Top 10 Steps to Bipolar Disorder Treatment

The goal of bipolar disorder treatment is to reduce your episodes of feeling too high (mania) and feeling too low (depression). Treatment can lessen mood swings and help you live a normal and fulfilling life. Because bipolar disorder is unpredictable, your treatment may need to change over time. Here is a step-by-step look at the possibilities.

1. Making You Safe

At the beginning of treatment, you will need to be evaluated. Your doctor, most likely a psychiatrist, will make sure that you are not a threat to yourself or others and that you have a support system at home. He or she will also want to find out whether you have any other health problems, are taking any medications, or are using any substances that could be causing your symptoms or could interfere with your treatment.

2. Controlling Mania and Depression

For many people, the first drug used to treat bipolar disorder is a mood stabilizer. Lithium (Lithobid) controls mania and helps prevent manic and depressive episodes. Doctors also commonly use medications that control seizures, called anticonvulsants, to balance moods. These include lamotrigine (Lamictal), valproic acid (Depakote), and carbamazepine (Tegretol).

3. Adding Drugs to Control Bipolar Disorder

If a mood stabilizer drug is not helping you, or if you have psychotic symptoms—seeing, hearing or believing things that are not real—your doctor may add an atypical antipsychotic medication. Atypical antipsychotic drugs include olanzapine (Zyprexa), aripiprazole (Abilify), and quetiapine (Seroquel).

4. Adding Drugs to Treat Depression

Mood stabilizers usually control mania and depression. However, if you have depression symptoms that don’t clear up after a few weeks, your doctor may add an antidepressant drug. The first choice for an antidepressant is usually either bupropion (Wellbutrin) or paroxetine (Paxil). It is safest to take an antidepressant along with a mood stabilizer.

5. Adding Drugs for Other Symptoms

Sometimes, even after your doctor has found the right drug or combination of drugs to control bipolar disorder, you may still have other symptoms. For anxiety, your doctor may add an antianxiety medication called a benzodiazepine. If you’re having trouble sleeping, your doctor may give you a sleep aid. Taking lithium can cause your thyroid gland to become less active than normal, so you might need to take thyroid hormone medication.

6. Getting Psychotherapy

In addition to medication, you’ll probably benefit from psychotherapy, or talk therapy, for bipolar disorder. Psychotherapy can show you how to change harmful behaviors, communicate better with others, keep to a regular schedule for sleeping and eating, and recognize symptoms of a relapse.

7. Caring for Yourself

Create and stick to a daily schedule of eating healthy meals and getting enough sleep at night. A daily routine helps control bipolar disorder. Also, keep a daily log. Tracking your symptoms and medication side effects, along with the other positive steps you’re taking, can help your doctor make any needed adjustments to keep you healthy.

8. Considering ECT

Electroconvulsive therapy (ECT) may be an option if medications aren’t helping you, or when your symptoms are very severe or life threatening. Often called shock therapy, ECT involves putting you to sleep and sending electrical waves through your brain for about a minute. There is a general misunderstanding regarding ECT among the lay community, steeped in misinformation. ECT is a safe and very effective treatment that has been around for decades. ECT can relieve severe bipolar symptoms, but it can also cause temporary confusion and memory loss.

9. Hanging Tough for the Long Haul

For most people, bipolar treatment lasts a lifetime and works best when you start early and stay with it. Studies show that most people get better, but may still have lingering symptoms. About 75% of people will experience a full relapse at some point. Learn as much as you can about your disease and work closely with your care team. Stopping your medication suddenly, or dropping out of your treatment is dangerous and increases your risk for suicide.

10. Working With Your Team

Healthcare providers who will help you with bipolar disorder include your primary care doctor and your psychiatrist, for medical management. Talk therapy and education about your disease may come from psychologists, social workers, and certified counselors. Finally, create a support system of friends and family and find a support group to talk with and share experiences. You are not alone—bipolar disorder affects about 2.3 million Americans.

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