As with heart disease and other medical conditions, bipolar disorder treatment focuses on taking the right medications and making lifestyle changes to reduce the risk of episodes.
In most cases, symptoms can be managed with the right combination of medication, psychotherapy and social/emotional support.
If left untreated, bipolar disorder tends to worsen, and the person experiences episodes of full-fledged mania and clinical depression.
Once bipolar medication is started, some individuals may live many years free of symptoms. Others continue to have mild but troubling depression or mood swings.
Bipolar Medications
Most people with bipolar disorder — even those with the most severe forms — can be helped by bipolar medication.
Because antidepressants alone can actually encourage episodes of mania or set off more frequent cycles, they are not the medication of choice in most cases of bipolar disorder.
A mood stabilizer combined with an antipsychotic or anticonvulsant is typically prescribed as part of the bipolar disorder treatment plan.
Antidepressants
While antidepressants are typically not prescribed alone for the treatment of manic depression, they are often prescribed in conjunction with another bipolar medication, typically a mood stabilizer, to help manage depressive episodes.
Common antidepressants include certain types of selective serotonin reuptake inhibitors (Zoloft®, Paxil®, Prozac®) and monocyclic aminoketones (Wellbutrin®).
Because they both have a low incidence of causing manic episodes, first choice antidepressants are Zoloft (especially in teens) and Wellbutrin.
While Paxil is in the same class of drugs as Zoloft and Prozac, it also has anti-anxiety effects.
Mood Stabilizers
One mood stabilizing bipolar medication, lithium, is usually very effective in controlling mania and preventing the occurrence of both manic and depressive episodes.
Exactly how lithium works is unknown. Lithium should not be used in cases of severe cardiovascular disease, renal disease, or brain damage, or when evidence of severe debilitation, dehydration or sodium depletion exists.
Anticonvulsants
The anticonvulsants dicalproex (more commonly known as Depakote®) and valproate are becoming more frequently used in bipolar treatment, and have shown to be especially useful in hard to treat cases.
For maximum effect, these medications are often combined with lithium. The FDA has approved both valproate and Depakote for treatment of acute mania.
Antipsychotics
Zyprexa® is a commonly prescribed antipsychotic medication for the short-term control of bipolar disorder. Zyprexa reduces the symptoms of mania by correcting elements of chemical imbalance that causes manic episodes.
The Compliance Problem
You might wonder why someone who takes lithium to control manic depression might suddenly stop taking his or her medication. After all, if you found a drug that got rid of your migraine headaches and had no serious side effects, why would you ever want the headaches back?
The truth is that the manic highs and even the depressive lows contribute some degree of “passion” to one’s personality—or so it seems. While bipolar artists do their best painting and writers produce their best poetry during high or low episodes, they find that medication may leave them feeling quite flat and relatively lacking in emotion. When they get to a point where they fear the loss of their talent, and even their very livelihood, they may decide to stop taking medication in favor of regaining the extremes of emotion that they prefer
Electroconvulsive Therapy
Electroconvulsive therapy (ECT), also known as electroshock therapy, was first used to treat schizophrenia in the 1940s. Doctors soon found that ECT was also helpful in relieving the symptoms of mood disorders, including bipolar disorder.
Electroconvulsive therapy is usually given every other day during the first few weeks. Treatments are then reduced to weekly, then every other week, and finally monthly.
While the typical three to twelve ECT treatments may take place over a few months, patients often experience a relief in symptoms within the first couple of weeks.
Interestingly, ECT is most effective in severe cases of manic depression.
Alternative Treatments
Some people have reported good results from regular acupuncture treatments (twice a week for six months, to start with) as well as herbal and nutritional supplements.