It is important that bipolar disorder is treated as soon as possible under medical supervision. Most people with bipolar disorder can see an improvement in their mood swings and the associated symptoms with proper treatment. As bipolar disorder is a recurrent illness, long-term preventive therapy is usually needed. In order to control the disease long term, a combination of medication and psychosocial treatment is recommended.
The role of the doctor
The doctor will most probably recommend treatment to stabilize the mood swings. However, even during treatment, mood swings can occur. This should be reported to the doctor. S/he may then be able to prevent a serious episode by adapting the treatment plan. It is therefore helpful to maintain a good relationship with the doctor and discuss any possible concerns that may have something to do with the treatment or with the illness itself.
Medications
Medications known as "mood stabilizers" are usually prescribed to stop the mood swings of patients with bipolar disorder. These treatments are mostly continued for a prolonged period of time (years). Other treatments may be added, mostly for shorter periods, to treat episodes of depression or mania, that occur despite the treatment with a mood stabilizer.
Antipsychotics
Antipsychotic medication, may be used for the treatment of bipolar disorder. These medicines are of particular value for the treatment of manic episodes and for relieving psychotic symptoms.
Lithium
Lithium has long been used as a first-line treatment to control mania and to prevent the recurrence of both manic and depressive periods (mood stabilizers).
Anticonvulsants
Certain anticonvulsants (treatments commonly used for epilepsy), can also be used as mood stabilizers and to treat mania, especially in patients who are not responding to other treatments.
Psychosocial treatments
There are a number of psychosocial treatments available. It has been shown that they can lead to increased mood stability, fewer hospitalisations and improved functioning. It should be noted that family members may also benefit from psychosocial therapy.
Cognitive behavioural therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviour.
Psychoeducation aims at teaching people with bipolar disorders and their families about the nature of the illness, and how to recognise signs of relapse, so they can seek early intervention and possibly avoid a severe episode of mania or depression. Family therapy aims at managing the stress that is often present within the family of those suffering from bipolar disorders.
Electroconvulsive therapy
Electroconvulsive therapy (ECT) is sometimes used when other therapy is ineffective.
Treatment planning
Why do you need to stick to the treatment plan?
All too often, people want to stop their medication because (1) they feel better, (2) they miss the 'highs' associated with mania/hypomania or (3) they are troubled by side effects. For successful treatment it is crucial for people with bipolar disorder to take medication regularly, even after the symptoms seem to have gone. If you stop medication you probably won't have another episode immediately in the next days or weeks but eventually you will probably have a relapse. It is important to remember that the more episodes you have, the harder it is to treat each subsequent episode and the more frequent episodes may become.
What should you tell your doctor?
It is best to communicate any changes in mood to your doctor. S/he may be able to prevent a severe manic or depressive episode by modifying your medication. Your doctor will be familiar with all the medications, including OTC ones that are being taken. They may interact with your medication for bipolar disorder. It is very important to take what your doctor prescribes correctly, and not stop taking them, even when your symptoms seem to have got better. Any concerns about medication, or plans to reduce or stop treatment should be discussed with your doctor first.
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Item code: NPR/08-0048
Date of Preparation: July 2009
