder may prevent those affected from recognizing that they have an illness.  Family, friends, and primary care physicians should provide encouragement and referrals for treatment. Psychological treatment can help the person and his/her family cope with the life management problems created by bipolar disorder. Medical treatment is usually needed to control mood swings with medication. To ensure proper treatment and personal safety, commitment to a hospital may be necessary for a person in a severe episode. Hospital commitment, which is placing a person in the hospital against their will, is sometimes necessary with bipolar disorder because of the effects of manic episodes. While the person is “high” he/she is not rational, and may engage in activities that are a threat to themselves or others. The person cannot understand the need for hospitalization because of the disturbance that occurs to his/her judgment. Suicidal thoughts, remarks, or behaviors should always be given immediate attention by a qualified professional. It is not true that if a person talks about suicide, they will not kill themselves. Self-destructive thoughts are sometimes acted out indirectly. For example, a person may drive excessively fast, or take drugs, or start confrontations with others, as a way to harm himself/herself. With appropriate treatment, the suicidal thoughts and behavior can be controlled and eliminated.

Bipolar disorder is a lifetime illness. To keep his/her mood stable, ongoing treatment is needed, even when the person is feeling better.  It may take time to discover the best treatment regimen for an individual. It is very important for both the person with bipolar disorder, and his/her family, to work with a psychologist and physician to develop the most appropriate treatment plan.  In addition to treatment, mutual support self-help groups can benefit patients and their families. National Depressive and Manic Depressive Association (NDMDA) and National Alliance for the Mentally Ill (NAMI) sponsor such groups.

Factors Preventing Early Detection of Bipolar Disorder

An early sign of manic-depressive illness may be hypomania--a state in which the person shows a high level of energy, excessive moodiness or irritability, and impulsive or reckless behavior.  Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong. In its early stages, bipolar disorder may masquerade as a problem other than mental illness. For example, it may first appear as alcohol or drug abuse, or poor school or work performance. If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.

Features of a Depressive Episode

Denial of problem

Provided by ArmMed Media
Revision date: July 5, 2011
Last revised: by Tatiana Kuznetsova, D.M.D.

RELATED STORIES:
Depression Treatment   Is It Clinical Depression or Sadness?   First Person Description of Major Depression   Selective Serotonin Reuptake Inhibitors (SSRI)   What Happens in the Depressed Brain?   Antidepressant Classes   Learn About Depression and Anxiety Disorders   Antidepressant Medication during Pregnancy & Postpartum   Don’t Stop Taking Your Antidepressants   Treatment of Major Depression   Major Depression in Children and Adolescents   Major Depression (Clinical Depression)

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