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Bipolar Disorder Treatment Options

Treatment for Bipolar Disorder

In the United States alone, over 6,000,000 Americans regularly struggle with some variation of bipolar disorder. Of this population, the vast majority have severe cases and most of them first developed these symptoms between the ages of 15 and 25. This awful mental disorder is marked by alternating severe mood swings known as manic and depression; either of these severe states can lead to broken lives, relationships, and futures. Fortunately, the majority of cases of bipolar disorder are treatable, if not curable, through a combination of medication and different types of bipolar disorder treatment options. Below we will thoroughly discuss all of the available resources to you if you or a loved one is currently struggling with bipolar disorder.

Medication

For many who are bipolar, much of the problem lies with the simple fact that your brain chemicals are out of balance and need to be corrected. In this case, you will require regular and ongoing treatment, but such treatment is relatively harmless and generally involves a combination of therapy and medication. Even if you are feeling 100%, it is recommended that you see your mental health care professional habitually.

For the initial wave of medication, most psychiatrists attempt to curb or control bipolar symptoms as fast as possible, so many of these drugs are more a broad swatch, internal carpet bomb. Once these negative symptoms are held in check, these medications will be fine-tuned, but just note that much of this process is somewhat trial and error; through discussion and observation, they are able to figure out what works well with you and what causes adverse effects.

In order to prevent relapse, you will regularly receive maintenance treatment. Such treatment should also curb or at least lower the risk of smaller mood swings evolving into full-blown depression or mania. There are a variety of medications your psychiatrist may prescribe including antidepressants, anxiety relievers, and mood stabilizers. Depending on the severity of your condition, your doctor may assign you one or more of these medications. Since they often take up to two months to manifest their full effects, doctors are careful about adding or removing different drugs. If they do, it is usually one at a time to better identify the effectiveness of each drug. Below are the types of medication employed to treat bipolar disorder:

Lithium

Probably the most common and effective drug at preventing mania or depression, Lithium is a mood-stabilizer that has been employed by doctors since the 70's. While it is effective against depression, its strength is controlling the symptoms of hyper-mania. A category D drug, it is generally advised that if pregnant, one avoids taking lithium; however, there are cases where the symptoms of bipolar disorder are so severe that it is worth the risk.

Side effects include digestive problems and potential weight gain. There are cases of the drug negatively affecting people’s kidney and thyroids, but this can be checked with routine blood tests.

Symbyax

This medication is a combination of an antipsychotic drug known as Olanzapine and an SSRI known as Fluoxetine. It is unique in that it has the properties of both a mood stabilizer as well as an antidepressant; therefore it is sometimes used to treat depression or bipolar disorders when the patient has not responded positively to other forms of medicine. It acts by creating a chemical balance with neurotransmitters and has shown to positively help with sleep, overall mood, and concentration; it has also shown to help decrease anxiety in some users.

Benzodiazepines

Categorized as a form of anti-depressant or anti-anxiety, benzos are depressants upon the CNS (central nervous system) and do so by invigorating the brain’s GABA (gamma-aminobutyric acid) receptors. GABA receptors affect pain sensitivity, anxiety levels, mood patterns and sleeping habits. GABA stimulation depresses nerve activity, leading to a sedative feeling that alters the way the brain receives fear or anxiety signals.

Benzos include: Alprazolam (Xanax), Clonazepam (Klonopin), Daiazepam (Valium), and Lorazepam (Ativan). Short-term side effects include: euphoria, extreme relaxation, drowsiness, balance and memory problems, inhibited muscle coordination.

Benzos are not recommended for long-term use. Studies have shown that daily benzo use lasting longer than three months can lead to upticks in addiction, amnesia, Alzheimer’s, brain damage, and overdose. Therefore, they should be used with caution and only to treat severe episodes.

Antipsychotics

Another bipolar treatment option, antipsychotics do not cure psychosis, rather they reduce and control the symptoms of being in a hostile state. Such symptoms they mitigate include mania, violent or angry behavior, severe agitation or anxiety, delusions, confusion, hallucinations, and paranoia.

Antipsychotics used to treat bipolar disorder include: Asenapine (Saphris), Olanzapine (Zyprexa), Risperdal (Risperidone), and Quetiapine (Seroquel).

Side effects include drowsiness, blurred vision, dry mouth, lowered libido and weight gain. They have been associated with memory and attention loss and sometimes cause body or facial motor ticks.

Anticonvulsants

Anticonvulsants are mood stabilizers that have been employed since the 90's for the treatment of bipolar disorder. Initially, these pharmacological agents were used to treat epileptic seizures, but are more commonly being used as mood stabilizers for those with bipolar disorder since they seem to suppress the more severe symptoms of mania. Although benzodiazepines technically fall under the same umbrella of anticonvulsants, the most commonly used medications include: Divalproex sodium (Depakote), Lamotrigine (Lamictal), and Valproic Acid (Depakene)

Short-term side effects include dizziness, drowsiness, fatigue, inability to remain still, nausea, tremors, rash, and weight gains.

Long-term side effects of anticonvulsants have shown that some users exhibit an increased risk of suicidal behavior or thoughts.

Antidepressants

Initially created in the 50's antidepressants have seen a massive uptick in use over the last two decades. Such medications are meant to relieve symptoms of anxiety disorders, depression, dysthymia, and social anxiety disorders. They act by remedying chemical neurotransmitter imbalances within the brain that control mood or behavioral changes. These include tricyclics, SSRIs (serotonin-reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors, and MAOIs (monoamine oxidase inhibitors), although MAOIs are only prescribed if the patient responds negatively to the SSRI or SNRI.

Antidepressants are regularly prescribed in conjunction with mood stabilizers since some antidepressants trigger episodes of mania.

Tricyclics include: Amitriptyline, Desipramine (Norpramin), Imipramine (Tofranil), and Nortriptyline (Pamelor).

SNRIs include: Desvenlafaxine (Pristiq), Duloxetine (Cymbalta, Yentreve), and Venlafaxine (Effexor).

SSRIs include: Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil), and Sertaline (Zoloft).

MAOIs include: Phenelzine (Nardil), and Tranylcypromine (Parnate).

Behavioral Therapy

Similar to addiction therapy, behavioral therapy is the overarching term used to describe the various types of therapy that have arisen to combat mental health disorders. The goal of such treatment is to help the patient see the negative, unhealthy or self-destructive patterns in their life and seek to change them since many of these behaviors are ones that are learned or have developed through repetition.

Cognitive Behavioral Therapy – One of the most popular and effective therapeutic treatments for bipolar disorder, as the name suggests, CBT combines the practices of behavioral therapy with cognitive therapy. Such treatment focuses on how beliefs and thoughts affect one's moods and actions and seek to solve current and fixable problems. Ideally, such micro-actions will positively change someone's behavioral and thought patterns in the long term.

There are six basic steps to CBT:

  1. Accept your diagnosis: The initial step involves coming to terms with your bipolar disorder, understanding what it does and acknowledging that it is the root cause of many of your issues. Many have trouble or feel guilty by conceding this fact, so it is essential that they learn the causes, and signs, and symptoms of bipolar disorder. Doing so allows them to accept that they need help, but confirms that they are not an isolated case.
  2. Mood Observation: Those suffering from bipolar disorder are asked to keep notes in a journal or worksheet, logging observations or particular instances that stood out. They are asked to rate their daily mood on a scale of 0-10, 0 standing for depressed, five standing for an average day, and ten standing for a very elevated or irritable mood. By keeping a log, they can study this by themselves, or discuss with their therapists and look for triggers that lead to mood swings.
  3. Cognitive Reformation: By noting triggers or flawed thinking patterns, the patient becomes more self-aware in the future. During this reformative stage, the patient attempts to identify flawed thinking, alter flawed reasoning, or avoid problem areas. This stage is awkward, but with the help of a therapist, the patient should slowly improve in the way they self-assess. This increased self-awareness can keep their thoughts balanced and prevent them from entering into negative thought loops that drag them into states of mania or depression.
  4. Problem Solving: At this stage, the patient is acquiring the ability to identify problems, come up with solutions, pick the ideal solution, employ it, and then see an outcome. Generally, this is first learned and engaged in therapy sessions until it becomes a habitual behavior. Such problem solving can be applied from anything to relationships, to work, to bad decisions, to bad thoughts. The goal is not to allow these stressors or triggers to gain control over your thoughts and actions.
  5. Improving Social Skills: Many who have bipolar disorder have trouble blending in or developing ordinary social skills due to the symptoms of their disorder. This causes them to feel both lonely and out of control, but by learning social skills and tools they can better manage relationships, which are a vital aspect of healthy and happy living.
  6. Stabilization: Creating a rhythm or routine is one of the most important things a person with bipolar disorder can do. Fashioning a predictable and healthy pattern to the day helps stabilize moods, and prevents them from falling into depressive doldrums that mainly involve cycles of oversleeping. This includes regular exercise, chores and house upkeep, consistent meals and sleep schedules, getting involved in the community, and spending times with family and friends.

Electroconvulsive Therapy

ECT, also known as shock therapy is an effective treatment for several mental disorders, despite what your initial feelings towards it might be. Initially introduced in the 30's and made infamous through movies such as, "One Flew Over the Cuckoo's Nest" ECT was much different back then than it is now. At the time, muscle relaxants were not developed or put in use, and the doctor's ability to modulate the shock voltage to the brain was arcane at best. As a result, patients would regularly suffer broken bones or various injuries due to the violent convulsions and seizures caused by the electric shock to the brain. These days, however, ECT is used for those who do not respond to therapy or medication and, according to the U.S. Food and Drug Administration, it has shown to be useful in aiding nearly 80% of people who suffer from clinical depression.

There are two types of ECT, bilateral and unilateral. With bilateral ECT, electrodes are placed on both sides of the head, and the shock affects the entirety of the brain. With unilateral ECT, a single electrode is situated directly at the top of one's head, and another is placed on the right side of the temple. This is meant to affect only the right side of one's brain. Both forms have been shown to be extremely effective at lessening or removing the most severe symptoms of bipolar disorder including catatonia, psychosis, and suicidality.

The Procedure

Doctors have those undergoing ECT stop drinking and eating for a period of time leading up to the procedure. On the day of, the doctor gives the patient muscle relaxants and general anesthesia. The anesthesia will put the patient to sleep and the relaxants will help involuntary convulsions. Do not worry; you will have no memory of the procedure.

Once asleep, the doctor places the two electrodes on your scalp, with the spots dependent upon the type of ECT. A controlled electrical current will pass between the electrodes for 30 to 60 seconds, causing the brain to have a seizure, which is a short-term alteration of how the brain functions electrically. All the while, your blood pressure, heart rhythm and other vitals will be monitored. Afterward, you will go home on the same day. To receive the benefits from ECT, at least eight sessions are required over a month-long period, and some patients need a once-a-month maintenance ECT.

If you are dealing with bipolar disorder and a substance abuse problem at the same time, Peaks Recovery is here to help you. Our experienced staff has been highly trained to deal with co-occurring disorders and can help any patient overcome their co-occurring disorder. Call us today for more information on bipolar disorder causes, symptoms, and treatment methods.