What Causes Bipolar Disorder
Although the exact cause is unknown, there does seem to be a genetic link, and you are more likely to get bipolar disorder if you have another family member with the condition.
Symptoms are often triggered by a stressful situation or circumstance. This may take the form of a relationship breakdown physical, sexual, or emotional abuse money problems or the death of a close family member or loved one.
Symptoms are thought to be due to changes in the balance of some neurotransmitters in the brain, specifically noradrenaline, serotonin, and dopamine.
It can be hard to recognize bipolar disorder initially. During a manic phase, a person with bipolar disorder may be incredibly fun to be around. However, as the condition progresses, these manic episodes become more extreme.
Some people with bipolar disorder only experience slight mania and are mainly depressed. Misdiagnosis as depression is common. If an antidepressant is prescribed without a mood stabilizer, it will often catapult the person into a full-on manic state. Recognizing bipolar illness is important for treatment, as mood stabilizing agents are the best type of medication.
Overdosage Of Antimanic Medicines
Lithium, carbamazepine and valproic acid are excreted in breast milk.
Lithium is contraindicated in severe renal impairment, as the risk of toxicity is enhanced. Carbamazepine and valproic acid do not generally require dose adjustment in renal impairment.
Carbamazepine and valproic acid are contraindicated in acute liver disease. In chronic liver disease, health care providers should prescribed lower doses. Lithium does not generally require dose adjustment in liver impairment.
Severe Mania Or Mixed Episodes
Combined therapy with an antipsychotic agent and another antimanic medication is recommended for patients with severe mania or mixed episodes, with or without psychotic features. Thus, lithium, a drug commonly used for prophylaxis and treatment of manic episodes, or valproate may be used in combination with antipsychotic agents .
Despite the serious side effects associated with clozapine, the Veterans Administration/Department of Defense suggest this drug may be added to existing medications if it was successfully used previously for severe mania or mixed episodes or if other antipsychotic agents are unsuccessful.
Reevaluate nonhospitalized patients being treated for severe mania or mixed episodes every 2-5 days until symptomatic improvement, and adjust medication dosages and regimens as needed. The therapeutic range of lithium is a serum trough concentration between 0.6-1.2 mEq/L for valproate, 50-125 mcg/mL and for carbamazepine, 4-12 mcg/mL. If the patients serum concentrations of their medication fall below the therapeutic range, adjust the drugs dose to the maximum range. For medications without known therapeutic plasma concentrations, increase the dose until symptomatic improvement, patient intolerance, or the manufacturers maximum dose limits have been reached.
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Medicines For Bipolar Depression
Most of the time, doctors will start bipolar disorder treatment by prescribing a mood-stabilizing drug like lithium. But the FDA has approved some medicines for bipolar depression, too:
For some people, traditional antidepressants may trigger a manic episode. Because of this risk, your doctor should keep track of you closely if you take one.
What Will My Doctor Need To Know
To help decide which medication to offer, your doctor might need to look into factors such as:
- Your current symptoms. For example, if you’re currently experiencing a manic, hypomanic, depressive or mixed episode.
- Your past symptoms. Such as the types of mood episodes you have experienced, and how long they have lasted.
- How you’ve responded to treatments in the past.
- The risk of another episode. This could includewhat has triggered episodes in the past.
- Your physical health. In particular if you have kidney problems, weight problems or diabetes.
- How likely you are to stick to a medication routine.
- Your sex and age. In particular whether you are able to become pregnant.
- In older people, a test of mental processes. For example, the test used to diagnose dementia.
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Considerations Of Outpatient Treatment
Outpatient treatment for patients with bipolar disorder, or manic-depressive illness , has 4 major goals, as follows:
Look at areas of stress and find ways to handle them: The stresses can stem from family or work, but if they accumulate, they propel the person into mania or depression this is a form of psychotherapy
Monitor and support the medication: Medications make an incredible difference, and the key is to obtain the benefits while avoiding adverse effects patients are ambivalent about their medicationsalthough they recognize that the drugs help and prevent hospitalizations, they also resent that they need them the goal is to address their feelings and allow them to continue with the medications
Develop and maintain the therapeutic alliance: This is one of the many reasons for the practitioner to deal with the patients ambivalence about the medications over time, the strength of the alliance helps keep the patients symptoms at a minimum and helps the patient remain in the community
Provide education : The clinician must help educate both the patient and the family about bipolar illness patients and families need to be aware of the dangers of substance abuse, the situations that would lead to relapse, and the essential role of medications support groups for patients and families are of tremendous importance
Patient self-management support
Community resource linkages
How Many Bipolar Mania Medications Are There
There are several bipolar mania medications, but the most commonly prescribed drugs include antipsychotics and mood stabilizers. These drugs help to control mood swings and prevent the symptoms of psychosis that often occur in mania, such as delusions and hallucinations.
According to the National Institute of Health, there is substantial evidence that supports the use of the following drugs in acute bipolar mania:
- Mood stabilizers, such as lithium
- Antipsychotics, such as chlorpromazine haloperidol , Risperidone and others
While medications can be prescribed to treat the acute symptoms of mania, most people with bipolar type I disorder decide to take medication long-term. Whats more, combination therapy is usually recommended to help people manage the ongoing effects of this condition. Sometimes, compulsory admission to a mental health hospital may be required if mania is severe, especially if your safety is at risk .
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Tips For Getting The Most Out Of Medication For Bipolar Disorder
Avoid antidepressants. The treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse or trigger a manic episode. Try mood stabilizers first and never take antidepressants without them.
Take advantage of natural mood stabilizers. Your lifestyle can have a huge impact on your symptoms. If you make healthy daily choices, you may be able to reduce the amount of medication you need. Mood stabilizers that dont require a prescription include keeping a strict sleep schedule, exercising regularly, practicing relaxation techniques, and developing a solid support system.
Add therapy to your treatment plan. Research shows that people who take medication for bipolar disorder tend to recover much faster and control their moods better if they also get therapy. Therapy gives you the tools to cope with lifes difficulties, monitor your progress, and deal with the problems bipolar disorder is causing in your personal and professional life.
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Drug Selection And Use
Choice of drug treatment for bipolar disorders Bipolar Disorders Bipolar disorders are characterized by episodes of mania and depression, which may alternate, although many patients have a predominance of one or the other. Exact cause is unknown, but heredity… read more can be difficult because all drugs have significant adverse effects, drug interactions are common, and no drug is universally effective. Selection should be based on what has previously been effective and well-tolerated in a given patient. If there is no prior experience , choice is based on the patients medical history and the severity of symptoms.
For severe manic psychosis, in which immediate patient safety and management is compromised, urgent behavioral control usually requires a sedating 2nd-generation antipsychotic Second-generation antipsychotics Antipsychotic drugs are divided into conventional antipsychotics and 2nd-generation antipsychotics based on their specific neurotransmitter receptor affinity and activity. SGAs may offer… read more , sometimes supplemented initially with a benzodiazepine such as lorazepam or clonazepam 2 to 4 mg IM or orally 3 times a day.
For less severe acute episodes in patients without contraindications , lithium is a good first choice for both mania and depressive episodes. Because its onset is slow , patients with significant symptoms may also be given an anticonvulsant or a 2nd-generation antipsychotic.
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What Kinds Of Therapies Work For Bipolar And Addiction Treatment
Several therapeutic approaches have also been shown to be effective in treating bipolar and substance use disorders. These therapies include:2,14
- Cognitive-Behavioral Therapy : CBT is a type of behavioral therapy where people learn to challenge ineffective thoughts, replace them with more helpful ones, and change their behaviors.
- Dialectical Behavior Therapy : DBT is an approach that incorporates mindfulness and increases the management of difficult emotions. DBT can also teach people skills to manage destructive, self-harming behaviors and suicidal urges.
- Integrated Group Therapy : This type of therapy was specifically developed for patients with co-occurring bipolar disorder and substance use disorder. It treats both disorders at the same time by helping patients understand how the two disorders relate to each other and how recovery and relapse are linked to thoughts and behaviors.
How To Help A Loved One With Bipolar Disorder And Addiction
If you know someone struggling with co-occurring bipolar and substance use disorder, you may be wondering how you can help them. You can take steps to support and assist your loved one to reach out to get the professional treatment they need.
Ways to help your loved one with co-occurring disorders includes:
- Educate yourself about addiction, co-occurring disorders, and bipolar disorder.
- Plan what you want to say and write it down. Remember to remain empathetic, avoid stigmatizing language, and do not blame or shame your loved one.
- Choose a neutral time and place to have a conversation with your loved one.
- Set boundaries and maintain them.
- Research inpatient addiction treatment in New Jersey.
- Offer to go with them to the doctor or to tour rehab facilities.
- Seek support and help for yourself, such as joining a support group, taking with a trusted friend or family member, or getting into therapy.
- Help your loved one find support groups like Alcoholics Anonymous or Narcotics Anonymous .
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How Is Bipolar Disorder Diagnosed
A diagnosis of bipolar disorder is made only by taking careful note of symptoms, and their severity, length, and frequency. The most telling are periods of hypomania or mania. Reviewing history from close friends and family is often very helpful to distinguish bipolar disorder from major depression.
If you or someone you know has symptoms of bipolar disorder, see your family healthcare provider or a psychiatrist. A referral may then be made to an appropriate mental health expert.
A thorough medical evaluation should be performed. Your doctor will ask questions about your personal and family history of mental illness. You may also be asked to complete a mood disorders or depression-screening questionnaire. This is a series of questions that you will be asked to answer verbally or in writing.
Important Help And Support
In the manic phase of bipolar disorder, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car. Drinks and foods containing caffeine — tea, coffee, and cola– should be allowed in moderation. Avoid alcohol at all times. It is very important for a patient experiencing manic symptoms to receive prompt psychiatric assessment. Family members may need to contact the doctor, because oftentimes patients in a manic or hypomanic episode have little insight into their illness and may refuse treatment. But prompt intervention, including possible medication adjustments at an early point in an episode, may prevent further problems and the need for hospitalization.
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Who Experiences Bipolar Disorder
Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder . Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.
While bipolar disorder occurs equally in women and men, women are more likely to meet criteria for bipolar II disorder. Women with bipolar disorder may switch moods more quickly this is called “rapid cycling.” Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.
An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder .
Are Antidepressants Used To Treat Bipolar Depression
While antidepressants are effective treatment for people with major depressive disorder, they are not always as effective for bipolar depression, and generally should not be given alone in people with bipolar I disorder. When antidepressants are given alone to someone with bipolar disorder, there’s a risk the drug might ignite a manic episode in some patients. Knowing this, most doctors may avoid using antidepressants as monotherapy for bipolar depression.
A very large randomized study sponsored by the National Institute of Mental Health called the Systematic Treatment Enhancement Program for Bipolar Disorder showed that mood stabilizers alone produced a stable improvement only in about 1 in 4 people with bipolar depression, and surprisingly, adding an antidepressant to the mood stabilizer did not boost improvement further. The STEP-BD study underscored the need to find treatments other than mood stabilizers or antidepressants for bipolar depression.
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The Experiments Of John Cade
As in many other events in biomedical research, chance played an important role in the introduction of lithium into the psychopharmacological arsenal . Thanks to the careful observation of Australian psychiatrist John F. Cade , who in 1949 was Senior Medical Officer, in the Victorian Department of Mental Hygiene of Australia , he noted how patients with thyroid endocrine diseases presented themselves symptoms that were similar to the clinical manifestations of manic-depressive disorder, so that individuals with hyperthyroidism experienced symptoms similar to those seen in individuals in the manic phase, while the traits of thyroid hypofunction were resembling those of the depressive phase .
John Frederick Cade , authentic pioneer of modern psychopharmacology with his experiments on lithium.
The kitchen at Bundoora Repatriation Mental Hospital where John Cade conducted some of his lithium experiments.
Laboratory notes by Cade regarding the effects of the injection of different compounds and lithium salts to guinea pigs.
Medical Journal of Australia, Volume 3, September 1949, in which the results of the clinical experiments by John Cade about lithium salts and the handling of hectic manic and schizophrenic patients were published .
Antidepressants For Bipolar Disorder
Your doctor might offer you a type of antidepressant medication, such as selective serotonin reuptake inhibitors . Antidepressants might be offered in combination with one of the medications described above.
Remember: always check with your doctor or pharmacist before taking any medications together, or closely following one another. The medications could interact badly with each other.
For example, combining lithium with SSRIs can increase the risk of side effects like serotonin syndrome.
For more information, see our pages on antidepressants.
It took me almost 11 years of living with the disorder before I found the right medication to keep my episodes at bay, and my moods properly stabilised.
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Psychosocial Interventions For Weight Management
Weight gain is a significant and frustrating side effects of some medications used to treat the symptoms of bipolar disorder. Weight gain can lead to problems such as diabetes and hypertension, making it a serious health issue for many individuals.
Resources to support weight loss are available. Weight programs generally last 3 months or longer and include education about nutrition and portion control. Participants learn skills to monitor their daily food intake and activity levels, have regular weigh-ins, and set realistic and attainable personal wellness goals.
Participation in such a program can help prevent additional weight gain and lead to modest weight loss. The VAs version of this program is called MOVE! It is offered in a supportive group setting.
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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.
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