While no cure exists for bipolar disorder, effective management of this illness can enable most people to lead highly functioning, healthy lives. Managing bipolar disorder is complex and may include psychotherapy, medication and lifestyle changes. The support of loved ones and a strong commitment to your own wellness are key elements to disease management as well.
Medication
Drug treatment for bipolar disorder can include mood-stabilizing medications, anti-psychotic medications and anti-convulsants. Consulting a competent psychiatrist is vital, as medicating bipolar disorder is quite complex, and many risk factors exist. The National Institute on Mental Health cautions, "Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found."
It is important to note that misdiagnosis of depression occurs frequently with bipolar disorder because many people present for treatment when they experience serious depression. Taking antidepressants on their own can trigger manic episodes in people with bipolar disorder, so it is vital that a full history of mood and behavior be taken for accurate diagnosis and effective and safe treatment.
Mood-Stabilizing Medications
The most common treatment for bipolar disorder is mood-stabilizing medications. Treatment with mood-stabilizing medication is usually long term. Mood stabilizers are effective for treating both the manic and depressive symptoms, and for prevention or minimization of future symptoms. Mood stabilizers include lithium, the most frequently prescribed medication for bipolar disorder. Brand names for lithium include Eskalith and Lithobid. Valproic acid or divalproex sodium (Depakote) are somewhat newer alternatives to lithium and are anticonvulsants. The National Institute for Mental Health raises some concerns about young women taking valproic acid, which can be read here: nimh.nih.gov/health/publications/bipolar-disorder/how-is-bipolar-disorder-treated.shtml
Anti-Seizure Medications
Medications designed to control seizures are now commonly used as mood stabilizers. As mentioned, valproic acid and divalproex sodium are two anticonvulsants that can treat bipolar disorder. Lamictal is a newer drug in this class. RxList details some considerations regarding women using oral contraceptives taking Lamictal: rxlist.com/lamictal-drug.htm . Other anticonvulsant medications sometimes prescribed to treat bipolar disorder include gabapentin (Neurontin), oxcarbazepine (Trileptal) and topiramate (Topamax).
Many of the anticonvulsant medications come with an FDA warning that their use may increase the risk of suicidal thoughts and behaviors. The National Institute for Mental Health warns, "People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional."
Atypical Antipsychotic Medications
Atypical antipsychotic medications can treat the mania that can exist in bipolar I, and in certain cases can be included along with other medications to control symptoms. Earlier antipsychotic medications often carried serious side effects, and so the label "atypical antipsychotics" indicates that these drugs come from a new class and are different biochemically.
Atypical antipsychotic medications include Risperidone (Risperdal) and ziprasidone (Geodon). Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes, according to the National Institute of Mental Health. Olanzapine (Zyprexa) and Aripiprazole (Abilify) are also used. Clearly, a number of anticonvulsant medications treat bipolar disorder. A psychiatrist can help to inform patients about side effects, effective drug combinations and risks associated with usage.
Psychotherapy
Just about any psychotherapeutic modality can be effective in treating bipolar disorder. Some types of therapy include cognitive behavioral therapy, which focuses on how thinking affects behavior and feelings. It is generally very structured. Psychodynamic therapy works from the premise that each person is unique and that treatment should not be overly structured. A psychodynamic therapist pays close attention to the deeper processes of the patient, including dreams, longstanding patterns, childhood experiences, and relationship history. These are the two most common types of psychotherapy, and both (and others) can be greatly helpful for people struggling with bipolar disorder and its impact on their lives. Often, a patient will sign releases for his psychotherapist and psychiatrist to consult, which can streamline treatment.
