Mental Health

Bipolar disorder requires lifelong treatment, even during periods when the patient feels better. Treatment is usually treated by a psychiatrist. The patient may have a team that includes a psychologist, or a social worker. The primary treatments for bipolar disorder include medications; individual, group or family psychological counseling (psychotherapy); and/ or education and support groups. “The overall treatment of bipolar disorder is conveniently approached by considering, the treatment of the manic or mixed-manic episode first, then the treatment of the depressive episode, in each instance considering three phases of treatment: acute, continuation, and preventive. As will be seen, of all the medications useful in bipolar disorder, lithium is probably the best choice as it is the only one which has been shown to be effective for all three phases of treatment for both manic and depressive episodes” (Boland 2010).

Lithium protects against depression and mania and it decreases the risk of suicide and short-term mortality. Lithium is used for the acute phase, the second mood stabilizer is Divalproex. It is effective in a couple of days, while Lithium takes longer time, usually one or two weeks. Some BD patients need to be locked in a closed unit, and those under acute mania need to be secluded. Continuation treatment consists of avoiding a breakthrough of symptoms while the episode stills on. Lithium is still used in this phase while blood tests are done because when mania is controlled, the blood levels rise as an indicator. Treatment should continue if the patient’s life is unstable, and if lithium was prescribed, it is important to continue the dose over a few weeks time, since abrupt discontinuation of lithium predisposes to a recurrence of mania. Preventive treatment continues with mood stabilizers, and with psychotherapy.

Olanzapine seems to be effective in the preventive treatment. For the depressive episode is important the patient takes a mood stabilizer at the same time to avoid the risk of an antidepressant triggering the mania episode. Other medication includes: Anticonvulsants. Mood-stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal). The medication asenapine (Saphris) may be helpful in treating mixed episodes. Common side effects include weight gain, dizziness and drowsiness. Rarely, other serious problems, such as skin rashes, blood disorders or liver problems. Antipsychotics. Such as aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel), may help people who don’t benefit from anticonvulsants. The only antipsychotic approved by the U.S. Food and Drug Administration (FDA) for treating BPD is quetiapine. Common side effects include weight gain, sleepiness, memory loss, involuntary body/ facial movements. Antidepressants. Sometimes antidepressants can trigger manic episodes, but must be taken along with a mood stabilizer. Symbyax. It works as a depression treatment and a mood stabilizer. Symbyax is approved by the FDA and some side effects can include weight gain, drowsiness and increased appetite. Benzodiazepines are anti anxiety medications that help with anxiety and improve sleep. Examples are clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). Some side effects can include drowsiness, reduced muscle coordination, and problems with balance and memory.