Management Of Hypomania/mania/mixed Episode
The goal of management in mania/mixed episode is to control the aggression, agitation and disruptiveness of patients at the earliest. Depending of the severity of symptoms, inpatient care may be considered. If patient is on antidepressants then this is to be stopped immediately.
If a patient comes with a breakthrough hypomanic/manic episode, then the first step in the management involves optimization of the ongoing agent. The optimisation can be done by monitoring the serum levels of agents like lithium and valproate. If required, additional antipsychotics and benzodiazepines may be used, depending upon severity of the episode.
If the first-line agent used in optimal dose fails , another first line agent need to be added to the ongoing treatment. Alternative strategies may include changing lithium to valproate or vice versa, changing to carbamazepine, adding antipsychotic medication if not used earlier, changing the antipsychotic if used earlier. ECT may be considered if patient is very disruptive, not responding to a trial of combination of medications, has history of good response to ECT in the past, pregnancy and those experiencing mixed episode. Psychosocial interventions like psychoeducation of patient and family and family focused intervention be started at the earliest. Psychosocial interventions like CBT or IPSRT, focused specifically on the patient, should be considered when patient is cooperative.
How Is Bipolar Disorder Treated
Bipolar disorder can be treated. For best results, medication needs to be combined with therapy sessions and the instigation of good routines.
The most effective treatment for bipolar disorder is a mood stabilizing agent. These medications even out the troughs and the peaks of mood swings to keep you on a more even keel. Other treatments may include antipsychotics or antidepressants.
Medications should be combined with nonpharmacological treatments, such as:
- Cognitive-behavioral therapy: This looks into any negative thought patterns you may have and challenges them in order to change your behavior.
- Interpersonal and social rhythm therapy: This aims to improve disruptions to your biological or social rhythms .
- Family focused therapy: This involves your family in your treatment, educating them and allowing them to support you fully.
Overview Of Bipolar Drugs
In summary, medication for bipolar depression comes in several types of bipolar drugs that to a greater or lesser extent target the depressive pole of bipolar symptoms.
The mood stabilizers: First and foremost lithium, although some anticonvulsant drugs also have mood stabilizing properties. For example, Lamictal, Depakote, and Tegretol.
Antidepressants: These can include SSRIs such as Prozac, SNRIs such as Effexor, and other well known antidepressants such as Wellbutrin.
The key point is that these conventional antidepressants should not be used to treat bipolar depression unless used in combination with a med that is a mood stabilizer or an anti-manic agent.
This is because antidepressants on their own can cause a switch into the manic state.
Atypical Anti-psychotics: These are second generation anti-psychotics with different side effects than the original anti-psychotic medications. Some, such as Geodon are anti-manics, while others, such as Seroquel and Latuda have an antidepressant effect.
Some atypical anti-psychotics such as Zyprexa are approved as maintenance treatments for bipolar disorder.
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Will The Medicine Work For Me
Your doctor canât predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different doses to figure out the right approach. And that can take time.
It can be frustrating, but don’t give up. Eventually, you and your doctor should be able to find a prescription that works for you.
Treating Bipolar Ii Depression With Antidepressants
The studies reviewed above examined either bipolar I depression or a mixture of bipolar I and II patients. As noted, bipolar II disorder may be far more dominated by depression compared to bipolar I patients . But, there are legitimate reasons to consider that the risk/benefit ratio of antidepressants in bipolar II patients may differ markedly from bipolar I patients. As one example, whereas when bipolar I patients switch, they do so almost equally into mania vs. hypomania , bipolar II patients switch into hypomania 90% of the time . Additionally, whether all hypomanias need to be treated is debatable . Finally, bipolar II patients demonstrate TEAS at approximately 50% the rate of bipolar I patients . Thus, switches with bipolar II patients are both less frequent and milder, diminishing the risk of antidepressant treatment considerably.
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Stick To Your Treatment
Medications for bipolar disorder are powerful drugs, and you must take them exactly as your doctor recommends. Don’t stop taking a medicine without your doctor’s approval. It can be dangerous.
When you’re feeling good, you might decide that you want to stop taking your medication. But that’s a bad idea unless your doctor agrees. Treatment only during mood episodes may not be enough to prevent symptoms from coming back. In most people, maintenance treatment between mood episodes makes mania and depression happen less often and makes them less severe. If you’re feeling good now, that’s likely because your medication is working. So stick with it.
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.
Medicines For Bipolar Depression
Most of the time, doctors will start bipolar disorder treatment by prescribing a mood-stabilizing drug like lithium. But the FDA has approved some medicines for bipolar depression, too:
For some people, traditional antidepressants may trigger a manic episode. Because of this risk, your doctor should keep track of you closely if you take one.
Prescribing For Bipolar Disorder
Discrepancies remain with recommendations made by the PAPHSS and other guidelines for bipolar depression. The differences are largely due to the PAPHSS emphasis on long-term adverse effects associated with potential treatments. When providing recommendations, other guidelines do not weigh adverse effects heavily in making their recommendations.
For example, here is a brief look at other clinical practice guidelines for treating bipolar disorder:
- The Canadian Network of Mood and Anxiety Treatments and International Society for Bipolar Disorders 2018 guideline update recommends quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine as first-line therapies for bipolar I.21
- The International College of Neuro-Psychopharmacology 2016 treatment Guidelines for Bipolar Disorder in Adults recommends lurasidone and quetiapine as first-line options. They note fluoxetine, escitalopram, olanzapine, and OFC as second-line recommendations with lithium recommended only after other options have failed.22
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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
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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Tips For Getting The Most Out Of Medication For Bipolar Disorder
Avoid antidepressants. The treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse or trigger a manic episode. Try mood stabilizers first and never take antidepressants without them.
Take advantage of natural mood stabilizers. Your lifestyle can have a huge impact on your symptoms. If you make healthy daily choices, you may be able to reduce the amount of medication you need. Mood stabilizers that dont require a prescription include keeping a strict sleep schedule, exercising regularly, practicing relaxation techniques, and developing a solid support system.
Add therapy to your treatment plan. Research shows that people who take medication for bipolar disorder tend to recover much faster and control their moods better if they also get therapy. Therapy gives you the tools to cope with lifes difficulties, monitor your progress, and deal with the problems bipolar disorder is causing in your personal and professional life.
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What Medication Is Best For Bipolar Depression
For patients with bipolar disorder, medication will likely be a part of ones treatment plan. Medication can bring mania and depression under control and prevent relapse once mood has stabilized. As people with diabetes need to take insulin to stay healthy, taking medication for bipolar disorder helps maintain a stable mood.
Treatment for bipolar depression has come a long way in a short while. Not so long ago, patients were given sedatives and medications with numerous side effects. Today, mood-stabilizing drugs are a mainstay treatment for bipolar disorder. Doctors may prescribe lithium, an antimanic drug, or an antipsychotic drugor a combination of bothto alleviate symptoms of depression without triggering a manic episode.
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Anxiety And Bipolar Depression: Treatment Options That Work
Each person dealing with bipolar depression and anxiety is unique. A treatment approach that works for one person might not work at all for another. While there isnt a single treatment that works for everybody, there is something for almost everyone. Its a matter of knowing and considering your options and working with your doctor to find the most effective approach to your mental health.
Effective treatment options for bipolar depression with anxiety include:
- Depression and anxiety medication, often a combination of different prescriptions
- Individual therapy
- Family therapy
Antidepressants In Bipolar Disorder: A Clinical Perspective
To summarize a relatively small but confusing literature:
The efficacy of antidepressants in bipolar depression remains unproven.
When added to mood stabilizers, antidepressants are not associated with increased switch .
No consistent evidence has demonstrated cycle acceleration in bipolar patients on modern antidepressants .
Bipolar II patients may be treated safely with antidepressants.
A subset of bipolar patients, both bipolar I and II, will need a maintenance regimen of mood stabilizers plus antidepressants and will not show mood instability with this regimen.
Given these conclusions, what principles should guide clinicians?
One or more attempts to discontinue the antidepressant resulting in depressive relapse.
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Bipolar Depression With Anxiety: What Treatments Work
Bipolar depression with anxiety is a common combination. About 75 percent of people with bipolar II disorder have at least one anxiety disorder . Anxiety disorders like generalized anxiety disorder , social anxiety disorder, and panic disorder are the most common disorders that occur alongside bipolar II disorder further, symptoms of these anxiety disorders are more likely to flare during a period of bipolar depression than an episode of mania. Given that bipolar depression with anxiety occurs quite frequently, its important to know more about these conditions, how this combination can affect people, and what treatments work.
Anxiety greatly influences someones experience with bipolar depression, including the symptoms they experience and how they respond to treatment. Both disorders worsen each other. Episodes of depression and anxiety are longer and more severe than when they occur on their own. The long-term outlook is worse, too, largely because it can be harder to treat comorbid anxiety and bipolar depression.
First Line/classic Treatments For Acute Bipolar Depression
The consensus in the field is that non-antidepressant treatments should be considered as monotherapy before using antidepressants to treat bipolar depression . . The medications with the best data from randomized controlled trials are second generation antipsychotics . Although this partly reflects the capacity of pharmaceutical firms to fund large scale studies, the consistent efficacy across multiple studies suggests true antidepressant activity. The two SGAs with the best data are quetiapine and lurasidone, both of which demonstrated efficacy in at least two large scale placebo controlled studies . Olanzapine and cariprazine have also shown efficacy in at least one double-blind study each. Not all SGAs have shown consistent efficacy. Ziprasidone was ineffective in one controlled study while aripiprazole failed its registrational trials . In general, optimal doses of SGAs for bipolar depression are substantially lower than the doses used to treat acute psychosis or acute mania .
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Nondrug Treatments Of Depression
Whilemedications are usually the cornerstone of treatment for bipolar disorder, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. Several specific forms of psychotherapy have been shown to help speed recovery and improve functioning in bipolar disorder, including cognitive-behavioral therapy, interpersonal/social rhythm therapy, family therapy, and group therapy. In addition, because denial is often a problem — sticking with medications can be especially tricky in adolescence — routine psychotherapy helps patients stay on their medications.
The newer types of nonpharmocological treatments of depression are:
- VNS involves implantation of a device that sends electrical signals to the vagus nerve in order to treat depression.
- TMS is a procedure which involves the use of an electromagnetic coil to create electrical currents and stimulate nerve cells in the mood centers of the brain as a treatment for depression.
- Light therapy has proved effective as an additional treatment when bipolar disorder has a connection to seasonal affective disorder. For those people who usually become depressed in winter, sitting for 20 minutes to 30 minutes a day in front of a special light box with a full-spectrum light can help treat depression.
Natural Therapies For Bipolar Depression
When combined with prescribed medication, these alternative approaches may help you better manage the symptoms of bipolar disorder.
Bipolar disorder requires managing two distinct categories of symptoms. Manic symptoms may include impulsive behavior, excessive irritability, and anxiety, while depressive symptoms may include a low mood, poor appetite, and emotional indifference, according to the National Institute of Mental Health. Though there aren’t many complementary or alternative medicine remedies for manic behavior, a few non-prescription therapies may help alleviate depression. Most people who have bipolar disorder spend the majority of their time depressed rather than manic, notes the National Institutes of Health.
But just because CAM therapies exist doesn’t mean that people with bipolar disorder should throw away their antidepressants. “Bipolar is a very serious, lifelong disorder,” says Philip Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City. “If you need an antidepressant, you should take it. These other types of therapies are additional or complementary rather than alternative.”
The complementary and non-pharmacological treatments that have shown some benefit for the depressive side of bipolar disorder are:
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What Is The Best Treatment For Bipolar Depression
Medical subject headings:
One of the challenges facing clinical psychiatry is how to treat bipolar depression effectively. Surprisingly, its neurobiology and rational decisions about its treatment remain somewhat of a mystery. Recent findings have even called into question the role of traditional antidepressants in bipolar depression when other classes of drugs may be more effective first-line treatments for this illness. Setting aside the thorny question of whether antidepressants induce manic switches or rapid cycling, it seems worthwhile to consider recent clinical studies and try to make sense of their implications for the neurobiology of bipolar depression.
Treating bipolar depression with antidepressants remains a popular option in clinical practice and published guidelines. Most clinicians choose the drug or class of drugs, usually selective serotonin reuptake inhibitors and bupropion, that is most effective and best tolerated. However, the recently published results from the STEP-BD project found no benefit to adding an antidepressant compared with placebo to a mood stabilizer in a large naturalistic sample of patients with bipolar I and II disorders. This intriguing finding certainly questions whether antidepressants, a common intervention for bipolar depression, are effective in the treatment of this remarkably disabling and difficult-to-manage condition.
Is Bipolar Disorder Ever Considered Cured
This is not clear at this time. Although the condition responds to treatment in most cases, bipolar disorder is generally seen as a chronic disease that may come and go for many years.
Your child will need to follow the treatment plan outlined by her care team, and any changes should be carefully discussed among all members of her treatment team.
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