There is no cure for bipolar disorder but it responds well to treatment. It is a recurrent, lifelong illness. People suffering from bipolar disorder may need long-term psychiatric care to monitor medication, enhance treatment compliance and prevent future episodes. A combination of medication and psychotherapy is optimal.
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Treatment aims are to:
1. Effectively treat whatever the current (acute) episode is (mania or depression).
2. Effectively reduce the risk and severity of further episodes with maintenance treatment and support.
Vigilance is the key to preventing relapse. If early symptoms are reported to the doctor when first noticed, adjustments can be made to the treatment plan in order to prevent a “full-blown” episode.
In the maintenance phase support is needed to continue the use of medication to prevent future episodes. This is often difficult as people feel so much better in these periods.
Medication - Manic episode
In the first instance a good assessment and clear diagnosis (to exclude medical causes) is essential. Commonly an acute episode of mania will require a period of hospitalisation.
The mainstay of medical treatment is the mood stabiliser lithium which is used in acute episodes or relapses. Drugs used to treat epilepsy, such as valproate (Epilim) and lamotrigine (Lamictin) are effective and can be prescribed if lithium is not tolerated well. Certain antipsychotic drugs such as olanzapine (Zyprexa) have also been used successfully to treat manic episodes. In episodes where psychotic symptoms are present, antipsychotics are invariably prescribed with the mood stabiliser until symptoms have subsided.
Benzodiazepines (tranquillisers) may be prescribed to manage agitation, psychosis or dangerous behaviour while waiting for a mood stabiliser to take effect.
Depression
The Selective Serotonin Reuptake Inhibitors (SSRI’s) are used most commonly.
These antidepressants act on the neurotransmitter serotonin. Examples of SSRI’s are sertraline (Zoloft) and fluoxetine (Lilly-Fluoxetine).
Antidepressants should never be used without a mood stabilising drug as they can trigger a manic episode.
Electroconvulsive therapy (ECT)
ECT is a safe and effective treatment for both mania and depression. This is generally reserved for people in hospital and as such for more severe episodes.
Maintenance therapy
Acute episodes represent only brief periods in the life of most people with bipolar disorder. To lengthen time between episodes and minimise the effects of further episodes the continued use of moodstablising medication (maintenance therapy) is essential. This may be difficult as maintenance therapy is needed in periods when people feel well. In this phase, people with bipolar disorder need ongoing psychotherapy to assist with understanding the risks of the illness and minimise early discontinuation.
Patients on lithium need regular blood tests to make sure that there is enough lithium in the body for it to work but not too much which can be harmful and lead to serious side-effects. This monitoring is done in routine follow-up with a physician.
Psychosocial support
As bipolar disorder disrupts a person’s life and relationships, psychotherapy can help people regain control and re-establish relationships with others. Support should extend to the family and support structures to help all involved come to terms with the illness. This aims to help people come to terms with their illness and motivate for better treatment compliance.
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