What is the Treatment for Bipolar Disorder?

How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.

The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.

Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.

These drugs are relatively safe but they don't come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.

For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.

What is the treatment for bipolar depression? In general, the mood stabilizers' dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a "therapeutic level." If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.

If these measures don't help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.

When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.

Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug's indication, side effects, and prognosis with or without treatment is a must.

Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won't suffice to address financial problems, marital conflict, work issues, and prior abuse.

In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.

Copyright © 2004. Dr. Michael G. Rayel ? author (First Aid to Mental Illness?Finalist, Reader's Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: An Emotional Intelligence Game. For info, visit http://www.oikosgame.com and http://www.soardime.com.

---

Behavioral Manifestations of Alzheimer?s Dementia

Alzheimer's Dementia has a combination of cognitive and behavioral manifestations.... Read More

Rediscovering the Mind

From the viewpoint of a modern microbiologist, we hear the... Read More

The Essence of Being Human

What does it mean to be Human? Well if you... Read More

Randomness of Human Thought

Random thought Sequence in the Human Mind. I want to... Read More

Jack the Ripper

At around 3.40am on August 31st 1888, a carter named... Read More

Attention Deficit Hyperactivity Disorder is Not Related to I.Q.

It's important to know that Attention Deficit Hyperactivity Disorder and... Read More

Morality As A Mental State

INTRODUCTIONMoral values, rules, principles, and judgements are often thought of... Read More

What?s the Problem: Introducing Solution Focus Pt 1

Solution Focus is the brain child of Insoo Kim Berg... Read More

What is the Theory of Multiple Intelligences? Part 1: Biological Basis

Howard Gardner's theory of multiple intelligences is based on the... Read More

Solution Focus Process: Solution Talk vs. Problem Talk Pt I

Solution Talk vs. Problem TalkProblem talk, of course, is talk... Read More

Mind Over Matter - Proven

THE ACTS OF CREATION:The following quote is a review I... Read More

Panic Attacks: Effective Ways to Cope

Jill is a 21 y/o college student who used to... Read More

Intuition

I. The Three IntuitionsIA. Eidetic IntuitionsIntuition is supposed to be... Read More

Intro to Being an ADHD Parent

In my fifteen years of private practice working with children... Read More

The Myth of Mental Illness

"You can know the name of a bird in all... Read More

The Iron Mask - The Common Sources of Personality Disorders

Do all personality disorders have a common psychodynamic source?To what... Read More

Why Other Children are Rejecting Your Child

IntroductionDeveloping healthy peer relationships is critical for the normal development... Read More

The Cultural Narcissist - Lasch In An Age Of Diminishing Expectations

"The new narcissist is haunted not by guilt but by... Read More

What is Narcissism?

A pattern of traits and behaviours which signify infatuation and... Read More

Why Does It Seem That There Are More Children With ADHD Than Ever Before?

Even though the percentage of people with Attention Deficit Hyperactivity... Read More

How Big of a Problem is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder - "ADD" or "ADHD" - affects... Read More

Psychological Tips for Effective Studying

STUDY STRATEGIES* Revise regularly- Revision should be continuous if you... Read More

What?s the Problem: Introducing Solution Focus Pt 2

Again, many of us think we listen, yet we don't... Read More

Solution Focus Process: Solution Talk vs. Problem Talk Pt 2

It is crucial that interviewing with helpee progress toward solutions.... Read More

What is the Theory of Multiple Intelligences? Part 2: Cultural Influence

Howard Gardner's theory of multiple intelligences developed as he worked... Read More

No Picnic In Sight

Upon being diagnosed with Obsessive-Compulsive Disorder, I saw the reality... Read More

The Cyber Narcissist

To the narcissist, the Internet is an alluring and irresistible... Read More

Synchronized Swimming Advantage for Twins

The Olympic Contests for Synchronized Swimming are a testament to... Read More

Short Story: The Next Level of Humanity

"Hey Mac, have you ever been thinking of someone and... Read More

Attention Deficit Hyperactivity Disorder: Neurologically Based

Attention Deficit Hyperactivity Disorder is a neurologically based disorder. This... Read More

Self Hypnosis or Shelf Hypnosis?

Self hypnosis is usually thought of as a person listening... Read More

Human Psychological Issues in the Recruitment of Suicide Bombers

Swedish Scientists did a study and found that young men... Read More

Are All Dementias Alzheimer?s?

I'm surprised when some patients and caregivers confuse dementia and... Read More