Tell Me More About Bipolar Disorder.
2. What are the physical treatments of bipolar disorder?
Medications fall into three categories – mood stabilizers, anti-depressant medications, and anti-psychotic medications. Mood stabilizers provide relief from episodes of mania or depression or help prevent them from occurring.
One medication, Lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Mood stabilizing anti-convulsants, such as Carbamazepine and Valproate, are also useful especially in bipolar episodes that are difficult to treat.
Anti-depressant medications specifically treat the depressive episode. However, if given alone, anti-depressants can sometimes cause a major problem in bipolar disorder by pushing the mood up too high, causing hypomania or mania. Therefore, in bipolar disorder, anti-depressants are given together with a mood stabilizer.
Finally, anti-psychotic medications are used to treat psychotic symptoms. The newer anti-psychotic agents ("atypical anti-psychotics") are also being used to treat all phases of the illness, like mood stabilizers, even if no psychotic symptoms are present.
Manic Episode Treatment
The best way to initially treat a manic episode, especially an acute manic episode, is to combine a mood stabilizer with an anti-psychotic medication. The first line mood stabilizers are Lithium and Valproate, with Carbamazepine as a good back-up, are particularly effective in times of rapid emotional cycling. The first line anti-psychotics commonly used include Olanzapine, Risperidone, and Quetiapine. It is also common to prescribe other medications to help with poor sleep, anxiety, and restlessness. Such medications include benzodiazepines such as Clonazepam or Lorazepam, which are used on a short term basis only.
Depressive Episode Treatment
For severe depression, a mood stabilizer medication may need to be combined with an anti-depressant medication. Currently, there are over 40 anti-depressants available. Anti-depressants usually take several weeks to show effects. While waiting for the anti-depressant to work, it may be helpful to take a sedating medication to help relieve insomnia, anxiety, or agitation. If depression persists despite use of anti-depressants with a mood stabilizer, adding Lithium (if not already used) or changing the mood stabilizer might help. After a person recovers from the depression, the doctor will help decide whether to taper off the anti-depressant. Combinations of mood stabilizers can also be used for treating depression. Newer treatments for bipolar disorder include using Lamotrigine or atypical anti-psychotics such as Olanzapine and Quetiapine.
Recovery Treatment
Bipolar disorder is a highly recurrent illness. People are much more likely to stay well if they remain on medications rather than stop them. People with bipolar disorder are often tempted to stop taking their medication because the person feels fine or are bothered by the medication side-effects. Stopping the medication almost always results in relapse within weeks.
Treatment over the long-term depends on the severity of the illness. People with a mild single episode usually stay on medications for one to two years. For most people, longer-term treatments are recommended and in many cases treatment may be needed indefinitely.
Hospitalization
During severe episodes of depression or mania, a person may exhibit aggressive risk taking behaviours, fail to look after his/her basic needs, or become suicidal and homicidal. Hospitalization is needed if the person is a safety risk to self or others.
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