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.
Bipolar And Still Depressed
A common problem experienced by people with bipolar disorder is that they may have been under medical care for a while and are taking medication, but are still depressed.
Why does this happen?
Sometimes it is due to poor medication compliance. If someone isnt taking ALL of their medication at the RIGHT DOSE AND THE RIGHT TIME, then they are very likely to experience mood swings, including episodes of depression.
Another reason is that they are getting inappropriate treatment. If you are still suffering from bipolar depression, you should explore otherbipolar depression treatment options with your psychiatrist.
How To Use Lamotrigine Odt
Read the Medication Guide provided by your pharmacist before you start taking lamotrigine and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.
Take this medication with or without food, usually 1 to 2 times daily or as directed by your doctor. Place the tablet on your tongue and move it around the mouth. Allow it to dissolve, and swallow with or without water, or use as directed by your doctor. If this medication comes in a blister pack, do not use the medication if the blisters are torn, broken, or missing.
Dosage is based on your medical condition, response to treatment, and use of certain interacting drugs. For children, the dosage is also based on weight.
It is very important to follow your doctor’s dosing instructions exactly. The dose must be increased slowly. It may take several weeks or months to reach the best dose for you and to get the full benefit from this medication. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time each day.
Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. Also, if you have stopped taking this medication, do not restart lamotrigine without consulting your doctor.
Tell your doctor if your condition does not improve or if it worsens.
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Maintenance Treatment For Bipolar Disorder
The primary goal of maintenance treatment is to prevent the recurrence of episode of either polarity, reduce/eliminate the residual symptoms and improve the overall functioning of the patient. In terms of pharmaco-therapeutic agents, best evidence for maintenance treatment is available for lithium and valproate. In recent years evidence has also emerged for use of olanzapine and quetiapine in prevention of recurrence of both depressive and manic episodes. However, these may be avoided because of associated higher risk of metabolic side effects. Long acting risperidone has been shown to be beneficial in prevention of recurrence. Lamotrigine has been shown to be efficacious in prevention of depressive episodes, but not for prevention of manic episodes. Olanzapine, aripiprazole, ziprasidone and asenapine has been shown to be of benefit in prevention of recurrence of manic episodes, but not for depressive episodes. Carbamazepine has also been shown to be effective in prevention of recurrence however, it is less preferred compared to lithium and valproate because of its side effect profile and drug interactions. Studies have also evaluated the efficacy of lithium and valproate in combination with various antipsychotics. Besides use of pharmacotherapy, there is evidence to suggest the beneficial role of adjunctive psychosocial intervention in the management of BPAD. Maintenance ECT may also be considered in patients who have responded to ECT during their acute episodes.
Anxiety And Bipolar Depression: Treatment Options That Work
Each person dealing with bipolar depression and anxiety is unique. A treatment approach that works for one person might not work at all for another. While there isnt a single treatment that works for everybody, there is something for almost everyone. Its a matter of knowing and considering your options and working with your doctor to find the most effective approach to your mental health.
Effective treatment options for bipolar depression with anxiety include:
- Depression and anxiety medication, often a combination of different prescriptions
- Individual therapy
- Family therapy
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Long Term Treatment With Antidepressants In Bipolar Disorder
Longer term studies examining the efficacy and safety of antidepressants, either as monotherapy with bipolar II patients or in combination with mood stabilizers in bipolar I and/or II patients are, understandably, few. Practice guidelines generally recommend only short term treatment with antidepressants in bipolar individuals . This paucity of data is particularly unfortunate given the evidence that a substantial proportion of bipolar patients treated in the community have antidepressants as part of their maintenance regimen . Naturalistic studies suggested that a subgroup of patients that responded to a mood stabilizer plus an antidepressant did better if the antidepressant was included as part of a maintenance regimen, with lower depressive relapse rates and no increase in manic switches compared to the cohort whose antidepressants were withdrawn .
In a recent meta-analysis of the eleven studies examining the efficacy and safety of longer term antidepressants , antidepressants were superior to placebo in preventing depressive episodes , with or without mood stabilizers with no increase in manic/hypomanic episodes . Shorter studies and longer term studies showed similar findings.
Rapid Cycling Affective Disorder
Rapid cycling affective disorder is characterised by having 4 or more episodes in a single year. These episodes should be separated from each other by partial or full remission for at least 2 months or a switch to an episode of opposite polarity. Many risk factors have been identified for development of RCAD. Accordingly, the first step in the management of RCAD is to evaluate the patients for underlying medical conditions which may be contributing to the RCAD. Among medications, use of antidepressants has been shown to increase cycling.
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Will The Medicine Work For Me
Your doctor canât predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different doses to figure out the right approach. And that can take time.
It can be frustrating, but don’t give up. Eventually, you and your doctor should be able to find a prescription that works for you.
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.
Best Treatment For Bipolar Depression: Therapy
While medication works at the neurological level to ease mood swings and depression symptoms, therapy allows you to process the frustrations of living with bipolar depression and to develop tools and coping skills to move forward.
Some of the helpful aspects of therapy include:
- Identifying negative thought patterns and replacing them with more positive ones
- Learning stress management skills
What Are Potential Side Effects Of Bipolar Medications
Common side effects of these drugs may include:
- Sexual problems
Its imperative to work with your doctor or psychiatrist to manage your drug therapy. Because bipolar disorder symptoms vary greatly from person to person, it can take time to identify the best medication to manage your symptoms. Sometimes, you may need to try a few medications or combinations of medications before finding the right one.
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Drugs To Treat Bipolar Disorder
Bipolar disorder medications
If you have bipolar disorder, youll need to be treated on an ongoing basis. In fact, you should be seeing a mental health professional regularly, even if you feel fine. Treatment usually includes a combination of medication and talk therapy.
Psychiatrists typically recommend medications as initial treatment to control symptoms as quickly as possible.
Once symptoms are under control, youll receive maintenance treatment to reduce the risk of relapse. Maintenance treatment also reduces the chance of minor shifts in mood developing into mania or depression.
Several types of medications are used to treat bipolar disorder. These include mood stabilizers, antidepressants, and drugs that relieve anxiety. Your doctor may prescribe one or a combination of medications for maximum effect.
Finding the right medication or combination of medications will take some trial and error. You may need to change medications due to side effects.
It can take up to eight weeks to see the full effects of each medication. Usually, only one medication is changed at a time. This helps your doctor to better monitor and identify which one isnt working.
The following types of medications are used to treat bipolar disorder.
Natural Therapies For Bipolar Depression
When combined with prescribed medication, these alternative approaches may help you better manage the symptoms of bipolar disorder.
Bipolar disorder requires managing two distinct categories of symptoms. Manic symptoms may include impulsive behavior, excessive irritability, and anxiety, while depressive symptoms may include a low mood, poor appetite, and emotional indifference, according to the National Institute of Mental Health. Though there aren’t many complementary or alternative medicine remedies for manic behavior, a few non-prescription therapies may help alleviate depression. Most people who have bipolar disorder spend the majority of their time depressed rather than manic, notes the National Institutes of Health.
But just because CAM therapies exist doesn’t mean that people with bipolar disorder should throw away their antidepressants. “Bipolar is a very serious, lifelong disorder,” says Philip Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City. “If you need an antidepressant, you should take it. These other types of therapies are additional or complementary rather than alternative.”
The complementary and non-pharmacological treatments that have shown some benefit for the depressive side of bipolar disorder are:
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What Medication Is Best For Bipolar Depression
For patients with bipolar disorder, medication will likely be a part of ones treatment plan. Medication can bring mania and depression under control and prevent relapse once mood has stabilized. As people with diabetes need to take insulin to stay healthy, taking medication for bipolar disorder helps maintain a stable mood.
Treatment for bipolar depression has come a long way in a short while. Not so long ago, patients were given sedatives and medications with numerous side effects. Today, mood-stabilizing drugs are a mainstay treatment for bipolar disorder. Doctors may prescribe lithium, an antimanic drug, or an antipsychotic drugor a combination of bothto alleviate symptoms of depression without triggering a manic episode.
Options For Management Of Bipolar Disorder
Treatment options for management of BPAD can be broadly classified as mood stabilizers, antidepressants, antipsychotic medications, electroconvulsive therapy , adjunctive medications and psychosocial interventions . Use of various treatment options is guided by the phase of illness in which patient presents to the clinician and past treatment history.
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Olanzapine And Fluoxetine Combination
As an alternative treatment, the use of olanzapine and fluoxetine combination is also approved for acute bipolar depression. However, due to significant metabolic effects resulting in long-term risk for morbidity and mortality, OFC is not recommended early on in treatment. The use of OFC should be reserved until after all the aforementioned first-line medications and valproate have been trialed .
In studies comparing OFC to lamotrigine, similar remission rates were found in both arms however, lamotrigine was better tolerated.16 Recent meta-analysis show combinations of second-generation antipsychotics and antidepressants do not provide the same effectiveness as OFC.2
Bipolar Disorder And Differences With Depression
Dramatic shifts in mood and energy levels characterize bipolar disorder. People with bipolar disorder will cycle through periods of high energy, called mania, and periods of depression, when they may feel sad and hopeless. The Diagnostic and Statistical Manual of Mental Disorders recognizes four distinct types of bipolar disorder:
- Bipolar I disorder: People with bipolar I disorder experience both episodes of mania and depression.
- Bipolar II disorder: People with bipolar II disorder also experience mania and depression. The periods of mania are typically mild, while the depressive periods are quite severe.
- Cyclothymic disorder: Cyclothymic disorder is a milder form of bipolar disorder. People with this condition still experience periods of mania and depression, but each cycle tends to be shorter and less severe.
- Other: Some people may be diagnosed with bipolar disorder with mixed features they experience periods of high energy and depression at the same time. Other types of bipolar disorder may be labeled unspecified. In these cases, a person still experiences mood elevation, but their symptoms do not fit the criteria of other types of bipolar disorder.
While there are different types of bipolar disorder, depressive episodes are a major symptom that they share in common. The severity of bipolar depression can vary based on the type of the disorder and the individual, but it is always an important symptom to treat.
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Finding The Right Bipolar Disorder Medication
It can take a while to find the right bipolar medication and dose. Everyone responds to medication differently, so you may have to try several bipolar disorder drugs before you find the one that works for you. Be patient, but dont settle for a bipolar medication that makes you feel lousy, either.
Once youve discovered the right bipolar disorder drug or drug cocktail, it may still take time to determine the optimal dose. In the case of mood stabilizing medications such as lithium, the difference between a beneficial dose and a toxic one is small. Frequent office visits to re-evaluate your medication needs and careful monitoring of symptoms and side effects will help you stay safe.
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 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.
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Our Tms Treatment Options And Process
If youre looking for TMS treatment in New York City, we offer TMS under the supervision of our expert team. At Principium Psychiatry, we work hard to develop a personalized care model designed to meet your individual needs. We accept insurance for TMS, including Medicare, and we offer flexible payment options. Our team is dedicated to working with you to get you the innovative, effective care you need.
What About Psychotherapy For Help With Bipolar Depression
Along with medications for bipolar depression, patients may benefit from ongoing psychotherapy. This one-on-one therapy combines interpersonal psychotherapy with behavioral techniques to help patients learn how to more effectively manage interpersonal problems, stay on their medications, and normalize their lifestyle habits. The STEP-BD study mentioned earlier found that in addition to medications, adding a structured psychotherapy — such as cognitive behavioral therapy, interpersonal/social rhythm therapy, or family-focused therapy — can speed up treatment response in bipolar depression by as much as 150%.
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Is Bipolar Disorder Ever Considered Cured
This is not clear at this time. Although the condition responds to treatment in most cases, bipolar disorder is generally seen as a chronic disease that may come and go for many years.
Your child will need to follow the treatment plan outlined by her care team, and any changes should be carefully discussed among all members of her treatment team.