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Understanding Bipolar Disorder Treatments

Bipolar disorder is a complex condition in which people suffer from dramatic shifts in their activity levels, mood and energy that are so severe that they affect the person’s ability to carry out everyday tasks.

Everyone experiences some ups and downs in attitude during their daily lives. For people with bipolar disorder, these swings are more intense. They may frequently occur so they can totally disrupt their everyday lives. 

Previously referred to as manic-depressive illness, the disorder is characterized by feelings of either extreme depression, sometimes bordering on suicidal thoughts, or alternately of mania and euphoria, in which the person cannot stop working, talking or engaging in highly repetitive behaviors. These shifts lead to the initial labeling of the condition as ‘manic depression’, but recent investigations have shown that the condition is more complex, and the terms bipolar I and bipolar II are now more properly used.

Bipolar I is diagnosed when a person undergoes at least one manic episode of high activity, excitement and disruptive behavior. In a manic episode, a person may become delusional and behave strangely, indulge in wild sexual encounters, spend excessive amounts of money, and spout grandiose ideas. Basically, he or she has lost touch with reality. 

A person may also undergo a complete turnaround and suffer from periods of deep depression. In many ways, the periods of depression closely resemble chronic clinical depression, with low energy and activity, a sense of worthlessness or guilt, and these can go as far as suicidal thoughts. Symptoms of bipolar I depression can last for weeks or months, and can cycle back into a manic phase without any signs or warnings.

Bipolar II differs from Bipolar I mainly in the level of the “ups” experienced in a mania phase (labeled as a hypomanic episode.) People only feel more positive and excited, and rarely get into a full-blown mania in which they engage in reckless behavior. The clinical depression phases mirror the ones experienced by people with bipolar I. Almost all individuals with bipolar I disorder will develop depression episodes after their first manic episode.

Between two and three percent of the U.S. population suffers from either form of bipolar disorder, amounting to nearly six million people.

The disorder is highly heritable, with 70 to 80 percent of people with the disorder having at least one relative with either bipolar disorder or clinical depression. In the United States, the mean age of onset is in the early 20s.

Treating bipolar disorder

For many decades, diagnosis of bipolar disorder was missed, either because a patient did not bring the symptoms to their doctor’s attention, or because it was thought to be a psychiatric condition that needed psychotherapy or even psychoanalysis. Only with the first steps taken in the 1970s of administering lithium to patients suffering from depression did the wider field of medications for bipolar disorders receive attention from the pharmaceutical sector. Lithium is the single most effective treatment in psychiatry. Its side effects are easily manageable, and many patients stay on low-dose lithium for decades. Its benefits, in terms of the relief of mania and the prophylaxis of depression, are incalculable.

Today, the main treatments for Bipolar Disorder fall into 7 categories.

Today, the main treatments fall into 7 categories:

Mood stabilizers – based on lithium Carbolith (Eskalith, Lithobid): highly effective at controlling mood swings, particularly highs. Lithium can take up to a month to work fully, which makes it better for long-term treatment rather than for acute manic episodes. Laboratory tests of blood levels of lithium must be conducted periodically to avoid side effects.

Another mood stabilizer prescribed in place of lithium is Lamictal (active ingredient: lamotrigine): This drug helps to delay episodes of depression, mania, and mixed episodes, being especially helpful in preventing depression.

Anticonvulsive drugs like Depakote (active ingredient: sodium valproate) and Trileptal (active ingredient: oxcarbazepine) also work to level out mood swings. They work by calming hyperactivity in the brain. They are most often prescribed for people who have four or more episodes of mania and depression in a single year. They have more rapid action than lithium, but may produce unwanted side effects like feeling excessively tired or sleepy, headaches and weight gain.

Antipsychotics can be prescribed in some circumstances, to control psychotic symptoms such as hallucinations or delusions, although hypomanic episodes do not really classify as psychotic episodes. Drugs such as Abilify (active ingredient: aripiprazole), Vraylar (active ingredient: cariprazine), Seroquel (active ingredient: quetiapine fumarate), Zyprexa (active ingredient: olanzapine), Risperdal (active ingredient: risperidone), and Geodon (active ingredient: ziprasidone) are sometimes used in patients undergoing a bout of hypomania. 

Benzodiazepines are minor tranquilizers used for short-term control of acute bouts of hypomania such as insomnia or agitation.

Tricyclic Antidepressants like Seroquel (active ingredient: quetiapine fumarate) are used specifically for bipolar II depression. They work by increasing activity levels of serotonin and norepinephrine in the brain. Scientists believe these play a role in regulating mood. However, they can increase the risk of mania.

Antidepressants using selective serotonin reuptake inhibitor (SSRI), such as Prozac (active ingredient: fluoxetine), Paxil (active ingredient: paroxetine), and Zoloft (active ingredient: sertraline) may  also be used in bipolar II depression, but are thought to be likely to cause or worsen hypomania in bipolar I disorder.

Psychotherapy, such as cognitive-behavioral therapy or “talk” therapy, may also help.

Electroconvulsive Therapy (ECT) is a treatment for severe manic or depressive episodes where immediate intervention may be needed

Because bipolar disorder may involve recurrent episodes, ongoing treatment with medication is often recommended to prevent relapse.

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