How Does Bipolar Disorder Affect Caregivers And Families
Caring for a child or teenager with bipolar disorder can be stressful for parents and families. Coping with a childs mood episodes and other problemssuch as short tempers and risky behaviorscan challenge any caregiver.
It is important that caregivers take care of themselves, too. Find someone you can talk to or consult your health care provider about support groups. Finding support and strategies for managing stress can help you and your child.
Which Bipolar Medicine Is Best
Doctors use many types of drugs to treat bipolar disorder. Some fight the extreme highs of mania and others treat the lows ofÂ;depression. You might take one drug at a time or a few at the same time.
The best bipolar medicine is the one that works best for you. Work with your doctor to decide on the medication plan that helps you the most.
You may keep taking these medications for years or decades, even if itâs been a long time since your last manic or depressive episode. This is called maintenance therapy and helps prevent recurrence of symptoms.
Top Mood Stabilizers For Bipolar Disorder
None of them are perfect, but a few rise to the top, according to recent guidelines.
RESEARCH UPDATE
Ive been pouring over textbooks and treatment guidelines, and these four mood stabilizers keep rising to the top.1-6 None of them are perfect, but each has a unique role in bipolar disorder:
- Lithium
- Lurasidone
- Lamotrigine
Lithium and quetiapine top the lists for all three phases of the illness: mania, depression, and the maintenance phase. Lurasidone and lamotrigine are either untested or ineffective in mania, but they are essential tools for bipolar depression.
Lithium
Lithium stands out for its preventative effects in bipolar disorder, but it also has important benefits outside of the manic-depressive symptom lists. It is the only mood stabilizer that significantly reduces the risk of suicide, and it reduces mortality in other ways as well. Although lithium is often avoided out of concerns of toxicity, it actually lowers the risk of cancer, heart disease, stroke, and viral illnesses.7 All of those occur at higher frequency in bipolar disorder. Vascular disease is the leading cause of death in bipolar disorder,8 and viral illnesses are both a consequence and cause of bipolar symptoms.9
Quetiapine
Lurasidone and Lamotrigine
The Bottom Line
For related content, see Dosing Secrets for the Top Mood Stabilizers.
Disclosures:
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The 10 Most Common Bipolar Disorder Symptoms
Bipolar disorder is a complicated mental health illness that is easily mistaken for other problems like ADHD or regular depression. ;;One way a doctor diagnoses the type of bipolar disorder a person suffers from is by looking at the symptoms the person has.
While not everyone who has bipolar disorder will suffer from all of the signs and symptoms of it and the symptoms usually vary in type and severity from person to person, there are certain common bipolar disorder symptoms that are usually found.
These symptoms can occur in both men and women.; While most of these signs of manic depression usually first manifest themselves in a persons teens or twenties they have been known to occur earlier or later in some cases.
The Top 10 Most Common Bipolar Disorder Symptoms in Adults
Mania
The one trait that all people who have bipolar disorder share is that each person with this condition will have at least one manic or mixed-manic event during their lifetime. ;;That is one of the hallmark symptoms of bipolar disorder and a key factor in its diagnosis.
Mania is a high-energy state of mind where the individual is likely to have a positive mood. ;The individual is likely to seem extremely energetic and in the case of the milder Bipolar II disorders is often highly productive when in a state of mania or hypomania. ;This is the happy mood that tends to go in cycles with other moods.
Depression
Mood Swings
Irritation
Sleep Issues
Inflated Ego or Self-Esteem
Constant Fatigue
Rapid Speech
Can Children And Teens With Bipolar Disorder Have Other Problems
Young people with bipolar disorder can have several problems at the same time. These;include:
- Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.
- Attention-deficit/hyperactivity disorder . Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.
- Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.
Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldnt usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.
If your child shows signs of suicidal thinking, take these signs seriously and call your childs health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline at 1800273TALK , or text the Crisis Text Line .; These services are confidential, free, and available 24/7.
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Types Of Mood Stabilizing Medication
The oldest and most studied of mood stabilizers is lithium. However, many drugs that were first developed as anticonvulsants to treat epilepsy also act as mood stabilizers. These include carbamazepine, divalproex and lamotrigine. Gabapentin and topiramate are also anticonvulsants that may act as mood stabilizers, but they are usually given in addition to other medications.
Lithium
Lithium is found in nature in some mineral waters and is also present in small amounts in the human body.
Lithium is used to treat mania and to prevent further episodes of mania and depression.
Common side-effects of lithium include increased thirst and urination, nausea, weight gain and a fine trembling of the hands. Less common side-effects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes and slight muscle weakness. These effects are generally mild and fade as treatment continues. If, however, any of these effects are severe, they should be reported to your doctor immediately. Thyroid and kidney function can be affected by lithium in some people and must be monitored regularly by your doctor.
Changing the amount of salt you use can also affect lithium levels: avoid switching to low- or no-salt diets.
Signs that the amount of lithium in the body is higher than it should be include severe nausea, vomiting and diarrhea, shaking and twitching, loss of balance, slurred speech, double vision and weakness.
Carbamazepine
Lamotrigine
Antipsychotics For Bipolar Disorder
You are most likely to be prescribed an antipsychotic if you have an episode of mania or severe depression in which you experience psychotic symptoms, such as hearing voices. However, some antipsychotics are increasingly prescribed even if you haven’t had psychotic symptoms, as their side effects might be less unpleasant, and they’re safer in pregnancy.
The National Institute for Health and Care Excellence treatment guidelines recommend the following antipsychotics:
- haloperidol
- olanzapine
- quetiapine
- risperidone
If your first antipsychotic doesn’t work, you should be offered a different one from the list above. If the second antipsychotic doesn’t work you may be offered lithium to take together with an antipsychotic.
If you’re prescribed an antipsychotic, you’ll need to have regular health checks with your doctor.
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Adjunctive Psychotherapy In Acute Treatment
Patients in acute manic episodes are not likely to respond well to intensive psychotherapy because of insufficient insight or rejection of help. Some trials have examined whether psychotherapy enhances remission from acute depression. The STEP-BD study compared up to 30 sessions of family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioural therapy with a brief psychoeducational therapy for 293 patients with acute depression who also received mood stabilisers. Over 1 year, patients in intensive therapy recovered more rapidly and were more likely to be clinically well in any study month than those in brief treatment. Effects extended to relationship functioning and life satis faction. No differences emerged between the three intensive modalities in symptoms or psychosocial functioning over 1 year. Interestingly, patients with depression in STEP-BD who were treated with mood stabilisers and randomly assigned to adjunctive anti depressant treatment did not recover faster than patients who were assigned to adjunctive placebo treatment. Therefore, psychosocial treatment might be a more effective adjunct to mood stabilisers than antidepressants after a bipolar depressive episode.
Serotonin And Norepinephrine Reuptake Inhibitors
- levomilnacipran
- weight gain or loss
- dizziness
Some of the side effects are temporary and go away within a few days to weeks of taking the drug, while others are long-term.
A person can ask their doctor about ways to reduce side effects, such as taking medications at different times of the day or with food.
Always talk to a doctor about any severe, concerning, or persistent side effects. A doctor may suggest changing doses or trying a different drug.
Although it can take several weeks for most medications to function, a person should speak to a doctor if their drugs are not helping reduce symptoms.
Finding the right medication can be a slow and frustrating process, but it is best to speak to a doctor before stopping or changing medications.
People who use medications for bipolar disorder should also call their doctor if they miss more than one or two doses.
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Interpersonal And Social Rhythm Therapy
Substantial evidence exists that mood instability in bipolar disorder is related to changes in circadian rhythms . The relation between sleep and mood disturbances seem to be bidirectional. Polymorphisms in CLOCK genes are related to circadian mood fluctuations and recurrences in bipolar disorder. In one promising animal model, mice with mutations in CLOCK genes behaved in ways that resembled manic behaviour in people ; these behaviours were reversed upon treatment with lithium.
What Is The Best Medication For Bipolar Disorder
Mood stabilizers are typically considered the best medication for bipolar disorder.;
However, treatment of bipolar disorder should be individually tailored to your symptoms, frequency of mood swings, and response to treatment. In addition to mood stabilizers, doctors may also prescribe atypical antipsychotics and antidepressants.
- Mood stabilizers
- First line of treatment for most people with bipolar disorder, used to control both mania and depression
- Common examples are Lithobid and Depakote although quetiapine has also shown good efficacy is quetiapine
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Where Do I Go For Help
If youre not sure where to get help, your doctor, pediatrician, or other family health care provider is a good place to start. A health care provider can refer you to a qualified mental health professional, such as a psychiatrist or psychologist, who has experience treating bipolar disorder and can evaluate your childs symptoms.
You can learn more about getting help and finding a health care provider on the National Institute of Mental Health website. Hospital health care providers can help in an emergency. The Substance Abuse and Mental Health Services Administration has an online tool to help you find mental health services in your area.
Question 2: What Causes People To Get Bipolar
Sadly there is no single cause or way you can suddenly develop a Bipolar disorder. While some of the most common causes are family members suffering from it some sort of brain injury or even something as straight forward as stress, significant loss or a traumatic event! Sadly those are the most common, but other people with Bipolar disorder seemingly have no trigger points at all .
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What Are The Symptoms Of Bipolar Disorder
Symptoms vary among people with bipolar disorder, depending on what type of bipolar disorder they have. All have slightly different symptoms. Symptoms reflect mood opposites and may include:
- Periods of high or irritable mood
- High energy levels
- Feelings of hopelessness or despair
- Refusal to get out of bed.
Some people only develop milder symptoms of mania without psychotic symptoms. This is called hypomania. People who dont have full blown episodes of mania are more likely to have bipolar II disorder.
These mood swings are much more severe than the normal ups and downs most people go through. In between mood swings, most people with bipolar disorder can lead relatively normal lives.
The time spent in each mood state varies depending on the type of bipolar disorder but can range from days to months. The severity of the mood state can also vary significantly, with some people only ever experiencing mild symptoms.
The Role Of Medication In Bipolar Disorder Treatment
If you have bipolar disorder, medication will likely be a part of your treatment plan. Medication can bring mania and depression under control and prevent relapse once your mood has stabilized. You may not like the idea of taking bipolar medication long term, especially if youre struggling with unpleasant side effects. But just as a diabetic needs to take insulin in order to stay healthy, taking medication for bipolar disorder will help you maintain a stable mood.
Since finding the right drug and dose can be tricky, its important to work closely with a specialist and re-evaluate your medication regularly. Its also important to remember that taking medication is just one aspect of a successful treatment program. There are plenty of other steps you can take to manage your symptoms and even reduce the amount of medication required. Healthy lifestyle changes, self-help coping strategies, and exploring therapy are also important in coping with bipolar disorder symptoms and helping you live a full, productive life.
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Question 7: Will I Have Bipolar Disorder If My Parents Do
It could be one parent or both of them, but the truth is you stand a much higher chance of getting it than people without a close family relative that suffers from bipolar. Butthis doesnt mean for sure you will suffer from it as many times it will skip one or several generations of family members. To be honest, it isnt all bad if you do have a family member going through the same thing as you are as their past experience with it can be your current best advice.
Addiction And Bipolar Disorder
In an attempt to regulate these changes in mood and energy, individuals with bipolar disorder may abuse drugs or alcohol. According to the Journal of Clinical Psychiatry, up to 70 percent of people who meet the criteria for bipolar disorder also have a history of substance abuse a percentage that far exceeds the general population. Substance abuse affects the outcomes of bipolar disorder in several ways:
- Intensification of symptoms
- Longer episodes of emotional instability
- Increased number of suicide attempts
- Diminished quality of life
Treating bipolar disorder and substance abuse can be complex, requiring intensive attention to the symptoms of mental illness as well as the behaviors associated with addiction. The results of treatment for individuals with dual diagnoses, or a mental illness co-occurring with a substance use disorder, are generally much better if both conditions are treated at the same time, within the same program. In order to provide the most effective care, staff should be cross-trained in mental health care and substance abuse treatment.
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Glutamate And Nmda Receptors
Glutamate levels are observed to be elevated during mania. Lithium is thought to provide long-term mood stabilization and have anti-manic properties by modulating glutamate levels. It is proposed that lithium competes with magnesium for binding to NMDA glutamate receptor, increasing the availability of glutamate in post-synapticneurons.The NMDA receptor is also affected by other neurotransmitters such as serotonin and dopamine. Effects observed appear exclusive to lithium and have not been observed by other monovalent ions such as rubidium and caesium.
Question 10: Do I Have To Take Bipolar Medications For The Rest Of My Life
This will all depend on how strong you can be mentally and the strength of your close support network. The drugs you will be given are not there to control you, they are there to help you survive those highs and lows by nubbing the mind a little. But yes, with supportive friends and family and a good mental state you can learn to live with it without the need for chemical medication. But this is something to discuss with your local doctor and do make sure you are 100% truthful with your feelings throughout this process.
While these are some of the most common questions I am sure there are many, many more people will have. As I have said before in this post the key thing to remember is to keep talking to people even if that is just friends and family, but especially your local therapist or doctor if you have access to one.
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Cyclic Amp Secondary Messengers
Lithium’s therapeutic effects are thought to be partially attributable to its interactions with several signal transduction mechanisms. The cyclic AMP secondary messenger system is shown to be modulated by lithium. Lithium was found to increase the basal levels of cyclic AMP but impair receptor coupled stimulation of cyclic AMP production. It is hypothesized that the dual effects of lithium are due to the inhibition of G-proteins that mediate cyclic AMP production. Over a long period of lithium treatment, cyclic AMP and adenylate cyclase levels are further changed by gene transcription factors.