Treating bipolar disorder
Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial
stabilization of their mood swings and related symptoms
with proper treatment. In most cases, bipolar disorder is much better controlled if treatment is
continuous than if it is on and off.
But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.
It is recommended that people with bipolar disorder see a psychiatrist for treatment. Psychiatrist are medical doctors (M.D.) with specific expertise in the diagnosis and treatment of mental and psychological disorders.
Drug therapies and treatment
Medications known as mood stabilizers are usually prescribed to help control bipolar disorder. Several different types of mood stabilizers are available and are usually prescribed for BD. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.
Lithium was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania. It is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication. Therefore, mood-stabilizing medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications.
People with rapid cycling tend to sometimes have co-occurring thyroid problems. One may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.
Psychological therapies (including psychosocial)
As an addition to medication, psychosocial treatments, including certain forms of psychotherapy are helpful in providing support, education, and guidance to people with bipolar disorder and their families. There is a good deal of data showing that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.
A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. Psychosocial interventions commonly used for bipolar disorder include cognitive behavioral therapy, family therapy, and a newer technique, interpersonal and social rhythm therapy.
In social rhythm therepy (SRT), for example, an effort is made to try to regularize daily routines and sleep schedules in an effort to help protect against manic episodes.