Bipolar disorder is a chronic condition that requires long term treatment.Treatment usually consists of medication, but psychotherapy can be of great benefit to people when combined with drug treatment.
Because of the nature of the illness, a single drug may not be enough to control symptoms during a mood episode, so often a combination of medication is necessary depending on the phase of the illness and the severity of the symptoms.
Mood stabilizers are the mainstay of drug treatment for bipolar disorder. They are used to treat manic, hypo manic and mixed episodes and are also used as long term, or maintenance treatment to prevent relapses and delay further mood episodes.
Some mood-stabilisers may take a week or two to reach a therapeutic blood level and then they may take a few more weeks to take effect. In acute situations, another drug may be needed while the mood-stabiliser starts to take effect.
The most commonly used mood stabilizer is lithium. This is the oldest and most widely used treatment and is usually the first drug you will be prescribed when diagnosed with bipolar disorder. Common side effects include : lethargy, diarrhea, nausea, frequent urination, tremor and weight gain. The blood level of lithium must be monitored regularly because the therapeutic blood
level is quite close to the toxic level. Once a stable blood level has been established, blood tests can be done every 4-6months.
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Antidepressants are used in the depressed phase of the illness. There are several types of antidepressant, each with a different mechanism of action. The most common are:
SSRIs (Selective Serotonin Re-uptake Inhibitors)
MAOIs (Monoamine Oxidase Inhibitors)
Bupropion (available in the USA only)
If used alone, antidepressants can sometimes cause “switching” into mania. Typically a mood stabilizer is prescribed in addition to the antidepressant to prevent this “overshoot” into mania. Antidepressants can take several weeks to take effect.
ECT (Electro convulsive Therapy) may be used for very severe, treatment resistant depression.
If the depression is very severe, hospitalization may be necessary because of the risk of suicide.
Mania is usually treated with a mood stabilizer, but additional treatment with a drug used to treat anxiety (an anxiolytic) may also be needed for the insomnia or agitation typically experienced in a manic episode.
If the manic symptoms are particularly severe, for example if delusions are experienced, an anti psychotic drug may be given in addition to the above.
Anxiolytic and anti psychotic medication acts quickly and may only be needed for a few weeks to control the acute symptoms.
Brief hospitalization may be necessary for the safety of an individual during a manic episode. Often people can lose insight into their illness during a manic episode. They need close supervision to prevent harm to themselves and to others.
Most Commonly Used Bipolar Medications
A review of the new antipsychotics–clozapine,
olanzapine, quetiapine, risperidone, sertindole,
and ziprasidone. Information reflecting current
knowledge about these medications’ clinical
efficacyin disorders other than schizophrenia
is also presented