Bipolar Disorder
Treatment
Bipolar disorder is a treatable psychiatric disorder. Before beginning
treatment it is important to get a thorough evaluation to rule out
potential causes of a manic or depressive episode (illnesses, medications,
drugs, alcohol), and to evaluate the presence of other psychiatric
disorders.
Alcohol or drugs do not cause bipolar disorder, but they can
make it more difficult to diagnose. More than half of individuals with
bipolar disorder abuse substances at some time in their lives.
The most common types of treatment are psychotherapy, and
antidepressant and mood stabilizer medication. Often both are used
together. Other treatments include electroconvulsive therapy (ECT) and
light therapy. There is no cure for bipolar disorder; however, it can be
treated successfully, and many individuals can return to their normal
selves.
Medication Therapy
There are more than a dozen medications that are effective for treating
the depressive and manic phases, respectively. Often medications need to
be used in combination. Bipolar disorder is a chronic medical illness
similar to other chronic medical illnesses such as diabetes and thyroid
disorder; thus, long-term treatment is indicated. After the resolution of
the depressive phase it is often possible to discontinue antidepressant
medication and be maintained only on a mood stabilizer.
Unfortunately, medications tend not to work immediately. Antidepressant
medications generally take three to six weeks to become fully effective;
mood stabilizers begin to work more quickly for the manic phase.
For years lithium was the mainstay of treatment. During the past ten
years anticonvulsants such as Tegretol and Depakote have been demonstrated
to be effective in treating the manic phase, and other medications are
being studied as mood stabilizers.
If one medication does not work that does not mean that another
medication will not be helpful. More often than not it is necessary to
combine medications to achieve maximum therapeutic effect.
Psychotherapy
While medication can help control the symptoms of depression and mania,
psychotherapy can help the individual cope with the stresses that might
trigger episodes. The two individual psychotherapies that have been the
most extensively studied for their effectiveness in treating depression
are cognitive-behavior therapy and interpersonal therapy.
- In
cognitive-behavior therapy the focus is on current behaviors, thoughts,
and beliefs.
- In interpersonal therapy the focus is on current
relationships.
Family therapy is often a helpful adjunct to coping with
this illness because of its impact upon family functioning as well as the
individual.
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