Living With Bipolar Disorder And Learning To Manage The Condition
If you’ve been diagnosed with bipolar disorder, its important to learn about the condition and its treatment so that you can work with your doctor to find the best course of treatment for you.
Learning about the disorder can also help you educate your family and friends about your struggles so that they can better support you. In addition, there are many and their families.
As you and your doctor work to refine your treatment to minimize both symptoms and side effects, try to be patient and remain motivated toward achieving your recovery goals. There are many combinations of treatments, and one of them will most likely work for you.
In addition, try to find healthy ways to channel your energy and manage or reduce stress. For example, it helps to quit drinking alcohol or using drugs, as these substances can worsen the risk-taking behaviors associated with episodes of mania or hypomania as well as make episodes of depression more severe.
Be sure to surround yourself with supportive, caring friends and family who will help you cope with your condition and who don’t encourage negative or destructive behaviors.
And exercise regularly because physical activity can reduce stress, stabilize your mood, and signal your brain to release chemicals called endorphins that make you feel good. Getting enough exercise can also help improve your sleep, which may help stabilize your mood. Work with your doctor to develop an exercise regimen that’s right for you.
Model For Management Of Bipolar Depression Using Lamotrigine
Various studies regularly reported partial rather than full response for lamotrigine in bipolar depression, both acute and maintenance. For depressive symptoms lamotrigine can serve as first choice drug for augmentation to a primary mood stabilizer for depressive symptoms. Since lamotrigine has certain limitations it can be supported with a second drug or non-drug intervention . Further a recent study showed that lower lamotrigine serum concentrations resulted in therapeutic benefit in-patient with bipolar disorder .
Antipsychotics For Bipolar Disorder
You are most likely to be prescribed an antipsychotic if you have an episode of mania or severe depression in which you experience psychotic symptoms, such as hearing voices. However, some antipsychotics are increasingly prescribed even if you haven’t had psychotic symptoms, as their side effects might be less unpleasant, and they’re safer in pregnancy.
The National Institute for Health and Care Excellence treatment guidelines recommend the following antipsychotics:
If your first antipsychotic doesn’t work, you should be offered a different one from the list above. If the second antipsychotic doesn’t work you may be offered lithium to take together with an antipsychotic.
If you’re prescribed an antipsychotic, you’ll need to have regular health checks with your doctor.
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Treatment For Children And Adolescents
Doctors are still trying to decide the best treatment approaches to bipolar disorder in children and adolescents. The drugs used for bipolar disorder have considerable side effects, which may be more severe in young people. Parents should consider the potential risks and benefits of treatment for their children.
Lithium is generally used as the first-line treatment, with valproate or atypical antipsychotics as alternatives. If treatment with a single drug does not work, a combination of drugs may be used. For atypical antipsychotic drugs, risperidone , aripiprazole , quetiapine , and olanzapine are approved for the treatment of mania in children and adolescents with bipolar disorder.
When prescribing atypical antipsychotics to children and adolescents, the benefits of treatment must be weighed against the potential harms of side effects. Atypical antipsychotics can increase the risk for weight gain and type 2 diabetes, heart problems, increased prolactin levels, sedation, and movement disorders . Doctors need to carefully monitor pediatric patients for potential development of any of these side effects.
Psychotherapy is also an important addition to drug treatment. Therapy that includes the entire family is important. ECT may benefit adolescents who have not been helped by medication.
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
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Drugs That Can Cause Depression
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
Many people are not aware that certain prescription drugs that have been associated with the emergence or worsening of depression symptoms as a side effect, even in people who might not ordinarily be prone to depression. A 2018 study published in JAMA found that more than a third of U.S. adults are currently taking a prescription medication that could potentially cause depression or increase suicide risk.
Given that depression is so common in patients with medical illness, it is often difficult to establish with certainty if these medications are to blame for the mood symptoms. However it is important to be aware of these possible associations.
How Are Antipsychotic Medications Used In Treating Bipolar Depression
Studies have shown that some antipsychotic drugs can also treat bipolar depression.
Quetiapine is used for the short-term treatment of bipolar depression. Another option is olanzapine with fluoxetine .
The atypical antipsychotic lurasidone can be taken alone or with lithium or valproate for treating bipolar depression. Cariprazine , a treatment for bipolar disorder, may also be an off-label option.
These medications work by affecting receptors for chemicals in the brain that help regulate mood and behavior.
Your doctor will weigh the pros and cons of the available medications to help you get relief from the bipolar depression without the risk of mania or drug interactions.
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The Role Of Medication In Bipolar Disorder Treatment
If you have bipolar disorder, medication will likely be a part of your treatment plan. Medication can bring mania and depression under control and prevent relapse once your mood has stabilized. You may not like the idea of taking bipolar medication long term, especially if youre struggling with unpleasant side effects. But just as a diabetic needs to take insulin in order to stay healthy, taking medication for bipolar disorder will help you maintain a stable mood.
Since finding the right drug and dose can be tricky, its important to work closely with a specialist and re-evaluate your medication regularly. Its also important to remember that taking medication is just one aspect of a successful treatment program. There are plenty of other steps you can take to manage your symptoms and even reduce the amount of medication required. Healthy lifestyle changes, self-help coping strategies, and exploring therapy are also important in coping with bipolar disorder symptoms and helping you live a full, productive life.
Behavioral And Emotional Complications
A small percentage of bipolar disorder people demonstrate heightened productivity or creativity during manic phases. More often, however, the distorted thinking and impaired judgment that are characteristic of manic episodes can lead to dangerous behavior including:
- Spending money with reckless abandon, causing financial ruin in some cases
- Angry, paranoid, and even violent behaviors
- Openly promiscuous behavior
Such behaviors are often followed by low self-esteem and guilt, which are experienced during the depressed phases. During all stages of the illness, people need to be reminded that the mood disturbance will pass and that its severity can be diminished by treatment. Manic episodes also affect a person’s family members and social circle and can create difficulties and tensions in interfamily and interpersonal relationships, as well as the workplace.
Both the depressive as well as manic phases of bipolar disorder can have a significant negative impact on a person’s ability to function.
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Treatment For Depressive Episodes
Depressive episodes are a particular challenge because many antidepressant drugs pose a risk for triggering mania. It is not clear if standard antidepressants work for bipolar depression. Depressive episodes are very difficult to control and people who do not respond to mood stabilizers may endure prolonged depressive episodes up to 2 to 3 months.
Lithium or lamotrigine are the standard first-line treatments for depressive episodes. Many studies indicate that lithium works better for controlling manic states, and that lamotrigine works better for bipolar depression.
If improvement does not occur within 2 to 4 weeks, an antidepressant may be added. Antidepressants alone are not recommended. The first choices for antidepressants are bupropion or SSRI such as fluoxetine .
Other drugs are also approved specifically for treatment of bipolar depression. Symbyax combines the atypical antipsychotic olanzapine with the SSRI antidepressant fluoxetine. Quetiapine is an atypical antipsychotic which is approved for both treatment of bipolar mania and bipolar depression. Lurasidone is an atypical antipsychotic approved for treating adults with depression associated with bipolar I disorder. It can be used either alone or in combination with lithium or valproate.
What To Do Next
If you believe that you may be experiencing symptoms of depression, whether they are related to a drug that you are taking or not, you should consult with your personal physician.
Do not stop taking your medication without your doctor’s permission. If you are experiencing severe depression or having thoughts of suicide, do not hesitate to seek immediate medical attention.
Every situation is different, so your doctor will look at your health history and symptoms in order to determine what steps to take next. In some cases, it may involve switching to a different medication or adjusting your dosage.
Your doctor will also try to determine if your depressive symptoms are linked to the new medication or some other cause. If there is an underlying depressive disorder, your doctor may recommend treatments such as antidepressants and psychotherapy.
If you or a loved one are struggling with depression, contact the Substance Abuse and Mental Health Services Administration National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
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Are Antidepressants Used To Treat Bipolar Depression
While antidepressants are effective treatment for people with major depressive disorder, they are not always as effective for bipolar depression, and generally should not be given alone in people with bipolar I disorder. When antidepressants are given alone to someone with bipolar disorder, there’s a risk the drug might ignite a manic episode in some patients. Knowing this, most doctors may avoid using antidepressants as monotherapy for bipolar depression.
A very large randomized study sponsored by the National Institute of Mental Health called the Systematic Treatment Enhancement Program for Bipolar Disorder showed that mood stabilizers alone produced a stable improvement only in about 1 in 4 people with bipolar depression, and surprisingly, adding an antidepressant to the mood stabilizer did not boost improvement further. The STEP-BD study underscored the need to find treatments other than mood stabilizers or antidepressants for bipolar depression.
What If I Dont Feel Better
If you dont feel better right away, remember that it isnt your fault and you havent failed. Never be afraid to get a second opinion if you dont feel your treatment is working as well as it should be. Here are some reasons the medication you are taking may be not be giving you the results you seek.
Not enough time
Often a medication may not appear to work when the reality is that it may not have had enough time to take effect. Most medications for mood disorders must be taken for a few weeks before you begin to see results. The length of time will vary by medication, taking between 2 and eight weeks before the full effect is felt. So, though it may not be easy, give your medication time to start working. Whenever your doctor prescribes a new medication or changes the dose of old medication, be sure to ask when you should judge whether its helping or not.
Dosage too low
With most medications used to treat mood disorders, the actual amount reaching the brain can be very different from one person to the next. A medication must reach the brain to be effective, so if your dose is too low and not enough reaches your brain, you might incorrectly assume the medication doesnt work when you just need your doctor to adjust your dosage.
Different type of medication needed
Not taking medications as prescribed
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Medication And Older Adults
With older adults, mood disorder symptoms can sometimes be mistaken for normal signs of aging. These symptoms are not a normal part of growing older. A thorough physical examination is required if symptoms of a mood disorder arise, and mental health treatment may be helpful. Its also important for older adults to be aware of possible medication interactions or medication side effects if they are taking several medications for different health conditions.
Questions To Ask Your Doctor:
- Should I consider bipolar medications?Together with your provider, you should look at the pros and cons of any medication for bipolar disorder youre thinking about taking.
- What are possible side effects of this medication?Its always important to understand the potential side effects of any medication. Not only can this help you decide which medication to try, but it can also help monitor how youre feeling once you start something new. Knowing what to look for can help catch any potentially dangerous side effects before they become a serious problem.
- What other treatments should I be considering for my bipolar disorder?There are a number of treatment options besides just taking medication for treating bipolar disorder. You might consider education, psychotherapy, self-management techniques, or even support groups.
- Should I consider treatment in conjunction with bipolar medication?Cognitive behavioral therapy has been found very effective in treating bipolar disorder. This type of therapy helps you identify and change negative thought patterns and behaviors that might be having a negative impact on your life. Talk therapy can also help you manage your bipolar disorder. By focusing on regulating your stress and making self-care a priority, youll be better able to manage a bipolar diagnosis.
If you are interested in finding the right medication to treat bipolar disorder, connect with a prescriber at Talkspace today.
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How To Get Bipolar Disorder Medication
Managing your bipolar disorder may mean multiple things. A combination of therapy and medication is often the most effective route. You should talk to your doctor if youre thinking about starting bipolar meds or think they may be helpful.
Take the following steps if youre looking for treatment with a bipolar disorder medication:
Drugs That Affect Hormones
These drugs include hormonal forms of birth control as well as estrogen replacement therapy for menopausal symptoms. Variations in hormone levels in women are often associated with depression symptoms, although it is not completely understood how this interaction occurs. Research suggests that progestin-only birth control is unlikely to cause symptoms of depression.
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Choice Of Treatment Settings
In general, most of the patients with BPAD are managed on the outpatient setting. However, some patients may require inpatient care. Whenever possible patient admitted to the inpatient setting should have accompanying family caregivers. In case inpatient care is required and such facilities are not available, than the patient and/or family need to be informed about the need for inpatient care and patient may be referred to the nearest available inpatient facility and admission may be facilitated.
Which Bipolar Medicine Is Best
Doctors use many types of drugs to treat bipolar disorder. Some fight the extreme highs of mania and others treat the lows of depression. You might take one drug at a time or a few at the same time.
The best bipolar medicine is the one that works best for you. Work with your doctor to decide on the medication plan that helps you the most.
You may keep taking these medications for years or decades, even if itâs been a long time since your last manic or depressive episode. This is called maintenance therapy and helps prevent recurrence of symptoms.
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Bipolar Depression Approved Medications
All four of the above medication categories used to treat mood disorders are either approved by the Food and Drug Administration for mood disorder treatment, or they are used in what’s called an off-label use. Off-label use is an ethical and legal use of medications that have not specifically been sanctioned for use of a specific condition by the FDA.
FDA Approved Bipolar Depression Medications: At this time, there are three specifically approved medications for bipolar depression treatment:
There are four medications approved for maintenance of bipolar disorder symptoms:
- Lithium â Approved 1974