Medicine to treat bipolar depression

Electroconvulsive therapy (ECT) is sometimes used for severely manic or depressed patients and for those who don't respond to medication or for those women who, while pregnant, experience symptoms. Because it can act quickly, it may be especially helpful for severely ill patients who are at high risk for attempting suicide. ECT fell out of favor in the 1960s partly due to distorted, negative portrayals of its use in the media. But modern procedures have been shown to be both safe and highly effective. The patient is first anesthetized and a muscle relaxant is given. Then, while the patient is asleep, a small electric current is passed through electrodes placed on the scalp to produce a grand mal seizure of short duration -- less than one minute. A course of treatment usually involves 6-12 treatments, typically administered three times per week. During the course of ECT treatments -- usually two to four weeks -- lithium and other mood stabilizers are sometimes discontinued to minimize side effects.They are then resumed after completion of the treatment.

The newer types of non pharmocological treatments of depression are:

• VNS (Vagus or Vagal Nerve Stimulation) involves implantation of a device that sends electrical signals to the vagus nerve in order to treat depression.
• TMS (Transcranial Magnetic Stimulation) is a procedure which involves the use of an electromagnetic coil to create electrical currents and stimulate nerve cells in the mood centers of the brain as a treatment for depression.
• Light therapy has proved effective as an additional treatment when bipolar disorder has a connection to seasonal affective disorder. For those people who usually become depressed in winter, sitting for 20 minutes to 30 minutes a day in front of a special light box with a full-spectrum light can help treat depression.

Home Environment and Bipolar Disorder

If someone you live with has bipolar disorder, maintain a calm environment, particularly when that person is in a manic phase. Keep to regular routines for daily activities -- sleeping, eating, and exercise. Adequate sleep is very important in preventing the onset of episodes. Avoid excessive stimulation. Parties, animated conversation, and long periods of watching television or videos can exacerbate manic symptoms. Alcohol or illicit drug use can cause or worsen mood symptoms and make prescription medicines work less effectively.

IMPORTANT! Help and Support

In the manic phase of bipolar disorder, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car. Drinks and foods containing caffeine -- tea, coffee, and cola-- should be allowed in moderation. Avoid alcohol at all times. It is very important for a patient experiencing manic symptoms to receive prompt psychiatric assessment. Family members may need to contact the doctor, because oftentimes patients in a manic or hypomanic episode have little insight into their illness and may refuse treatment. But prompt intervention, including possible medication adjustments at an early point in an episode, may prevent further problems and the need for hospitalization.

Bipolar Disorder Guide

1. Overview
2. Symptoms & Types
3. Treatment & Prevention
4. Living & Support

Treatment of bipolar disorder: what methods and drugs do doctors use?

Modern psychiatry is represented by new generation drugs, innovative approaches in psychotherapy. They are used in bipolar disorders. Patients should not be treated as if they were depression or schizophrenia - the drug regimen is selected depending on the phase and condition of the patient. If we are talking about depression, antidepressants are selected, if about mania, they are contraindicated, anxiolytics and sedatives are prescribed.

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Bipolar personality disorder is quite complex in terms of the treatment of the disease. Building a therapy strategy can only be entrusted to an experienced psychiatrist. In no case should patients self-medicate, as this may lead to a worsening of the condition. Treatment is primarily medical, but psychotherapy and lifestyle changes are also recommended. The treatment regimen is selected by the doctor individually, depending on the characteristics of the course of the disease and the psychotype of the patient. Abuse of antidepressants or refusal to take medications with a temporary improvement in well-being can lead to complications, so the patient should be constantly under the supervision of the attending physician.

Treatment of bipolar disorder: what methods and drugs do doctors use?

If you or someone close to you suffers from bipolar disorder, do not delay seeking qualified help. The sooner you start treatment, the higher your chances of success. Timely and effective treatment of bipolar disorder relieves its symptoms, reduces the frequency and intensity of mood swings, and helps to live a normal life. In a previous article on bipolar disorder, I have already looked at the general aspects of this disorder. Today's post is entirely dedicated to the treatment of bipolar disorder. In this regard, before you start reading, I will answer the most common question: Can bipolar disorder be cured on its own? The short and simple answer is NO! You can greatly help the treatment, make the process easier and more effective, but nothing more. For non-believers, I'll explain why. If the fact of the disease is established, then it manifested itself through the symptoms. Symptoms are what we see. Therefore, the disease takes over the mind, since we see its manifestations. If a person could suppress the manifestation of symptoms by willpower, then no one would ever know about any disease, that is, it would not exist. Any person experiences different emotions from time to time, but as long as he can control them, he is mentally healthy. If emotions take over and control the consciousness of a person, he is sick. How can a sick person fight on his own with what he cannot control? - No way! In this case, it is impossible to do without outside help.

Overview of bipolar disorder and its treatment

Bipolar disorder is a lifelong condition. Its manifestations are always unpredictable, so "ups" and "downs" alternate without any apparent pattern. If treatment is delayed, these ups and downs can be devastating. The recurring episodes of manic and depressive phases that characterize the disease make it difficult to lead a normal, stable, and productive life. In a manic phase, you may be hyperactive and irresponsible; in a depressive phase, it may be difficult for you to do anything at all. Early diagnosis and treatment will undoubtedly help to avoid these problems. The success of treatment for bipolar disorder depends on a number of factors. Medications alone are not enough. In order to get the most out of your treatment, it is very important to educate yourself and educate yourself about your illness, communicate with doctors and psychologists, and provide yourself with a strong support system to lead a healthy lifestyle and stick to your treatment plan. The healing process for bipolar disorder is long and will not happen overnight. Like the mood swings of bipolar disorder, treatment too will have its ups and downs. Finding the right treatment will take time, and failures happen along the way. But with proper attention to the disease, as well as a consistent commitment to the desire to improve your condition, you can take control of the symptoms of bipolar disorder and live life to the fullest. What can you do to feel better? Know the difference between the symptoms of the disease and the characteristics of your psyche. The professionals you turn to for help can help separate your personality traits from the symptoms of the disease, which will allow you to recognize in which cases changes in your behavior are caused by the disease and which are not. To do this, you must be open and honest about your behavior, because you will have to monitor it in order to improve the recognition of episodes of bipolar disorder. · Educate your family members and involve them in the process of fighting the disease. Your loved ones can help identify symptoms and monitor your behavior. They will also motivate and support you, which will certainly allow you to deal with future crises much more effectively. · Lead a healthy lifestyle. A normal and healthy lifestyle, including regular sleep, a healthy diet, the absence of alcohol, drugs and risky behavior is one of the main conditions for recovery. Develop an individualized treatment plan. Talk to your doctor about your medications, especially side effects that may be bothering you. There are many options for drug exposure and there is always plenty to choose from. It is very important to consult with specialists before making any changes in the treatment process, from the set of medications used, the schedule for taking them, and ending with the daily routine.

Accurate diagnosis of bipolar disorder

Obtaining an accurate diagnosis is the first step in the successful treatment of bipolar disorder. This is not always easy to do. The mood swings of bipolar disorder can be difficult to distinguish from other mental health problems such as depression, ADHD (attention deficit hyperactivity disorder), or borderline personality disorder. For many people with bipolar disorder, it takes years and multiple visits to the doctor before the problem is identified and properly diagnosed. Correctly diagnosing bipolar disorder can be difficult even for qualified professionals, so it is better to consult a psychiatrist with experience in the treatment of bipolar disorder, and not just a psychotherapist in an outpatient clinic or a local doctor. An experienced psychiatrist who specializes in the treatment of bipolar disorder is likely to be much better informed about the latest research in the field and advanced treatments. He also probably maintains contact with other specialists, which will make your treatment more effective. What to expect from the diagnosis? A diagnostic evaluation for bipolar disorder typically consists of the following: · Psychiatric evaluation - a complete psychiatric history (data collection and medical history) will be taken by a medical specialist. You will answer questions about your symptoms, tell your history of concerns, any treatment you may have received in the past, and your family history of mood disorders. · Physical Examination and Investigations – There are no specific laboratory tests to detect bipolar disorder. But the doctor must take a medical history and conduct a series of tests to rule out diseases or medications that may be causing your symptoms. For example, screening for thyroid disorders is especially important, as thyroid problems can cause mood swings that mimic the symptoms of bipolar disorder. In addition to a psychiatric evaluation and physical exam, your doctor may talk to family and friends about your mood and behavior. Very often, people around you can give a more accurate and objective picture of your symptoms. Diseases and drugs that can mimic symptoms of bipolar disorder Thyroid disorders Corticosteroids Antidepressants Adrenal disorders (eg, Addison's disease, Cushing's syndrome) Anxiety drugs Drugs for Parkinson's disease Vitamin B12 deficiency Neurological disorders (e.g. epilepsy, multiple sclerosis)

Types of Bipolar Disorder

I have already covered the types of this disorder in the article Bipolar Disorder, which you can read if some of the terms are not clear to you. But in order not to refer those who know what is at stake to another publication, I will once again remind you of the types of bipolar disorder, only in more detail. Each type of bipolar disorder is defined by the nature of the episodes of mania and depression. Treatment may differ depending on the type of bipolar disorder you have been diagnosed with. · Bipolar I disorder (mania and depression) - Bipolar I disorder is the classic form of the disease and also the most typical type of bipolar disorder. It is characterized by at least one episode of mania or a mixed episode. The vast majority of people with bipolar I disorder also have at least one episode of depression, although this is not necessary for a diagnosis. · Bipolar II disorder (hypomania and depression) - full-blown mania does not appear here. Instead, the illness involves recurring episodes of depression and hypomania (a mild form of mania). In order to be diagnosed with Bipolar II, you must have had at least one episode of hypomania and one major depressive episode. If you have had a manic episode at least once in your life, your diagnosis will be changed to Bipolar I disorder. · Cyclothymia (hypomania and mild depression) - Cyclothymia is a mild form of bipolar disorder. Like any bipolar disorder, cyclothymia is made up of cyclical mood swings. However, the highs and lows are not severe enough to unambiguously qualify as mania or depression. For a diagnosis of cyclothymia, you must experience multiple episodes of hypomania and mild depression over at least a two year period. Since people with cyclothymia are at an increased risk of developing full-blown bipolar disorder, this form of the disease needs to be carefully screened for accurate and timely diagnosis.

Bipolar disorder or depression?

Bipolar disorder is often misdiagnosed as depression. One reason for this is that most people with bipolar disorder seek help when they are in the depressive phase of the illness. If a person is going through a manic phase, he rarely sees a doctor because he doesn't acknowledge that there is a problem. In addition, in people with bipolar disorder, a significantly greater percentage of the time is spent in depressive phases than in manic or hypomanic phases. Misdiagnosed, bipolar disorder is a potentially dangerous problem because the treatment for bipolar depression is different from that for regular depression. In fact, antidepressants used to treat regular depression can significantly worsen bipolar disorder. Therefore, it is very important to contact a specialist in a timely manner, who will help you understand what is really happening. Signs that your depression is really bipolar disorder: · Episodes of depression are recurring. · You had your first episode of depression before the age of 25. · You have a relative with bipolar I disorder. · When you are not depressed, your mood and energy levels are higher than those of most other people. · When you are depressed, you sleep a lot and overeat. Episodes of depression are short (less than 3 months). You lose touch with reality when you are depressed. · You have had a case of postpartum depression. · You have had episodes of mania or hypomania while taking antidepressants. · Your antidepressants stopped working a few months after you started taking them. · You have tried 3 or more antidepressants without success, but nothing worked for you.

Treatment options for bipolar disorder

If your doctor determines that you have bipolar disorder, they will offer treatment options and possibly prescribe medication. You may also be referred to other specialists for advice and development of an individual treatment plan.

Comprehensive treatment for bipolar disorder

Comprehensive treatment plan for bipolar disorder aims to: Relieve symptoms Restore the ability to act and solve problems both at home and at work Reduce the chance of relapses A complete treatment plan includes: Medications - Medications are the backbone of the bipolar disorder treatment process. By taking stabilizing drugs, you minimize the "ups" and "downs" and retain the ability to manage the situation. · Psycho1therapy - necessary to deal with bipolar disorder and the problems that the disease has caused in your life. Working with a doctor, you will learn about how to deal with difficult or unpleasant emotions, reconnect with others, deal with stress, and learn how to manage your mood. · Education - Managing symptoms and preventing complications begins with an in-depth understanding of one's illness. Education is a key component of treatment. The more you and your loved ones know about bipolar disorder, the easier it will be to avoid problems and deal with setbacks. · Lifestyle changes – By carefully following a healthy lifestyle, you can minimize the impact of bipolar disorder symptoms. This includes maintaining a regular sleep pattern, avoiding alcohol and drugs, a consistent exercise program, avoiding conflict, avoiding stressful situations, and maintaining a positive mindset at all times. · Support – Life with bipolar disorder can be challenging, so having a strong support system can help change your outlook and increase positive motivation. Participation in a bipolar disorder support group will give you the opportunity to share your experiences and learn from those who have already gone through the stages that you are just going through now. The support of friends and family is also invaluable.

The role of medication in treating bipolar disorder

Most people with bipolar disorder need medication to keep their symptoms under control. Long-term drug treatment can reduce the frequency and severity of episodes of the disease, and sometimes prevent them completely. If you have been diagnosed with bipolar disorder, you and your doctor will work together to find the right drug or drug combination that is best for you. Because everyone reacts differently to medications, you may try a wide variety of medications before you find one (or group of medications) that relieves symptoms. Do not take it into your head to "get" medicines and take them - the consequences can be not just bad, but terrible · Visit your doctor regularly. It is important to have regular blood tests to ensure that the blood level of the drug is in the therapeutic range (sufficient for a therapeutic effect, but not so high as to aggravate the situation). Determining the exact dose of medication you need is a constant balancing act between too little and too much, so regular monitoring will help keep you from showing symptoms and keep you healthy. · Continue taking your medicines even if your mood is stable. Do not stop taking your medicines as soon as you start to feel better. Most people need to take medication on a regular basis to avoid relapses. · Don't expect medicines to solve all your problems. For bipolar disorder, medications can help reduce symptoms of mania and depression, but in order to feel better, it's important to lead a lifestyle that supports good health. This includes the support of others, therapeutic treatment and proper rest. · Be extremely careful with antidepressants. Studies show that antidepressants are not particularly effective in treating bipolar depression. In addition, they can cause mania or sudden and frequent jumps between depression and mania.

Psychotherapy as an important part of treatment

People who take drugs to treat bipolar disorder are much more likely to be cured if they also receive medical treatment. In therapy, you will learn how to deal with issues that cause symptoms of bipolar disorder, such as relationship issues and self-esteem. Therapy sessions will address other issues you struggle with, such as substance abuse or anxiety. Particularly useful in the treatment of bipolar disorder are the following three therapies: Cognitive Behavioral Therapy Interpersonal and Social Rhythm Therapy Family Therapy

Cognitive Behavioral Therapy

In Cognitive Behavioral Therapy sessions, you will learn about how your thoughts affect your emotions, and you will learn to change negative thought patterns into more positive ways of responding. In the treatment of bipolar disorder, the emphasis is on managing symptoms, avoiding relapse triggers, and dealing with problems that arise.

Interpersonal and social rhythm therapy

Interpersonal Therapy addresses the most pressing relationship issues to help you connect better with those around you. This type of treatment aims to reduce stress levels, and since stress is a trigger for bipolar disorder, interpersonal and social rhythmic therapy will help reduce mood swings, making them less frequent and less severe. In the treatment of bipolar disorder, interpersonal therapy is often combined with social rhythm therapy. It has been proven that people with bipolar disorder have an increased sensitivity to biological rhythms. In turn, biological rhythms can be easily disturbed by a mismatch between biorhythms and social rhythms. Social rhythm therapy focuses on stabilizing social rhythms such as sleeping, eating, working hours. When these rhythms are stabilized, the biological rhythms that control mood also remain stable.

Family therapy

Living with a person who suffers from bipolar disorder is very difficult, which leads to tension in family relationships. Family therapy is focused on solving these problems and is aimed at restoring a healthy and supportive home environment. Informing family members about the disease and teaching them how to deal with its symptoms is a major component of family therapy.

Alternative treatments for bipolar disorder

Most alternative treatments for bipolar disorder are actually complementary treatments, meaning they must be used in conjunction with medication, therapy, and lifestyle changes. Here are some useful additions: Day and Night Therapy — Like Social Rhythm Therapy, Day and Night Therapy focuses on the biological rhythms of people with bipolar disorder. This therapy offers assistance in organizing biorhythms by properly adjusting lighting at different times of the day to provide darkness when nighttime rest is needed and light when wakefulness is needed. One of the main components of this therapy is the restriction of daylight or artificial light for ten hours each night. · Focus and Meditation - Research has shown that focus based cognitive therapy and meditation help fight and prevent depression, anger, anxiety, and anxiety. Meditation, yoga, breathing exercises and focusing on one's own mind help break down negative thinking patterns. · Acupuncture — Acupuncture is currently being studied as an additional treatment for bipolar disorder. Some researchers believe that it may help people with bipolar disorder by modulating their response to stress. Research on acupuncture in the treatment of bipolar depression has already shown a reduction in symptoms, and every year there is more and more evidence that acupuncture can relieve the symptoms of not only depression, but also mania.

what they are and what effects they have

Psychiatrists usually recommend medication as the initial treatment to control symptoms as quickly as possible.

Once your symptoms are under control, you will receive supportive care to reduce your risk of relapse.

Supportive care also reduces the chance that minor mood changes turn into mania or depression.

These include mood stabilizers, antidepressants and anti-anxiety drugs. Your doctor may prescribe one or a combination of medications for maximum effect.

Finding the right remedy or combination of remedies will require trial and error.

You may need to change your medications because of side effects.

Each drug may take up to eight weeks to see the full effect.

Usually only one drug is changed at a time.

This helps your doctor better monitor and determine which one is not working.

Lithium (such as Lithobid) is a mood-stabilizing drug that has been used since the 1970s.

It helps control the symptoms of acute mania.

It is also effective in preventing the recurrence of periods of mania and depression.

Common side effects include weight gain and digestive problems.

The drug may also affect the thyroid and kidneys. Periodic blood tests are needed to monitor the condition of the thyroid gland and kidneys.

Lithium is a category D drug that should be avoided during pregnancy if possible.

However, in some cases the benefits may outweigh the potential risks.

Anticonvulsants are mood stabilizers used to treat bipolar disorder.

They have been in use since the mid-1990s. A

Anticonvulsants include:

• sodium divalproex (Depakot)
• lamotrigine (lamiktal)
• valproic acid (Depaken)

Common side effects of anticonvulsants include weight gain, drowsiness, and inability to sit still.

Anticonvulsants are also associated with an increased risk of suicidal thoughts and behavior.

Valproic acid is known to cause birth defects.

Lamictal is known to cause a dangerous rash.

Tell your doctor about any new rash that develops while taking Lamictal.

Antipsychotics are another treatment option. Some commonly prescribed antipsychotics include:

• olanzapine (Zyprexa)
• risperidone (Risperdal)
• Quetiapine (Seroquel)
• lurasidone (Latuda)
• aripiprazole (Abilify)
• Azenapine (Saphris)

Common side effects include weight gain, drowsiness, dry mouth, decreased libido, and blurred vision.

Antipsychotics may also affect memory and attention.

They are also known to cause involuntary movements of the face or body.

These include serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclics.

Antidepressants may be added to help manage depression in bipolar disorder, but they can sometimes cause manic episodes.

To reduce the risk of a mixed or manic episode, they are often given with mood stabilizers or antipsychotics.

As with any medication, talk to your doctor about the risks and benefits of taking antidepressants for bipolar disorder.

Some of the most commonly prescribed antidepressants are:

• SNRIs
• desvenlafaxine (Pristiq)
• duloxetine (Cymbalta, Yentreve)
• venlafaxine (Effexor)
• SSRIs
• citalopram (Celexa)
• escitalopram (Lexapro)
• fluoxetine (Prozac, weekly Prozac)
• paroxetine (Paxil, Paxil CR, Pekseva)
• sertraline (Zoloft)
• Tricyclics
• amitriptyline
• desipramine (Norpramine)
• imipramine (Tofranil, Tofranil-PM)
• nortriptyline (pamelor)
• IMAO
• phenelzine (nardil)
• tranylcypromine (parnate)

In general, MAOIs are rarely prescribed unless the patient has a poor response to SNRIs or SSRIs.

Common side effects include decreased sex drive, disturbed sleep, increased appetite, dry mouth, gastrointestinal disturbances, and menstrual problems.

While taking an MAOI, it is important to avoid other drugs and foods, such as wine and cheese, which can cause a rare but dangerous condition known as serotonin syndrome.

This is a group of drugs with anti-anxiety properties. Benzodiazepines include:

• alprazolam (Xanax)
• chlordiazepoxide (librium)
• clonazepam (Klonopin)
• diazepam (Valium)
• lorazepam (ativan)

Side effects may include drowsiness, decreased muscle coordination, and problems with balance and memory.

These drugs should be used with caution due to the risk of dependence.

This medication is a combination of fluoxetine and the antipsychotic olanzapine. Symbyax has both antidepressant and mood stabilizer properties.

Side effects may include increased appetite, sexual problems, drowsiness, fatigue, and dry mouth.

If your doctor prescribes this medicine, ask if separate prescriptions for the two ingredients are cheaper.

There is nothing special about the combination tablet. It's just a new formulation of two existing drugs.

• Bipolar disorder. (2016).
  nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
• FDA pregnancy categories (2017).
  chemm.nlm.nih.gov/pregnancycategories.htm
• Mayo Clinic staff. (2017). serotonin syndrome.
  mayoclinic.org/diseases-conditions/serotonin syndrome/symptoms-causes/syc-20354758
• Mayo Clinic staff. (2018). Bipolar disorder.
  mayoclinic.org/diseases-conditions/bipolar disorder/symptoms-causes/syc-20355955

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