Managing Bipolar Disorder

Bipolar disorder is a prevalent psychiatric disease characterized by range of elevated mood disorders often referred as mania. Depression commonly accompanies these mood disorders depending on the severity of the disorder. Bipolar spectrum, that is, the range of this disorder lies within three broad categories: bipolar II, cyclothymia, and bipolar I. this spectrum depends mainly on nature and asperity of the mood episodes that one goes through.

This disorder becomes full blown in the late adolescence or in some few cases, in early adulthood. Diagnosis relies on one’s experiences together with observable behaviors. Some of the abnormal episodes include distress, disruption, and increased rate of suicide among others. Causes of bipolar disorder include genetic factors and environmental factors, even though in some cases it is associated with positive accomplishments, creativity, and goal nisus.

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Problems associated with this disorder include stigma, stereotypes, and preconception against victims of this disorder. Unfortunately, bipolar disorder in most cases is misdiagnosed as schizophrenia and this delays its appropriate management. The prevalence of bipolar disorder stands at 5 million people in America alone.

This implies that, in every 45 adults, one of them has bipolar disorder. It is difficult to diagnose this disorder because there are no specimen tests with diagnosis relying mainly on observation, and this elevates the probability of misdiagnosis as aforementioned.

There are different ways of managing this disorder including mood stabilizers among other psychiatric medications. Practices like psychotherapy find wide application especially in cases where individuals show improved stability in recovery. This paper deals with the different ways of managing bipolar disorder from treatment to any other measure employed towards the management of this disorder.

Bipolar Disorder Management

1. Therapeutic Interventions

1.1 Antidepressants

1.1.1 Bupropion

This is one of the most efficacious antidepressants and it acts by suppressing neuronal reuptake of nor-epinephrine or noradrenalin and dopamine. 1 Research indicates that, bupropion significantly reduces the symptoms of depression and anxiety within the first weeks of its administration.

Apart from the short-term positive results, bupropion has long-term effects and this explains in part why the US opinion leaders have rated this drug highly in terms of bipolar management. 2 Even though this drug may precipitate mania, it is one of the best drugs of treating bipolar disorder and depression.

1.1.2 Selective Serotonin Reuptake Inhibitors (SSRIs)

As the name suggests, SSRIs promotes serotonin neurotransmission by suppressing neuronal 5-hydroxytryptamine (serotonin) reuptake. 3 This inhibition leads to reduced depression and increases chances of sleep. SSRIs are widely used in developed countries albeit there is limited study on their efficacy. The shortcomings of these drugs include intolerance, development of mixed states and patient’s noncompliance.

1.1.3 Tricyclic Antidepressants (TCA)

These drugs have short-term efficacy with the combination of lithium. TCA functions to reduce depression even though research work indicates that these drugs increase the probability of mania precipitation. 1 Nevertheless, TCA offers the best option in treating patients with ‘drug resistance’ symptoms.

1.1.4 Monoamine Oxidase Inhibitors (MAOIs)

These drugs act to inhibit the work of enzyme monoamine oxidase and this reduces levels of depression and bipolar disorder. Research indicates that, MAOIs are the best drugs in treating anergic depression, which is common among bipolar disorder patients. 3

However, these drugs have inauspicious effects and dietary restrictions and this provides challenge to the administration of the same. Nevertheless, in combination of lithium, MAOIs function well and the dietary interactions are significantly reduced hence its common application in fourth–line treatments. 1

1.2 Mood Stabilizers

Mood stabilizers are compounds that will work to reduce anxiety, depression, and bipolar disorder without major side effects. These are prophylactic agents, which are effective in all phases of sickness even though some substances that are effective at particular phases of sickness may fall under this category.

1.2.1 Lithium

Lithium is one of the most effective prophylactic agents whether used alone or in combination of antidepressants like selective serotonin reuptake inhibitors. It functions well in the long term taking over six weeks to yield antidepressant results. 1 Studies have strongly linked lithium with reduced suicide incidences and this property adds to its efficacy in treating bipolar disorder. However, just like any other compound, lithium has shortcomings including increased regress to mania and depression.

1.2.2 Carbamazepine

Even though there are limited studies of carbamazepine, the few existing one shows that this compound has antidepressant effect. 4 Unlike lithium, carbamazepine does not lead to relapse to mania and depression. However, the efficacy of this drug is modest at best. In combination with lithium, however, it works to treat acute bipolar syndrome. 2

1.2.3 Valproate Semisodium (Divalproex Sodium)

This is valproic acid and exists as a sodium salt, as an amide or as semi sodium made by mixture of sodium valproate and valproic acid. 5 It functions through regulating ?-amino butyric acid (GABA) neurotransmission. Its mood stabilizing effects results from its association with excitatory membranes. This is one of the commonly used mood stabilizers given that it has fewer side effects compared to the other mood stabilizers.

1.2.3 Lamotrigine

This mood stabilizer came into scene after it was found out that it would stabilize mood in epileptic victims. This then extended to bipolar disorder where this drug offers antidepressant effects. 1 Lamotrigine works in the short-term and has high efficacy due to its prophylactic characteristics. However, in some cases, individuals may develop serious skin rash with continued use of this drug. 1

1.2.4 Gabapentin

This is newly modeled anticonvulsant compound based on GABA. 1 Even though there is little research to determine its efficacy through placebo-controlled experiments, earlier studies indicates that, it can be used as adjuvant with other depressants like tricyclic antidepressants. 1

1.3. Antipsychotics

Antipsychotics are gaining popularity especially after research indicated that combination of amitriptyline, which is an antidepressant and perphanazine, which is antipsychotic, showed high efficacy in treating bipolar disorder. 6 This combination had higher efficacy than any other drug used alone.

However, these combined drugs expose bipolar patients to high chances of tardive dyskinesia and sedation among other effects like obesity. 1 Most other antipsychotics and antidepressants can be used as add ups to mood stabilizers to manage bipolar disorder. 6

1.4 Electroconvulsive Therapy (ECT)

There has been wide application of ECT in treating both bipolar and unipolar disorders but there is no enough research on the efficacy and the dosage of the same. 1 However, there is evidence that ECT reduces the effects of bipolar disorder.

2. Psychological Intervention

Given the fact that, bipolar disorder may result from both life experiences and environmental factors, it is important to note that, these same factors contribute largely to the recovery of a patient. 7 For instance, an individual may have high expectations in say examination, which may interfere with sleep/wake cycle due to serotonin imbalance.

These experiences increase mania relapses and may lead to depression. Therefore, social support is necessary in managing bipolar disorder. Studies indicate that victims of bipolar disorder are likely to recover quickly under the care of family members or psychologists. 7 Home-based treatments establish coherent daily routines and caretaking that enhances the chances of quick recovery.

2.1 Psycho Education

Psycho education offers information on bipolar disorder and arms patient with adequate information on how to cope with the illness and manage it successfully. 8 Family members also know how to handle a bipolar disorder patient and this process results to effective management of the same.

The information comes inform of video tapes, workbooks, or drafts that help to develop personal relapse prevention strategy. 7 Studies strongly link psycho education to improved recovery processes as it changes patient’s attitude and he or she complies with medication regiments, thus resulting to improved recovery.

2.2 Cognitive-Behavioral Therapy

The framework of cognitive-behavioral therapy focuses on alleviating psychological problems that lead to mania and depression. 7 Its main purpose is to address cognitive, behavioral and changes that lead to depression or relapse to mania. This strategy helps an individual to halt any further progress of the disorder as medication takes effect.

Through cognitive-behavioral therapies, an individual becomes aware of bipolar disorder symptoms and it becomes easy to deal with the symptoms as they arise. It also arms individual with the necessary techniques to face and handle stress-causing situations like strained relationships and financial stresses among other issues that lead to stress and depression. 7

2.3 Family-Focused Therapy

This form of therapy entails psycho education, problem-solving acquirements, and communication skills that help the family to handle bipolar disorder effectively. It helps families to come up with structures that checks mania relapses together with compliance to medical regiments. 8

This prepares family members to anticipate future relapses, creates awareness on how to reduce incidences that lead to relapses, and establishes a strong relationship between patient and the family, a factor that leads to reduced relapses. 7 Fundamentally, family-focused therapies act as adjuvant to medication. Moreover, home-based care offers a better recovery option compared to hospitalization.

2.4 Interpersonal and Social Rhythm Therapy

Under the contexts of “unstable or disrupted daily routines lead to circadian instability and affective episodes in vulnerable individuals”, interpersonal and social rhythm therapy came to being. 9 This therapy seeks to rectify noncompliance to medication, stressful life occurrences, and social rhythm disruptions. 7

Through the combination of these three rectifying methods, an individual stands high chances of mania recovery together with reduced chances of relapse. To counter stressful incidences, patients are required to maintain veritable sleep/wake cycles to maintain serotonin levels hence reduced chances of relapse. 9

They are also advised to engage in practices that lead to social stimulation that would result to mood stabilization. This therapy is more of counseling starting with pinpointing the cardinal interpersonal problem; setting targets to counter the identified problem; laying down plans to accomplish the set targets, and finally developing management strategies that would effect the laid down plans. 7

3. Personal Developments

Despite the fact that bipolar disorder management relies on medication and counseling, there is important role that an individual can play to ensure quick recovery and relapse prevention. A deep-set free will to overcome this disorder goes way beyond medication in the recovery process.

Individuals should have hope; that, all is going to be well. 7 This entails a strong conviction that one can cope and overcome his or her condition. Persistence and patience plays a major role towards recovery. Patients ought to understand that the way to recovery is long and there are no cutoffs. Patients need to develop self-discipline coupled with self-advocacy and this combination will enable someone to live a full life void of worry and anxiety; a factor that reduces relapses with a great margin. 7

Patients also ought to learn more about this disorder and this helps to acquire better management skills. It is important to note that self-efforts towards recovery will work in concert with all other strategies to ensure quick and effective recovery together with relapse prevention. 7

Conclusion

Bipolar disorder may be a devastating condition to not only patients, but also family members. Given its complex nature and limited research on the subject, this disorder remains a big challenge to professionals that are involved in the management of the same. However, there have been tremendous efforts to manage this disorder through medication, psychotherapy, and personal developments among other strategies.

There is assortment of drugs used in managing bipolar disorder with some working as antidepressants, mood stabilizers, or antipsychotics to reduce the effects of this disorder. On the other hand, psychotherapy entails psycho education among other varieties of therapies, which act as adjuvant to medications. Psychotherapy mostly entails practices that would result to reduced relapses together with preventing progress of mania and depression alike.

It is unfortunate that people with this disorder stand high chances of divorce and social isolation among other factors that lead to disruption of normal life. Nevertheless, with proper medication and the right attitude, individuals can manage to live relatively normal lives. There is hope.

End Notes

Gin, Malhi, Philip, Mitchell, and Shahzad, Salim. “Bipolar Depression Management Options.” 2003. 17 (3); 9-25
Haykal Roef, and Akiskal Harnt. “Bupropion as a Promising Approach to Rapid Cycling Bipolar 2 patients.” 1990. 51:450-5
Montgomery, Scott. “Efficacy in Long-Term Treatment of Depression,” 1996. J Clin Psychiatry; 57: 24-30
Ballenger, John, and Post, Roxanne. “Carbamazepine in Manic-Depressive Illness: A New Treatment.” 1980. Am J Psychiatry, 137: 782-90
Calabrese, Jael, Markovitz, Potz, and Kimmel, Susan. “Spectrum of Efficacy Of Valproate in 78 Rapid-Cycling Bipolar Patients.” 1992. J Clin Psychopharmacology, 12: 538-68
Parker, George, and Malhi, Ghal. “Are Atypical Antipsychotic Drugs Also Atypical Antidepressants?” 2001. Aust N Z J Psychiatry, 35 (5): 631-8
Steinkuller, Andrea, and Rheineck, Jane. “A Review of Evidence-Based Therapeutic Interventions for Bipolar Disorder. 2009. Journal of Mental Health Counseling, 31 (4): 338-50
Morris, Col, Miklowitz, Dowtz, and Waxmonsky, Jared. “Family-Focused Treatment for Bipolar Disorder in Adults and Youth.” 2009. Journal of Clinical Psychology. 63, 433-45
Zaretsky, Aely, Rizvi, Suel, and Parikh, Shik. “How Well Do Psychosocial Interventions Work In Bipolar Disorder?” 2007. Canadian Journal of Psychiatry. 52, 14-21

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