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For
the one percent of the population with bipolar disorder, symptoms
may follow one of two patterns.
Bipolar
I is
the "classic" form of bipolar disorder. This form of the
disease causes widely spaced, long-lasting bouts of mania followed
by long-lasting bouts of depression.
With
bipolar
II, the disease causes at
least one mild manic episode, with episodes of major depression.
Currently,
there is no recognized form of bipolar disorder involving mania
alone. Doctors diagnose nearly all patients who have manic episodes
as bipolar.
For
most people with bipolar disorder, a complete cycle of mood changes
takes at least four months. Some people complete mood cycles in a
matter of days or even hours. People who go through at least four
complete mood cycles within a single year are considered "rapid
cyclers." Women are more likely to be rapid cyclers than men.
Since
bipolar disorder is a chronic, life-long medical condition, the goal
of treatment is to manage the disease—not to cure it. Fortunately,
most people with bipolar disorder respond to drug therapy.
MOOD
STABILIZING DRUGS—taken
alone or with other drugs—can help minimize the extremes of
becoming too depressed or too high.
The
oldest and most common mood stabilizer is lithium. Lithium is often
the first medicine doctors prescribe to treat bipolar disorder and,
for 50 to 60 percent of patients, lithium alone is enough to manage
the disease.
People
taking lithium need blood tests fairly often at first, while
establishing the correct dosage. After determining the proper
dosage, the doctor will schedule follow-up blood tests every six
months or so.
ANTICONVULSANTS,
first developed to treat epilepsy, are also useful in treating
bipolar disorder. Some of the more commonly-prescribed brands are
Depakote, Tegretol and Neurontin.
ANTIDEPRESSANTS
may be the best choice in cases where bipolar disorder causes severe
depression without full-blown manic episodes.
Selective
serotonin reuptake inhibitors—SSRIs—are the newest class of
antidepressants. Some SSRI brands are Prozac, Paxil, Zoloft, Luvox
and Effexor. Other types of antidepressants the doctor may prescribe
are tricyclics and monoamine oxidase inhibitors, usually called MAO
Inhibitors or MAOIs.
Antidepressants
can trigger mania or rapid cycling when used to treat symptoms of
bipolar disorder. The doctor will monitor closely at first to make
sure the antidepressant is relieving symptoms of depression without
causing a mood swing too far in the other direction.
It can
take as long as six weeks for antidepressants to become fully
effective, and many people have to try several before finding the
one that works best.
ANTIPSYCHOTICS—also
referred to as neuroleptics or major tranquilizers—can help
relieve a manic episode while waiting for a mood stabilizer to work.
The doctor may prescribe an antipsychotic in a relatively low dose
to relieve insomnia or anxiety.
PSYCHOTHERAPY,
combined with drug therapy, is the most effective treatment for
bipolar disorder. The therapist’s primary goal is to help
stabilize moods and avoid future episodes of mania or depression.
Through
individual or group therapy, people with bipolar disorder can learn
more about managing the disease. If moods seem to fluctuate more at
times of stress, the therapist can teach stress management
techniques to help prevent a relapse. The therapist may suggest
bringing a family member or close friend to one or more sessions so
the relative or friend can recognize warning signs of a relapse and
get help before symptoms worsen.
Although
the frequency of therapy sessions may be cut back, once moods
stabilize, it’s still critically important to keep taking any
prescribed medicine. Plan on touching base with the doctor or case
manager every few months to make sure the medicine is still
effective at keeping moods stable.
HOSPITAL
CARE may be
appropriate if symptoms worsen significantly at either extreme or
the doctor believes there’s a possibility of self-inflicted injury
or harm to others. The length of the hospital stay depends on how
long it takes the patient’s moods to stabilize.
COMMUNITY
SUPPORT SERVICES
can help deal with some of the problems people with bipolar disorder
often experience.
Financial
help may be needed if the illness has interfered with work or caused
uncontrolled spending—a common problem during periods of mania.
Food stamps, subsidized housing, disability income and other
government assistance may be available to individuals and families
whose financial problems are significant.
As
moods become more stable, employment counseling and job training
programs can help.
The
symptoms of bipolar disorder can be extremely stressful, so entire
families may benefit from education courses, family counseling and
support groups.
Call
the toll-free NAMI North Carolina Helpline at 800 451-9682 to find
out if classes and support groups are available in your area.
To find out about
other support services, ask a therapist or case manager or call the
local community mental health center.
IF
YOU OR SOMEONE YOU LOVE HAS BIPOLAR DISORDER,
remember mood disorders have biochemical causes. There is no reason
to feel ashamed or embarrassed.
People
with untreated mood disorders find it difficult, if not impossible,
to change their behavior on their own. No matter how motivated they
are to get well, significant, lasting improvements will come only
with effective, ongoing treatment.
Nearly
all people with bipolar illness improve with some form of drug
therapy. If the first medicine doesn’t work, others may, so be
prepared to try a number of alternatives before finding the
treatment that works best.
Bipolar
disorder cannot be cured, and most people who have the disease will
need treatment and support services at least some of the time for
the rest of their lives.
Email
NAMI North Carolina or call the Helpline at 800 451-9682
for information about resources,
family support groups and education available in or near your
community. |
