Antipsychotics For Bipolar Disorder
If you’re currently experiencing a manic or hypomanic episode, your doctor is likely to prescribe you an antipsychotic.
Your doctor is also likely to prescribe antipsychotics if you experience psychotic symptoms in an episode of mania or severe depression.
The National Institute for Health and Care Excellence the organisation that produces guidelines on best practice in healthcare recommends the following antipsychotics:
- haloperidol also known as Dozic, Haldol, Haldol Decanoate, Serenace
- olanzapine also known as Zalasta, Zyprexa, ZypAdhera
- quetiapine also known as Atrolak, Biquelle, Ebesque, Seroquel, Tenprolide, Zaluron
- risperidone also known as Risperdal, Risperdal Consta
If your first antipsychotic doesn’t work, your doctor might offer another from the list above. If the second doesn’t work, your doctor might offer lithium to take together with an antipsychotic.
If you take an antipsychotic, you’ll need to have regular health checks with your doctor.
For more information, see our pages on antipsychotics.
What Makes Bipolar Disorder So Challenging
Comorbid psychiatric disorders, most often anxiety disorders, are common .3 Over a third of cases, especially those with early onset disorder, also have an alcohol or drug disorder, either as a precipitant or secondary complication.
Box 1 Differential diagnosis of bipolar disorder
* Comorbidity with bipolar disorder must also be considered.
Poor insight into being ill and rejection of help are more common in acute mania than in other phases of illness. This can necessitate compulsory treatment and make collaborative management difficult, even after recovery from acute episodes.10 Disinhibited and violent behaviour in mania may lead to risk or harm to others and involvement of the criminal justice system. By contrast, hypomania often escapes medical attention and, even if recognised, there can be a reluctance to seek treatment or prevent recurrence. The patient may view hypomania as positive and associated with increased energy and productivity. Episodes of hypomania or mania nearly always have negative social, financial, and occupational consequences, which can be long lasting and, particularly with mania, devastating.
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 , midwife, GP and health visitor.
The following medicines are not routinely prescribed for pregnant women with bipolar disorder, as they may harm the baby:
Don’t Miss: Three Phases Of Schizophrenia
Management Of Comorbid Disorders
The basic principle of management of comorbid disorders would be first to achieve mood regulation with the help of mood stabilizers. A mood stabilizer which can take care of both the bipolarity and comorbid disorder should be preferred such as valproate for panic disorder and alcohol dependence or migraine, carbamazepine for alcohol withdrawal, Topiramate in alcohol dependencies, obesity, migraine, binge eating, and gabapentin in social anxiety disorder.
Many comorbid psychiatric disorders like anxiety disorder, obsessive compulsive disorder, eating disorder etc., respond to antidepressants, but it would be prudent to use them along with mood stabilizers to avoid the risk of cycle acceleration. In case antidepressants have to be avoided, psychotherapic measures like cognitive behavioral therapy interpersonal therapy may be used.
What Causes Bipolar Disorder
Similar genetic risk factors are involved in whether someone develops bipolar disorder, severe depression or schizophrenia. There are also environmental risk factors, and these can interact with genetic risk factors to increase or decrease your risk of developing these conditions.
For example, you might have genetic risk factors that mean you are more likely to develop bipolar disorder. However, if you grow up or live in a stable and positive environment this may reduce your risk of developing a serious mental illness.
Having a parent with a serious mental illness like bipolar is the strongest known risk factor for developing a serious mental illness yourself. Children with a parent who has a serious mental illness have a 1 in 3 chance of developing a serious mental illness themselves.
When thinking about the causes of developing bipolar disorder, it is important to remember that lots of different things are involved, and that no single risk factor causes bipolar disorder.3
Recommended Reading: How Is A Depression Shown On A Contour Map
Main Facts And Figures
- in 2014, there were no meaningful differences between ethnic groups in the percentage of adults who had a positive screening for bipolar disorder
- the small number of positive screenings for certain ethnic groups means any apparent differences are too uncertain to draw reliable conclusions
- these figures should not be used as evidence of real differences between ethnic groups in the population as a whole
Bipolar Disorder Is Not Serious
Downplaying the seriousness of bipolar disorder minimizes our daily fight with the bipolar battle. When you hear individuals candidly joke about bipolar disorder, they are contributing to the stigma surrounding it.
Yes, there are degrees of severity when it comes to this illness. The severity is regarding the symptomology. However, it does not matter what type of bipolar disorder you are diagnosed.
The type of bipolar is just a way to communicate the treatment route you should follow.
As a mental illness, bipolar disorder is extremely serious. It is not only an illness about mood fluctuations.
Bipolar disorder increases the intensity of these mood fluctuations. It also directly impacts energy level, motivation and overall ability to function.
Suicide is also a real threat.
Youre damn straight it is!
Also Check: Anxiety From Dehydration
People Commonly Affected By Bipolar Disorder
Bipolar disorder is fairly common.
Bipolar disorder can occur at any age. It often develops between the ages of 15 and 19 and rarely develops after 40. Men and women from all backgrounds are equally likely to develop bipolar disorder.
The pattern of mood swings in bipolar disorder varies widely between people.
For example, some people only have a couple of bipolar episodes in their lifetime and are stable in between, while others have many episodes.
Faq Frequently Asked Questions
Author: Dr Joanne Van der Velden PhD, BSc First answered: 25 Nov 2014Last reviewed: 14 May 2019Rating: 4.8 out of 5Votes: 308 Category: Depression
All Health& ‘s health information is accredited by international standards and approved by our world-class Health& Medical Advisory Board.
Always ask your doctor or healthcare provider any questions you may have regarding a medical condition. In case of emergency, call your doctor or dial 911 , or dial 112 , or dial 000 immediately.
You May Like: Serotonin And Eating Disorders
Societys Attitude Towards Bipolar Disorder
Bipolar disorder is becoming more widely understood in the UK, and storylines such as that of Stacey and her mother Jean in EastEnders, and celebrities like Stephen Fry and Frank Bruno speaking out about their own experiences of bipolar illness, have helped more people to recognise the name of the disorder.
That said, there are still a lot of myths surrounding bipolar, and sadly, there is still a lot of work to be done around the stigma that can be attached to this diagnosis.
A common myth is that people love the highs that they experience in bipolar and will avoid taking their medication so they can still experience this euphoria.
While this is true for some individuals, for many the mania is as distressing and damaging, if not more so in some cases, as the depressive lows.
Mania is not always pleasant, it can be scary, and can sometimes manifest as extreme anxiety and a total inability to rest.
Not everyone in a manic state experiences euphoria, and even if they do, the consequences following their disinhibited actions can be hard to deal with.
Symptoms Of Mania In Bipolar Disorder
Intense feelings of optimism and wellbeing associated with a manic episode may seem preferable to the depressive symptoms of bipolar. However, these feelings can be equally disruptive to your daily life. It is important to not make any big life decisions during a phase of mania. You must also be aware of the potentially harmful side effects of this phase.
Usually affecting your relationships at home and work, mania can make it near impossible to cope with day-to-day life. Depending on the type of bipolar you are diagnosed with, you may experience a milder form of mania known as hypomania, which causes less extreme emotions.
The symptoms you may experience during an episode of mania include:
- Increased energy and desire to be active
- Extreme irritability
- Racing thoughts and talking quickly
- Not needing as much sleep
- Unrealistic beliefs about your own abilities
- Intrusive or aggressive behaviour
Recommended Reading: Phobia Of Big Words
The Bipolar Diagnosis Disaster
Other DBSA bipolar disorder statistics from 2000 shows that people with the disorder suffer through as long as 10 years of coping with symptoms before getting diagnosed accurately.
Only 1 person in 4 receives an accurate diagnosis in less than 3 years!
According to Dr Wes Burgess in his Bipolar Handbook: A recent study showed that almost 70% of bipolar patients had been misdiagnosed more than 3 times before receiving their correct diagnosis.
This high incidence of delayed diagnosis and misdiagnosis may explain why the bipolar disorder statistics around suicide are so appalling:
the disorder results in 9.2 years reduction in expected life span
up to 1 in 5 bipolar people completes suicide.
In the book Why am I still depressed? , Dr Jim Phelps states the suicide rate in Bipolar II is as high as, and in some studies higher than, in Bipolar I.
According to Dr Wes Burgess in his book, The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers, Penguin 2006:
30% of individuals with bipolar disorder will attempt suicide during their lives, and 20% will succeed . . . . Suicide is more common in bipolar depression than in unipolar major depression, panic disorder, or even schizophrenia. HOWEVER, THE SUICIDE RATE GOES DOWN DRAMATICALLY WITH ADEQUATE TREATMENT.
How Often Do Bipolar Episodes Occur
This can depend on a lot of things, such as:
- your exact diagnosis
- how well you’re able to manage your symptoms
- whether certain situations or experiences can trigger your episodes (for example, you might find that getting very
- little sleep while going through a stressful life event could trigger an episode of mania)
- how you define an episode personally
What’s normal for you can also change over time. However, many people find that:
- mania can start suddenly and last between two weeks and four or five months
- depressive episodes can last longer sometimes for several months
You may be told your bipolar is rapid cycling if you have experienced four or more depressive, manic, hypomanic or mixed episodes within a year. This might mean you feel stable for a few weeks between episodes, or that your mood can change as quickly as within the same day, or even the same hour.
Currently, rapid cycling is not officially considered a separate type of bipolar disorder, but more research is needed to know for sure or to better understand it.
For more information on rapid cycling, see the Bipolar UK website.
“It’s a lot harder coming to terms with being stable than I could have imagined. I’ve had to struggle with a ‘new’ identity and way of life after spending so many years thinking the ups and downs of bipolar are ‘normal’.”
You May Like: Topographic Depression
Staying Active And Eating Well
Eating well and keeping fit are important for everyone. Exercise can also help reduce the symptoms of bipolar disorder, particularly depressive symptoms.
It may also give you something to focus on and provide a routine, which is important for many people.
A healthy diet, combined with exercise, may also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.
Some treatments also increase the risk of developing diabetes, or worsen the illness in people that already have it. Maintaining a healthy weight and exercising are an important way of limiting that risk.
You should have a check-up at least once a year to monitor your risk of developing cardiovascular disease or diabetes.
This will include recording your weight, checking your blood pressure and having any appropriate blood tests.
How Is Bipolar Disorder Managed
Acute treatment of episodes of illness aims to resolve symptoms and reduce immediate risk to self or others. Long term treatment aims to prevent future episodes of illness and help regain a premorbid level of functioning, improve physical health, and reduce longer term suicide risk. Patients cycling between mania or hypomania and depression are especially difficult to treat, and stabilising mood is as important as treating the acute episode.
Drugs form the mainstay of treatment for bipolar I and II disorders but their role in milder disorders is less well established . Specific psychotherapies are important adjuncts in reducing relapse, treating depression, and improving function . Other crucial elements include ensuring a strong therapeutic alliance with treating clinicians, maintaining continuity of care, and tackling comorbid disorders and risk factors for relapse, including alcohol and substance misuse and disrupted circadian rhythms.
Effective treatments for bipolar disorder18 19 23-32
Given the lack of evidence on how to treat comorbid psychiatric disorders , usual practice is to stabilise mood and then carefully treat the specific disorder.
Recommended Reading: What Does A Ptsd Flashback Look Like
Risks Associated With Mood
The potential risks of medications during pregnancy include malformations, obstetrical, and neonatal complications and long-term neurobehavioral effects.
Neurobehavioral teratogenicity can result from medication exposure after the first trimester of pregnancy. Unfortunately, there is a dearth of long-term studies of children of women with BD exposed to medications during pregnancy. Maximizing safety requires familiarity with the impact of individual medications across these domains and interventional strategies to reduce risks.
Malformations associated with maternal drug use depend on the properties of the drug and the point of exposure: Up to 32 days postconception can affect neural tube development and closure days 2156 after conception may affect normal heart formation and during days 4263 may influence development of the lip and palate. Craniofacial anomalies can also occur after the first trimester.
Given that more than 50% of pregnancies are unplanned, by the time women and their clinicians are aware of the pregnancy, the period of susceptibility to these risks would have already occurred. Clinicians should provide maintenance treatments in anticipation of potential pregnancy and be aware of which medications pose the fewest risks.
Campaign For Faster Diagnosis
A diagnosis makes it possible for someone to get effective treatment and support, and to live well with bipolar.
Its estimated that at least one in 20 people who take their own life have a diagnosis of bipolar.
The shorter the delay in diagnosis, the sooner someone can empower themselves with effective self-management and foster a positive circle with fewer relapses in both the short and long-term.
We want to give people with bipolar who dont have a diagnosis a voice.
Please help us reach decision-makers by signing our petition. Once we reach 10,000 signatures, were more likely to get a response from the government. And, we know its incredibly ambitious, but if we get to 100,000 we may get a debate in parliament.
Also Check: Prodromal Symptoms Of Schizophrenia Are Evident
Bipolar Disorder And Overall Health
- On average, bipolar disorder results in 9.2 years reduction in expected life span .
- The risk of suicide is high in people with bipolar disorder with 15% to 17% committing suicide.
- Up to 60% of people with any mental health disorder, including bipolar disorder, develop substance use disorders.
- Of those with bipolar disorder, many report co-occurring health conditions, which are most commonly migraine, asthma, and high cholesterol. High blood pressure, thyroid disease, and osteoarthritis were also identified as high probability co-occurring health problems.
How Do I Distinguish Between Bipolar And Unipolar Depression
Depression occurring in bipolar disorder cannot be reliably distinguished from unipolar depression on the basis of symptoms alone. In the absence of a history of elevated mood, a comprehensive review of studies comparing depression in the two disorders has proposed an approach based on symptom profile, family history, and illness course .22
Box 3 Distinguishing between bipolar I depression and unipolar depression*
Clinical suspicion increases with the number of features present for both types of depression
Greater likelihood of bipolar I depression
Atypical depressive features
Later onset of depression
Longer duration of depressive episode
No family history of bipolar disorder
*Based on a comprehensive review of studies comparing the clinical features of depression in the two disorders22
You May Like: Sesquipedalophobia Definition
Bipolar Disorder With Impairment Among Adults
- Of adults with bipolar disorder in the past year, degree of impairment ranged from moderate to serious, as shown in Figure 2. Impairment was determined by scores on the Sheehan Disability Scale.
- An estimated 82.9% of people with bipolar disorder had serious impairment, the highest percent serious impairment among mood disorders.3
- An estimated 17.1% had moderate impairment.
Is Bipolar A Womens Disease
Despite the stereotypes, men and women are affected in equal numbers. However, research does show some differences in how the disorder develops:
women are 3 times more likely than men to experience rapid cycling.
women may have more depressive episodes and more mixed episodes than men.
Other interesting research from the Depression and Bipolar Support Alliance in 2000 showed a gender bias women are far more likely to be misdiagnosed with depression and men are far more likely to be misdiagnosed with schizophrenia.
Also Check: Fear Of Long Words Phobia Name
Anticonvulsants For Bipolar Disorder
Three anticonvulsant drugs, used as mood stabilisers, are licensed to treat bipolar disorder:
- carbamazepine also known as Tegretol. This is sometimes prescribed to treat episodes of mania. It can be prescribed if lithium is ineffective or unsuitable for you. For more information, see our page on carbamazepine.
- valproate also known as Depakote, Epilim. This can be used to treat episodes of mania and is typically a long-term treatment. It can be prescribed if lithium is ineffective or unsuitable for you. Your doctor is unlikely to prescribe you valproate if you’re able to become pregnant. This is because it can lead to significant risks in pregnancy. For more information, see our page on valproate.
- lamotrigine also known as Lamictal. This is licensed to treat severe depression in bipolar disorder, but NICE does not recommend it for treating mania. If you’re pregnant and taking lamotrigine, NICE recommends regular check-ups. For more information, see our page on lamotrigine.
For more information, see our pages on mood stabilisers.
Medication can help keep your moods on an even keel, but it is trial and error.