Bipolar Disorder also known as Manic Depressive Illness involves outstanding mood swings. The individual has periods of depression, and periods when they feel either unusually good or pressured and irritable. It affects 1-2% of the population. Genetics plays a significant role. About 15% of children with one bipolar parent develop the disorder.
Treatments include medication, supportive psychotherapy and occasionally ECT. Medications include lithium, anticonvulsant drugs (carbamazepine (Tegretol), valproate (Depakote), gabapentin (Neurontin) and lamotrigine Lamictal), antidepressants (such as bupropion (Wellbutrin)or sertraline (Zoloft)), neuroleptics (e.g. haloperidol) and benzodiazepines (e.g. lorazepam) Treatment choices depend on the type and phase of the illness. There is growing evidence that patients with less frequent and more intense mood swings respond best to lithium, while those with more than 4 mood swings per year respond best to the anticonvulsant’ mood stabilizers. When a person is acutely manic, they may require hospitalization. Antipsychotic and antianxiety drugs can help control symptoms during this period.
The depressive phase may not respond as well to lithium and most anticonvulsants. While antidepressants can help, they carry a moderate risk of overshooting into mania; thus they are generally used with a mood stabilizer. One promising drug, lamotrigine (Lamictal), may have specific antidepressant in addition to anti-manic properties. Lamotrigine is usually increased slowly to minimize the chance that it might cause a rash.
ECT helps severe depression or mania. It is most often used when medication doesn’t work or is unsafe.
Lithium is a top choice for acute mania and for maintenance in classic’ bipolar disorder. Because of its narrow therapeutic range, blood levels must be monitored; also heart and kidney function (EKG, blood and urine tests). Medications such as diuretics, that block its excretion require caution.
Anticonvulsants have an edge with rapid-cycling and mixed mood states (e.g. depression with racing thoughts). Except for gabapentin (Neurontin) and lamotrigine (Lamictal), they require blood tests. Carbamazepine (Tegretol) is monitored with blood levels; also CBC, platelets and liver function tests. Valproate (Depakote) requires CBC, platelet count and liver function tests; blood levels may be helpful. Lamotrigine (Lamictal) requires caution because of its association with a rare but dangerous skin rash (exfoliative dermatitis); risk can be minimized by starting with low doses and increasing gradually. Use lower doses with medications that slow lamotrigine metabolism (e.g. valproate). Gabapentin is generally safe and does not require blood tests.
It is not unusual for patients to need more than one mood stabilizing medication for best results.
Because bipolar disorders are generally recurrent, maintenance treatment is usually needed. This is especially true when there have been multiple episodes, a clear family history of bipolar disorder or symptom onset before age 18. Effective maintenance requires full doses of mood stabilizing medications and ongoing medical monitoring. Psychotherapy can help patients and their families understand the illness, can teach the importance of early relapse detection, and ensure compliance with medication. In therapy, patients can deal with past instability and prepare constructively for the future.