Treatment for bipolar disorders should include both pharmacotherapy and psychotherapy. Because stressful life events are associated with increases in relapse rates, therapy should address the number and severity of stressors in an individual’s life.
The pharmacological treatment of bipolar disorders is divided into initial treatment to get the condition under control, and maintenance treatment. Treatment of bipolar disorders requires different strategies for the patient who is experiencing mania, hypomania, or depression. The primary treatment has been mood stabilizers (lithium, valproic acid (Depakote, Depakene), carbamazepine (Tegretol), oxcarbazepine (Trileptal), lamotrigine, antipsychotics (primarily atypical), and benzodiazepines. Each of these medications is associated with a unique side effect and safety profile, and no one drug is predictably effective for all patients. Often, a practitioner will try different medications before an optimal treatment is found.
For the treatment of acute mania, lithium carbonate is considered the typical mood stabilizer. But because it can take a while to be effective, it is usually supplemented in the early stages of treatment by atypical antipsychotics, mood-stabilizing anticonvulsants, or high-potency benzodiazepines.
For treatment of bipolar depression, lamotrigine, quetiapine, (Seroquel), or other mood stabilizers or atypical antipsychotic medication can be used either alone or in combination. A fixed combination of olanzapine and fluoxetine has been shown to be effective in treating acute bipolar depression for an 8-week period without inducing mania or hypomania. Other medications may be used when a patient does not respond to standard antidepressants.
Maintaining the treatment of bipolar disorder to prevent recurrence of mood episodes is the greatest challenge of managing this condition. Lithium, carbamazepine, and valproic acid, alone or in combination, are the most widely used drugs in the long-term treatment of patients with bipolar disorder. In addition, thyroid supplementation is often needed during long-term treatment.
Patients may be asked to keep a daily record of their mood patterns or other facts that could help in finding the right treatment.
Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family, or group settings. Several types of therapy may be helpful. These include:
Mental Health Library Sources:
Information included in all topics of the Mental Health Library comes from the Desk Reference to the Diagnostic Criteria From DSM-5 and Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry. Complete diagnostic and treatment information may be found within these publications.
Information within the Mental Health Library is not intended to be used for self-diagnosis purposes. Rather, it is provided as a public educational service to make people aware of mental health conditions. Please consult a qualified mental health professional for a diagnosis of any suspected mental health illness.
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