Bipolar Disorder: Treatment Overview
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Treatment Overview
Although there is no cure for bipolar disorder, it can be effectively treated with a combination of medications and counseling. It is important to take your medications exactly as prescribed, even when you feel well. Your doctor may have to try different combinations of medications to find what's right for you.
Initial treatment
The first treatment for bipolar disorder often happens in the "acute" phase, when a person may have his or her first manic episode. In the acute phase, you may be suicidal or psychotic or using such poor judgment that you are in danger of harming yourself. Your doctor may decide you should be hospitalized for your own safety, especially if he or she believes you are suicidal. Medications that may be used for initial treatment include:
- Mood stabilizers, such as lithium carbonate (Eskalith, Lithane, and Lithobid, for example). Experts believe lithium may affect certain brain chemicals (neurotransmitters) that cause mood changes, but how the medication works is not completely understood. Anticonvulsants, such as valproate sodium (Depakene Syrup), divalproex (Depakote), and carbamazepine (Tegretol and Equetro) are also mood stabilizers. Valproate and divalproex are used to treat manic episodes. The anticonvulsant lamotrigine (Lamictal) was approved for the long-term maintenance treatment of bipolar I disorder and may be helpful for depression. Anticonvulsants can be helpful in hard-to-treat bipolar episodes. A mood stabilizer and an antipsychotic are often used as the first medications for acute manic episodes.
- Antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), and haloperidol (Haldol). Antipsychotics improve manic episodes. They may be used in combination with mood stabilizers and anticonvulsants.
- Benzodiazepines, such as diazepam (Valium). These may be used instead of antipsychotics or as an additional medication during a manic phase.
Ongoing treatment
Ongoing treatment for bipolar disorder includes counseling and adjusting medications with the goal of preventing manic and depressive episodes. It may take months for your symptoms to go away and for you to be able to function normally.
Mood stabilizers are generally used long-term, and other medications are prescribed for episodes of mania or depression that happen even though you are taking the mood stabilizers. If you've had three or more manic episodes, you may benefit by taking medications for the rest of your life. Counseling may help you deal with troubled relationships and enable you to function at work.
Antidepressants, such as fluoxetine (Prozac, for example), are used very carefully to treat depression because they can trigger a manic episode. Experts now recommend that antidepressants only be used for short periods of time during severe episodes of depression and that they be combined with mood stabilizers.9
Treatment if the condition gets worse
In some cases, electroconvulsive therapy (ECT) may be an option. In this procedure, brief electrical stimulation to the brain is given through electrodes placed on the head. The stimulation produces a short seizure that is thought to balance brain chemicals.
If you also have anxiety symptoms, such as worrying and not sleeping, panic attacks, or symptoms of psychosis, you may need additional medications.
What To Think About
When you and your doctor are discussing your medications, think about whether your lifestyle allows you to take medications on time every day. A medication you only take once a day may work best for you if you have a hard time remembering to take your medications.
The side effects of the medications should also be considered. You may be able to tolerate some side effects better than others. Discuss the side effects of each medication with your doctor as you consider your treatment options.
The use of antidepressants alone has been linked to an increase in manic episodes.7 Antidepressant treatment needs to be monitored closely and always used in combination with other drugs, such as mood stabilizers or antipsychotics, to avoid causing a manic episode.9
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| Last updated: | April 18, 2006 |
|---|---|
| Author: | Cynthia Tank |
| Reviewed By: | Adam Husney, MD - Family Medicine, Lisa S. Weinstock, MD - Psychiatry |
| Editors: | Susan Van Houten, RN, BSN, MBA, Terrina Vail |
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