Treatment options for bipolar
Bipolar disorder - Diagnosis and treatment
Diagnosis
To determine if you have bipolar disorder, your evaluation may include:
- Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
- Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
- Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
- Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.
Diagnosis in children
Although diagnosis of children and teenagers with bipolar disorder includes the same criteria that are used for adults, symptoms in children and teens often have different patterns and may not fit neatly into the diagnostic categories.
Also, children who have bipolar disorder are frequently also diagnosed with other mental health conditions such as attention-deficit/hyperactivity disorder (ADHD) or behavior problems, which can make diagnosis more complicated. Referral to a child psychiatrist with experience in bipolar disorder is recommended.
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- Bipolar disorder care at Mayo Clinic
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Treatment
Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders.
You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.
Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:
- Medications. Often, you'll need to start taking medications to balance your moods right away.
- Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
- Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
- Substance abuse treatment. If you have problems with alcohol or drugs, you'll also need substance abuse treatment.
Otherwise, it can be very difficult to manage bipolar disorder. - Hospitalization. Your doctor may recommend hospitalization if you're behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you're having a manic or major depressive episode.
The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.
Medications
A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on your particular symptoms.
Medications may include:
- Mood stabilizers. You'll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
- Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic.
- Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
- Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.
Finding the right medication
Finding the right medication or medications for you will likely take some trial and error. If one doesn't work well for you, there are several others to try.
This process requires patience, as some medications need weeks to months to take full effect. Generally only one medication is changed at a time so that your doctor can identify which medications work to relieve your symptoms with the least bothersome side effects. Medications also may need to be adjusted as your symptoms change.
Side effects
Mild side effects often improve as you find the right medications and doses that work for you, and your body adjusts to the medications. Talk to your doctor or mental health professional if you have bothersome side effects.
Don't make changes or stop taking your medications. If you stop your medication, you may experience withdrawal effects or your symptoms may worsen or return. You may become very depressed, feel suicidal, or go into a manic or hypomanic episode.
If you think you need to make a change, call your doctor.
Medications and pregnancy
A number of medications for bipolar disorder can be associated with birth defects and can pass through breast milk to your baby. Certain medications, such as valproic acid and divalproex sodium, should not be used during pregnancy. Also, birth control medications may lose effectiveness when taken along with certain bipolar disorder medications.
Discuss treatment options with your doctor before you become pregnant, if possible. If you're taking medication to treat your bipolar disorder and think you may be pregnant, talk to your doctor right away.
Psychotherapy
Psychotherapy is a vital part of bipolar disorder treatment and can be provided in individual, family or group settings. Several types of therapy may be helpful. These include:
- Interpersonal and social rhythm therapy (IPSRT). IPSRT focuses on the stabilization of daily rhythms, such as sleeping, waking and mealtimes.
A consistent routine allows for better mood management. People with bipolar disorder may benefit from establishing a daily routine for sleep, diet and exercise. - Cognitive behavioral therapy (CBT). The focus is identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help identify what triggers your bipolar episodes. You also learn effective strategies to manage stress and to cope with upsetting situations.
- Psychoeducation. Learning about bipolar disorder (psychoeducation) can help you and your loved ones understand the condition. Knowing what's going on can help you get the best support, identify issues, make a plan to prevent relapse and stick with treatment.
- Family-focused therapy. Family support and communication can help you stick with your treatment plan and help you and your loved ones recognize and manage warning signs of mood swings.
Other treatment options
Depending on your needs, other treatments may be added to your depression therapy.
During electroconvulsive therapy (ECT), electrical currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can reverse symptoms of certain mental illnesses. ECT may be an option for bipolar treatment if you don't get better with medications, can't take antidepressants for health reasons such as pregnancy or are at high risk of suicide.
Transcranial magnetic stimulation (TMS) is being investigated as an option for those who haven't responded to antidepressants.
Treatment in children and teenagers
Treatments for children and teenagers are generally decided on a case-by-case basis, depending on symptoms, medication side effects and other factors. Generally, treatment includes:
- Medications. Children and teens with bipolar disorder are often prescribed the same types of medications as those used in adults. There's less research on the safety and effectiveness of bipolar medications in children than in adults, so treatment decisions are often based on adult research.
- Psychotherapy. Initial and long-term therapy can help keep symptoms from returning. Psychotherapy can help children and teens manage their routines, develop coping skills, address learning difficulties, resolve social problems, and help strengthen family bonds and communication. And, if needed, it can help treat substance abuse problems common in older children and teens with bipolar disorder.
- Psychoeducation. Psychoeducation can include learning the symptoms of bipolar disorder and how they differ from behavior related to your child's developmental age, the situation and appropriate cultural behavior. Understanding about bipolar disorder can also help you support your child.
- Support. Working with teachers and school counselors and encouraging support from family and friends can help identify services and encourage success.
More Information
- Bipolar disorder care at Mayo Clinic
- Bipolar medications and weight gain
- Bipolar treatment: I vs.
II - Cognitive behavioral therapy
- Electroconvulsive therapy (ECT)
- Family therapy
- Psychotherapy
- Transcranial magnetic stimulation
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Lifestyle and home remedies
You'll probably need to make lifestyle changes to stop cycles of behavior that worsen your bipolar disorder. Here are some steps to take:
- Quit drinking or using recreational drugs. One of the biggest concerns with bipolar disorder is the negative consequences of risk-taking behavior and drug or alcohol abuse. Get help if you have trouble quitting on your own.
- Form healthy relationships. Surround yourself with people who are a positive influence. Friends and family members can provide support and help you watch for warning signs of mood shifts.
- Create a healthy routine.
Having a regular routine for sleeping, eating and physical activity can help balance your moods. Check with your doctor before starting any exercise program. Eat a healthy diet. If you take lithium, talk with your doctor about appropriate fluid and salt intake. If you have trouble sleeping, talk to your doctor or mental health professional about what you can do. - Check first before taking other medications. Call the doctor who's treating you for bipolar disorder before you take medications prescribed by another doctor or any over-the-counter supplements or medications. Sometimes other medications trigger episodes of depression or mania or may interfere with medications you're taking for bipolar disorder.
- Consider keeping a mood chart. Keeping a record of your daily moods, treatments, sleep, activities and feelings may help identify triggers, effective treatment options and when treatment needs to be adjusted.
Alternative medicine
There isn't much research on alternative or complementary medicine — sometimes called integrative medicine — and bipolar disorder.
Most of the studies are on major depression, so it isn't clear how these nontraditional approaches work for bipolar disorder.
If you choose to use alternative or complementary medicine in addition to your physician-recommended treatment, take some precautions first:
- Don't stop taking your prescribed medications or skip therapy sessions. Alternative or complementary medicine is not a substitute for regular medical care when it comes to treating bipolar disorder.
- Be honest with your doctors and mental health professionals. Tell them exactly which alternative or complementary treatments you use or would like to try.
- Be aware of potential dangers. Alternative and complementary products aren't regulated the way prescription drugs are. Just because it's natural doesn't mean it's safe. Before using alternative or complementary medicine, talk to your doctor about the risks, including possible serious interactions with medications.
Coping and support
Coping with bipolar disorder can be challenging. Here are some strategies that can help:
- Learn about bipolar disorder. Education about your condition can empower you and motivate you to stick to your treatment plan and recognize mood changes. Help educate your family and friends about what you're going through.
- Stay focused on your goals. Learning to manage bipolar disorder can take time. Stay motivated by keeping your goals in mind and reminding yourself that you can work to repair damaged relationships and other problems caused by your mood swings.
- Join a support group. Support groups for people with bipolar disorder can help you connect to others facing similar challenges and share experiences.
- Find healthy outlets. Explore healthy ways to channel your energy, such as hobbies, exercise and recreational activities.
- Learn ways to relax and manage stress.
Yoga, tai chi, massage, meditation or other relaxation techniques can be helpful.
Preparing for your appointment
You may start by seeing your primary care doctor or a psychiatrist. You may want to take a family member or friend along to your appointment, if possible, for support and to help remember information.
What you can do
Before your appointment, make a list of:
- Any symptoms you've had, including any that may seem unrelated to the reason for the appointment
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins, herbs or other supplements you're taking, and the dosages
- Questions to ask your doctor
Some questions to ask your doctor may include:
- Do I have bipolar disorder?
- Are there any other possible causes for my symptoms?
- What kinds of tests will I need?
- What treatments are available? Which do you recommend for me?
- What side effects are possible with that treatment?
- What are the alternatives to the primary approach that you're suggesting?
- I have these other health conditions.
How can I best manage these conditions together? - Should I see a psychiatrist or other mental health professional?
- Is there a generic alternative to the medicine you're prescribing?
- Are there any brochures or other printed material that I can have?
- What websites do you recommend?
Don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor will likely ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:
- When did you or your loved ones first begin noticing your symptoms?
- How frequently do your moods change?
- Do you ever have suicidal thoughts when you're feeling down?
- Do your symptoms interfere with your daily life or relationships?
- Do you have any blood relatives with bipolar disorder or depression?
- What other mental or physical health conditions do you have?
- Do you drink alcohol, smoke cigarettes or use recreational drugs?
- How much do you sleep at night? Does it change over time?
- Do you go through periods when you take risks that you wouldn't normally take, such as unsafe sex or unwise, spontaneous financial decisions?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
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Treatment - Bipolar disorder - NHS
Treatment for bipolar disorder aims to reduce the severity and number of episodes of depression and mania to allow as normal a life as possible.
Treatment options for bipolar disorder
If a person is not treated, episodes of bipolar-related mania can last for between 3 and 6 months.
Episodes of depression tend to last longer, often 6 to 12 months.
But with effective treatment, episodes usually improve within about 3 months.
Most people with bipolar disorder can be treated using a combination of different treatments.
These can include 1 or more of the following:
- medicine to prevent episodes of mania and depression – these are known as mood stabilisers, and you take them every day on a long-term basis
- medicine to treat the main symptoms of depression and mania when they happen
- learning to recognise the triggers and signs of an episode of depression or mania
- psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships
- lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep
Most people with bipolar disorder can receive most of their treatment without having to stay in hospital.
But hospital treatment may be needed if your symptoms are severe or you're being treated under the Mental Health Act, as there's a danger you may self-harm or hurt others.
In some circumstances, you could have treatment in a day hospital and return home at night.
Medicines for bipolar disorder
Several medicines are available to help stabilise mood swings.
These are commonly called mood stabilisers and include:
- lithium
- anticonvulsant medicines
- antipsychotic medicines
If you're already taking medicine for bipolar disorder and you develop depression, your GP will check you're taking the correct dose. If you're not, they'll change it.
Episodes of depression are treated slightly differently in bipolar disorder, as taking antidepressants alone may lead to a relapse.
Most guidelines suggest depression in bipolar disorder can be treated with just a mood stabiliser.
But antidepressants are commonly used alongside a mood stabiliser or antipsychotic.
Find out more about antidepressants
If your GP or psychiatrist recommends you stop taking bipolar disorder medicine, the dose should be gradually reduced over at least 4 weeks, and up to 3 months if you're taking an antipsychotic or lithium.
If you have to stop taking lithium for any reason, talk to your GP about taking an antipsychotic or valproate instead.
Lithium
In the UK, lithium is the main medicine used to treat bipolar disorder.
Lithium is a long-term treatment for episodes of mania and depression. It's usually prescribed for at least 6 months.
If you're prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly unless told to by your doctor.
For lithium to be effective, the dosage must be correct. If it's incorrect, you may get side effects such as diarrhoea and getting sick.
Tell your doctor immediately if you have side effects while taking lithium.
You'll need regular blood tests at least every 3 months while taking lithium. This is to make sure your lithium levels are not too high or too low.
Your kidney and thyroid function will also need to be checked every 2 to 3 months if the dose of lithium is being adjusted, and every 12 months in all other cases.
While you're taking lithium, avoid using non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, unless they're prescribed by your GP.
In the UK, lithium and the antipsychotic medicine aripiprazole are currently the only medicines that are officially approved for use in teenagers with bipolar disorder.
But the Royal College of Paediatrics and Child Health says that other bipolar medicines may be prescribed for children if recommended by their doctor.
Anticonvulsant medicines
Anticonvulsant medicines include:
- valproate
- carbamazepine
- lamotrigine
These medicines are sometimes used to treat episodes of mania. They're also long-term mood stabilisers.
Anticonvulsant medicines are often used to treat epilepsy, but they're also effective in treating bipolar disorder.
A single anticonvulsant medicine may be used, or they may be used in combination with lithium when bipolar disorder does not respond to lithium on its own.
Valproate
Valproate is not usually prescribed for women of childbearing age because there's a risk of physical defects in babies, such as spina bifida, heart abnormalities and cleft lip.
There may also be an increased risk of developmental problems, such as lower intellectual abilities, poor speaking and understanding, memory problems, autistic spectrum disorders, and delayed walking and talking.
Learn more about the risks of valproate medicines during pregnancy
In women, your GP may decide to use valproate if there's no alternative or you have been assessed and it's unlikely you'll respond to other treatments.
They'll need to check you're using a reliable contraception and will advise you on the risks of taking the medicine during pregnancy.
Find out more about pregnancy and taking medicine for a mental health condition
Carbamazepine
Carbamazepine is usually only prescribed on the advice of an expert in bipolar disorder. To begin with, the dose will be low and then gradually increased.
Your progress will be carefully monitored if you're taking other medication, including the contraceptive pill.
Blood tests to check your liver and kidney function will be carried out when you start taking carbamazepine and again after 6 months.
You'll also need to have a blood count at the start and after 6 months, and you may also have your weight and height monitored.
Lamotrigine
If you're prescribed lamotrigine, you'll usually be started on a low dose, which will be increased gradually.
See your GP straight away if you're taking lamotrigine and develop a rash. You'll need to have an annual health check, but other tests are not usually needed.
Women who are taking the contraceptive pill should talk to their GP about switching to a different method of contraception.
Antipsychotic medicines
Antipsychotic medicines are sometimes prescribed to treat episodes of mania.
They include:
- aripiprazole
- olanzapine
- quetiapine
- risperidone
They may also be used as a long-term mood stabiliser. Quetiapine may also be used for long-term bipolar depression.
Antipsychotic medicines can be particularly useful if symptoms are severe or behaviour is disturbed.
As antipsychotics can cause side effects, such as blurred vision, a dry mouth, constipation and weight gain, the initial dose will usually be low.
If you're prescribed an antipsychotic medicine, you'll need to have regular health checks at least every 3 months, but possibly more often, particularly if you have diabetes.
If your symptoms do not improve, you may be offered lithium and valproate as well.
Rapid cycling
You may be prescribed a combination of lithium and valproate if you experience rapid cycling, where you quickly change from highs to lows without a "normal" period in between.
If this does not help, you may be offered lithium on its own, or a combination of lithium, valproate and lamotrigine.
But you will not usually be prescribed an antidepressant unless an expert in bipolar disorder has recommended it.
Learning to recognise triggers
If you have bipolar disorder, you can learn to recognise the warning signs of an approaching episode of mania or depression.
A community mental health worker, such as a psychiatric nurse, may be able to help you identify your early signs of relapse from your history.
This will not prevent the episode occurring, but it'll allow you to get help in time.
This may mean making some changes to your treatment, perhaps by adding an antidepressant or antipsychotic medicine to the mood-stabilising medication you're already taking.
Your GP or specialist can advise you on this.
Psychological treatment
Some people find psychological treatment helpful when used alongside medicine in between episodes of mania or depression.
This may include:
- psychoeducation – to find out more about bipolar disorder
- cognitive behavioural therapy (CBT) – this is most useful when treating depression
- family therapy – a type of talking therapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health
Psychological treatment usually consists of around 16 sessions. Each session lasts an hour and takes place over a period of 6 to 9 months.
Pregnancy and bipolar medicines
One of the main problems is that the risks of taking bipolar medicines during pregnancy are not well understood.
If you're pregnant and you have bipolar disorder, a written plan for your treatment should be developed as soon as possible.
The plan should be drawn up with you, your partner, your obstetrician (pregnancy specialist), midwife, GP and health visitor.
The following medicines are not routinely prescribed for pregnant women with bipolar disorder, as they may harm the baby:
- valproate
- carbamazepine
- lithium
- lamotrigine
- paroxetine
- benzodiazepines (tranquillisers), such as diazepam (Valium) and lorazepam (Ativan)
If you become pregnant while taking medicine that's been prescribed for bipolar disorder, it's important that you do not stop taking it until you have discussed it with your doctor.
If bipolar medicine is prescribed for bipolar disorder after the baby's born, it may also affect your decision whether to breastfeed.
Your pharmacist, midwife or mental health team can give you advice based on your circumstances.
Treatment of bipolar affective disorder in St. Petersburg
- Main
- Psychotherapy
- Treatment of bipolar disorder
Usually the symptoms of bipolar disorder are attributed to personality traits or mood swings, which are logically explained. And, as a rule, even close relatives may not suspect that a person suffers from one of the most common mental disorders.
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Bipolar affective disorder is difficult to diagnose at an early stage of the disease. Therefore, we recommend that the patient himself or his relatives begin to keep a diary, recording daily the features of the psycho-emotional state and key events that affect the occurrence of depressive and / or manic episodes. Such a diary will help the doctor determine the type of disease and prescribe the necessary treatment for bipolar disorder, and in the future to monitor the dynamics of the state of health. nine0011
Bipolar affective disorder is treated as an outpatient or inpatient clinic. At the peak of a depressive episode, when there is a risk of suicide, as well as to reduce the timing of the selection of pharmacotherapy, treatment of bipolar disorder should be carried out in a hospital. Bipolar personality disorder, left untreated, can progress and cause a deterioration in quality of life. Over a long distance, the disease inevitably leads to family conflicts, alcoholism or drug addiction, social degradation and, ultimately, suicide.
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With the right treatment for bipolar disorder, you can stabilize your psycho-emotional state and eventually achieve remission. Usually, it takes 15 to 20 days of hospital treatment to stabilize the psycho-emotional state. Achieving remission is possible subject to compliance with the prescribed drugs, with periodic outpatient visits to the attending physician to correct therapy.
Bipolar disorder consultation:
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- Post-discharge management
- Psychotherapy for couples and families
- Psychosocial personality correction
| Service | Price | |
|---|---|---|
| Outpatient treatment | nine0043||
| Psychiatric consultation | 5 000 ₽ | |
| Psychotherapist appointment | 5 000 ₽ | |
Reception of the chief physician Bocharov A. V. (Associate Professor, PhD) | 6 000 ₽ | |
| Psychiatric consultation at home | 6 000 ₽ | |
| Treatment in a hospital | ||
| Delivery to hospital | Is free | |
| Standard Chamber | nine0046 | 8 900 ₽ |
| 3-bed superior room | 12 000 ₽ | |
| 2-bed superior room | 15 000 ₽ | |
| 1 local VIP room | 19 500 ₽ | |
| Doctor's appointment 2 weeks after discharge | Is free | |
Causes of bipolar disorder
The main causes of bipolar affective disorder include genetic predisposition, disturbances in the metabolism of neurotransmitters and changes in nerve cells, and severe stress.
In other words, the disease can occur in any person, regardless of age, gender and social status. nine0011
Genetic causes
Genetic causes of bipolar disorder are a risk factor for the development of the disease. It should be emphasized that the disease itself is not inherited. However, inherited features of the regulation of neurotransmitters in the brain increase the risk of developing bipolar disorder in close relatives (for example, siblings) by 4–7 times.
Metabolic disorders in the brain
Another cause of bipolar disorder may be a metabolic disorder in the brain. An abnormal increase and decrease in the concentration of biologically active chemical compounds (mainly dopamine, serotonin and norepinephrine), which transmit nerve signals, is the cause of the manic and depressive phases. nine0011
Severe stress and the “biological defect” model
The psyche of each person has an individual threshold for resistance to stress. And the word "stress" does not necessarily mean difficult life situations - be it a dismissal, financial problems, family conflicts, divorce, or the death of a loved one.
Stress factors can be an upcoming birthday, puberty, marriage or the birth of a child.
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Fig. Zubin and Spring's stress-vulnerability model.
a) Low vulnerability, BD can only develop under severe stress.
b) High vulnerability, BAD develops even under low intensity stress.
c) Individual vulnerability, corresponds to the intensity of stress.
Symptoms of bipolar disorder
Treatment of bipolar disorder in our clinic
Typically treatment of bipolar disorder is carried out in the hospital of the clinic. The conditions of the hospital allow to reduce the duration of treatment - to conduct an examination, quickly normalize the patient's psycho-emotional state, select drugs and their minimum effective dosage, conduct dynamic monitoring and adjust pharmacotherapy.
Examination
On the day of hospitalization, the patient undergoes an examination, which includes:
- psychodiagnostics;
- consultation of a therapist;
- consultation with a neurologist; nine0004
- laboratory tests;
- EEG.
Lab tests include blood tests for hormonal status (generally, thyroid problems are found in people with bipolar disorder). Pathology of the thyroid gland directly affects mood swings, therefore, when treating bipolar disorder, it is important for a doctor to know the patient's hormonal background, for example: to prescribe drugs that normalize the thyroid gland, or to exclude lithium, which inhibits its work. nine0011
Drug treatment
Based on the results, the doctor will prescribe a treatment for bipolar disorder - select drugs that relieve autonomic symptoms and normalize the psycho-emotional state (normotimics, antidepressants). Usually, the first signs of improvement in mental health are observed on the fifth day after the start of drug treatment for bipolar disorder. However, the final correction of psychopharmacotherapy can take up to 10 days.
Psychotherapeutic assistance
After stabilization of the psycho-emotional state, the patient begins attending group psychotherapy sessions.
Group sessions with psychotherapists and psychologists of our clinic are held daily. Under the guidance of experienced facilitators, the patient will have the opportunity to work through their experiences and fears, get rid of pathological patterns, and receive professional help from psychologists and psychotherapists with clinical experience.
Post-discharge management
Discharge is usually after remission, 14-21 days treatment for bipolar disorder . Then the patient continues to take the prescribed drugs and visit the attending physician once every 1-3 months for 1 year. Subject to the achievement of stable remission, after 1 year, in some cases, it is possible to completely abandon the drug treatment of bipolar disorder.
Treatment of bipolar disorder in St. Petersburg is carried out at: st. Marata, 78. We take on complex cases, including the treatment of adolescent patients and patients with drug resistance. nine0011
Treatment of bipolar comorbidities
Psychotherapeutic treatment of bipolar disorder
Psychotherapeutic treatment of bipolar affective disorder, as an adjunct to pharmacotherapy, allows a faster deep remission.
Such treatment begins already in the hospital and can be continued after discharge. The number of sessions, their frequency and the form of psychotherapy (individual, family or hypnotherapy) you can choose together with the doctor. nine0011
In addition to individual psychotherapy sessions that correct the patient's personality, family consultations are possible. At family therapy sessions, relatives can better understand the nature of the disease and learn the right behavior that contributes to a speedy recovery. In addition, studies show that psychotherapeutic care reduces the number of hospitalizations for relapses.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy corrects abnormal behavior and thought patterns that occur in patients with bipolar affective disorder. In addition, during psychotherapy sessions, the patient will be able to learn to recognize relapses of the disease, cope with them on their own or seek help in time, preventing a full-blown episode.
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Family Therapy
If bipolar disorder has caused a deterioration in relationships with those closest to you, we recommend that you seek the help of a family therapist. The doctor will help relatives understand the features of the disease, resolve interpersonal conflicts and restore harmony in the family.
Individual sessions of psychotherapy help overcome mood swings during the formation of stable remission. By learning to control the psycho-emotional state, as well as working through pathological patterns, it becomes easier for the patient to cope with exacerbations of the condition, which may occur for some time after undergoing treatment in the hospital. nine0011
The consequences of not getting help
To describe what bipolar disorder is in simple terms, it is necessary to understand the specifics of the condition in which people with this disease find themselves. Living with bipolar affective disorder is not easy. People learn to live with bipolar disorder over the years, experiencing rapid ups and downs in both career and family life.
Imagine that you are walking on a zebra - now you are full of strength and enthusiasm, and the next minute you stop in a stupor and everything falls out of your hands: life loses its meaning, achievements no longer seem so significant, you want to escape from everyday life, hide from your eyes relatives, change their place of residence and work. nine0011
Add to this state of misunderstanding on the part of relatives and friends, who begin to consider you frivolous and incapable of finishing what you started to the end. At some point, you quarrel with relatives and, it would seem, nothing keeps you in this familiar and gray life. You can stay in this state for months, and then everything starts all over again. You are full of strength and enthusiasm - set yourself bold tasks, hardly sleep, call friends and want to hug strangers (just like that, because you are full of boundless love). nine0011
However, few "lucky people" with bipolar disorder manage to experience a depressive episode on their own from year to year.
Moreover, the depressive state distorts reality no less than the euphoria of the manic stage. It can take years or decades to learn how to "live" with bipolar disorder. But many do not succeed in doing this - and the lives of these people cannot be envied. Unfortunately, some of them are socially degraded or commit suicide.
Bipolar disorder in women
If you do not seek help in time, bipolar disorder in women can lead to family conflicts, divorce, promiscuity, and the development of borderline mental disorders. To a lesser extent, women with bipolar disorder are prone to alcoholism and drug addiction, although this scenario cannot be completely excluded.
Bipolar disorder in men
The development of bipolar disorder in men causes deterioration of relationships at work (possibly dismissal), family quarrels, seeking relationships on the side, addiction to alcohol and / or gambling (gambling, Internet surfing). Ultimately, domestic violence is not ruled out against the backdrop of a depressive episode.
nine0011
Remember, mental disorders, like somatic diseases, require treatment. When you find yourself in a difficult situation, when your loved one suffers from bipolar disorder, it is necessary to remain calm and show compassion. As a rule, patients themselves cannot adequately assess their condition, so it is often the relatives who need to take the first step to start treatment and sign up for a consultation with a psychiatrist.
Sources
Bipolar disorder, focus on depression — https://psychiatr.ru
Treatments for bipolar disorder - https://www.webmd.com
Social cognitive deficits in patients with bipolar disorder in remission - https://pubmed.ncbi.nlm.nih.gov
Psychiatric disorders - https:/ /www.who.int
Update date: 09/06/2022
- Bipolar disorder
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Treatment for bipolar disorder
Gorkov Alexander
Ivanovich
Psychotherapist, psychologist
Top category
Experience 48 years
Psychotherapist, psychologist
Experience 48 years
Sinenchenko Andrey
Georgievich
Psychiatrist, psychotherapist
PhD
Experience 22 years
Psychiatrist, psychotherapist, narcologist
Work experience 22 years
Bocharov Alexey
Viktorovich
Psychiatrist, psychotherapist
Head physician of clinic
Experience 41 years
Psychiatrist, psychotherapist, sexologist, child psychiatrist
Experience 41 years
Dobromyslov Vitaly
Germanovich
Psychotherapist, hypnotherapist
Top category
Experience 27 years
Psychotherapist, hypnotherapist, narcologist
Work experience 27 years
Chuban Olga
Ivanovna
Psychiatrist, psychotherapist
First category
Work experience 13 years
Psychiatrist, psychotherapist, psychologist
Work experience 13 years
Zaripov Airat
Akhmadullovich
Psychotherapist, psychologist
Top category
Experience 25 years
Psychotherapist, psychologist
Experience 25 years
nine0010 Suslennikova ElenaViktorovna
Psychiatrist, psychotherapist
First category
Experience 25 years
Psychiatrist, psychotherapist
Experience 25 years
Nazarova Tamara
Kimovna
Psychotherapist, narcologist
Top category
Experience 38 years
Psychotherapist, psychologist, narcologist
Experience 38 years
Prokhorchev Konstantin
Sergeevich
Psychiatrist, psychotherapist
First category
Work experience 12 years
Psychiatrist, psychotherapist
Work experience 12 years
Miroshnikova Natalia
Valentinovna
Top category
Experience 36 years
Psychotherapist, psychologist
Work experience 36 years
Zhelobetskaya Maria
Sergeevna
Psychiatrist, psychotherapist
Top category
Experience 22 years
Psychiatrist, psychotherapist
Work experience 22 years
Stetsiv Lyudmila
Gennadievna
Psychiatrist, psychotherapist
PhD
Experience 31 years
Psychiatrist, psychotherapist
Work experience 31 years
Endrzheevskaya Diana
Vadimovna
Psychiatrist, psychotherapist
Second category
Work experience 14 years
Psychiatrist, child psychiatrist, psychotherapist
Work experience 14 years
Sannikova Elena
Georgievna
Psychologist, psychotherapist
Work experience 19 years
Psychologist, psychotherapist, sexologist
Work experience 19 years
Zun Sergey
Andreevich
Psychiatrist, narcologist
PhD
Experience 33 years
Psychiatrist, narcologist, psychotherapist
Work experience 33 years
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Treatment of bipolar disorder: what methods and drugs do doctors use?
Modern psychiatry is represented by new generation drugs, innovative approaches to 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. nine0011
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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. nine0011
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. nine0011
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.
· Live a healthy life. 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. nine0011
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. nine0011
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. nine0011
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 focuses on: Relieving symptoms Restoring the ability to function and solve problems both at home and at work Reducing the likelihood 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. nine0011
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. nine0011
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.
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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.
