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Treatment

Because of the complex etiology of bipolar disorder and the wide range and severity of potential symptoms, lifelong treatment is required, typically managed by a psychiatrist, often with support from a team that also includes psychologists, social workers, and psychiatric nurses. The primary treatments for bipolar disorder include medications; individual, group, or family psychotherapy; or education and support groups.

Pharmacotherapy

A number of medications are available to treat bipolar disorder—mood stabilizers, antidepressants, or anxiolytics—and some approaches may involve combinations of medications for more effective outcomes. Medications include:

  • Lithium is effective in stabilizing mood and preventing the extreme highs and lows of certain categories of bipolar disorder.
  • Anticonvulsant mood-stabilizers include valproic acid, divalproex, and lamotrigine. Asenapine may be effective in treating mixed episodes.
  • Antipsychotic medications—aripiprazole, olanzapine, risperidone, and quetiapine—may be effective in patients who do not benefit from anticonvulsants. The only FDA-approved antipsychotic for treatment of bipolar disorder is quetiapine, although some practitioners prescribe other agents off label. Antipsychotic medications may be associated with memory and attention disturbances and involuntary facial or body movements.
  • Some clinicians prescribe antidepressants in the management of bipolar disorder, but they may trigger manic episodes in some patients, although such episodes may be manageable with use of a mood stabilizer. Older antidepressants—eg, tricyclics and MAOIs—are associated with a number of potentially dangerous adverse events and require careful monitoring.
  • A coformulated version of the antidepressant fluoxetine and the antipsychotic olanzapine (Symbyax®) is approved by the FDA specifically for the treatment of bipolar disorder.
  • Benzodiazepine anxiolytics—such as clonazepam, lorazepam, diazepam, chlordiazepoxide, and alprazolam—may decrease anxiety and improve sleep.

Psychotherapy

Psychotherapy plays a vital role in the management of bipolar disorder. Potentially effective therapeutic modes include:

  • Cognitive behavioral therapy (CBT) focuses on identifying unhealthy, negative beliefs and behaviors and replacing them with healthy, positive ones. CBT can help patients identify bipolar episode triggers and learn effective strategies to manage stress and other upsetting situations.
  • With psychoeducation, patients and family members and friends learn to understand bipolar disorder with the goal of finding the most effective treatment and support and learning to recognize warning signs of mood swings.
  • In family therapy, patients and family members work with a psychologist or other mental health provider to identify and reduce family stress, with the intent of learning how to communicate better, solve problems, and resolve conflicts.
  • In group therapy, patients communicate with and learn from other bipolar patients
  • Other therapies that have been studied with some evidence of success include early identification and therapy for worsening symptoms (prodrome detection) and therapy to identify and resolve problems with daily routine and interpersonal relationships (interpersonal and social rhythm therapy).

Other treatment modalities may include:

  • Transcranial magnetic stimulation for the alleviation of depressive symptoms
  • Electroconvulsive therapy (ECT) for patients having episodes of severe depression or suicidal ideation or those who have not achieved symptom improvement despite other treatment
  • For some patients experiencing a manic episode or deep depression, inpatient treatment may help to stabilize mood. [Mayo Clinic]

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