The following is an Editorial Resource from YourTotalHealth.

Reviewed by:  Steven A. King, M.D.

 People who have bipolar disorder can lead happy, productive, successful lives. That’s the number-one message that mental health experts want you to know. “Bipolar disorder is a pretty complex beast and each individual is unique,” says Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness and assistant professor of psychiatry at Harvard Medical School. “Each individual with bipolar disorder is a package of strengths and vulnerabilities.” The goal of treatment for bipolar disorder is to help you maximize your strengths and function optimally every day. The most effective treatment regimens for bipolar disorder involve a three-pronged approach that includes medication, therapy and healthy lifestyle habits.

Medications

Although the exact causes of bipolar disorder are unknown, brain chemistry is a factor and genetics are thought to play a role (some scientists are working to identify the genes involved in the disorder). At any time, the brains of people with bipolar disorder may have too many or too few of certain neurotransmitters, such as serotonin and dopamine, the substances that convey messages between brain cells. Additionally, the pathways through which those substances travel can be abnormal. “One theory is that when you’re depressed, you’re getting too little dopamine function in areas that are related to reward processing, so that you’re not able to experience reward or pleasure during depression,” says Wayne C. Drevets, M.D., chief of neuroimaging in mood and anxiety disorders at NIMH. “In contrast, there’s evidence that that same dopamine system is in overdrive during mania, so you’re more likely to find even simple things rewarding or pleasurable.” It appears that medications for bipolar disorder work to correct these defects in the brain and are considered the cornerstone of treatment. The medications used in treating bipolar disorder include:

• Mood stabilizing drugs. These include lithium, and anticonvulsant medications, such as valproate and lamotrigine. These are especially effective in treating manic episodes and in preventing recurrences of both manic and depressive episodes. Recent brain-imaging studies indicate that one way these drugs may do this is by actually normalizing or enlarging the areas of the brain associated with emotional control..
  
  
• Antidepressant medications. These may be given in combination with mood-stabilizing drugs to control depression in some people with bipolar disorder. When given alone, they may help relieve depressive symptoms, but can provoke mania and/or rapid-cycling in people with bipolar disorder. In fact, antidepressant-induced mania is generally regarded as one of the symptoms of bipolar disorder.
  
  
• Antipsychotic medications. These can help alleviate symptoms of psychosis in people with bipolar disorder, and there is a growing body of evidence that some antipsychotics also have mood-stabilizing effects. (Some antipsychotics already are FDA approved for the treatment of bipolar disorder.)
  
  
• Sedative medications. Such drugs are sometimes given to people with bipolar disorder to treat insomnia and improve sleep.

Talking It Over

In addition to medication, “psychosocial treatments”—psychotherapy, education, support groups— all can be incredibly helpful. For one thing, they may help people with bipolar disorder stick to their treatment plan. In one study, the Depression and Bipolar Support Alliance found that patient-to-patient support groups improved treatment compliance by almost 86 percent and reduced hospitalizations.

Different kinds of therapy may be helpful to different people or at different stages of treatment.

• Cognitive behavioral therapy (CBT). Through CBT, people with bipolar disorder can learn to change and control inappropriate thought patterns and behaviors.
  
  
• Psychoeducation. Psychoeducation helps people with bipolar and their families understand the illness and recognize early signs of manic or depressive episodes so that steps can be taken to minimize their severity.
  
  
• Interpersonal therapy (IPT) and social rhythm therapy. These therapies help people with bipolar disorder strengthen their relationships with others, and normalize their daily routines to give them a sense of control over their daily lives. It also helps to keep their circadian rhythms stable—there is some evidence that changes in circadian rhythms and sleep-wake cycles can set off bipolar symptoms.

In a recent review of 18 studies of psychotherapy, researchers at the University of Colorado at Boulder found that treatments that emphasize cognitive and interpersonal coping strategies have stronger effects on depression, while treatments that focus on getting people to take their medicine and recognize the earliest signs of mood symptoms have stronger effects on mania. (For more on ways to adapt some of the principles of interpersonal and social rhythm therapies into your everyday life, see 7 Ways to Minimize Your Symptoms.) 

What's Next: Explore Complementary Medicine

• 7 Ways to Minimize Symptoms
  
• The Smart Patient Guide
  
• Form a Support Network
  

Review Date: May 01, 2009