Treatment:

Periods of depression or mania return in most patients, even with treatment. The main goals of treatment are to:

• Avoid moving from one phase to another
• Avoid the need for a hospital stay
• Help the patient function as well as possible between episodes
• Prevent self-injury and suicide
• Make the episodes less frequent and severe

The health care provider will first try to find out what may have triggered the mood episode. The provider may also look for any medical or emotional problems that might affect treatment.

The following drugs, called mood stabilizers, are usually used first:

• Carbamazepine
• Lamotrigine
• Lithium
• Valproate (valproic acid)

Other antiseizure drugs may also be tried.

Other drugs used to treat bipolar disorder include:

• Antipsychotic drugs and anti-anxiety drugs (benzodiazepines) for mood problems
• Antidepressant medications can be added to treat depression. People with bipolar disorder are more likely to have manic or hypomanic episodes if they are put on antidepressants. Because of this, antidepressants are only used in people who also take a mood stabilizer.

Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar disorder if it does not respond to medication. ECT uses an electrical current to cause a brief seizure while the patient is under anesthesia. ECT is the most effective treatment for depression that is not relieved with medications.

Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. It is most often used after ECT.

Patients who are in the middle of manic or depressive episodes may need to stay in a hospital until their mood is stable and their behavior is under control.

Doctors are still trying to decide the best way to treat bipolar disorder in children and adolescents. Parents should consider the possible risks and benefits of treatment for their children.

SUPPORT PROGRAMS AND THERAPIES

Family treatments that combine support and education about bipolar disorder (psychoeducation) may help families cope and reduce the odds of symptoms returning. Programs that offer outreach and community support services can help people who do not have family and social support.

Important skills include:

• Coping with symptoms that are present even while taking medications
• Learning a healthy lifestyle, including getting enough sleep and staying away from recreational drugs
• Learning to take medications correctly and how to manage side effects
• Learning to watch for the return of symptoms, and knowing what to do when they return
• Family members and caregivers are very important in the treatment of bipolar disorder. They can help patients find the right support services, and make sure the patient takes medication correctly.

Getting enough sleep is very important in bipolar disorder. A lack of sleep can trigger a manic episode. Therapy may be helpful during the depressive phase. Joining a support group may help bipolar disorder patients and their loved ones.

• A patient with bipolar disorder cannot always tell the doctor about the state of the illness. Patients often have trouble recognizing their own manic symptoms.
• Changes in mood with bipolar disorder are not predictable. It it is sometimes hard to tell whether a patient is responding to treatment or naturally coming out of a bipolar phase.
• Treatments for children and the elderly are not well-studied.

Expectations (prognosis):

Mood-stabilizing medication can help control the symptoms of bipolar disorder. However, patients often need help and support to take medicine properly and to make sure that mania and depression are treated as early as possible.

Some people stop taking the medication as soon as they feel better or because the mania feels good. Stopping medication can cause serious problems.

Suicide is a very real risk during both mania and depression. People with bipolar disorder or think or talk about suicide need immediate emergency attention.

Complications:

Stopping medication or taking it the wrong way can cause your symptoms to come back, and lead to the following complications:

• Alcohol and/or drug abuse
• Problems with relationships, work, and finances
• Suicidal thoughts and behaviors

This illness is hard to treat. Patients, their friends, and family must know the risks of not treating bipolar disorder.

Calling your health care provider:

Call your health provider or an emergency number right way if:

• You are having thoughts of death or suicide
• You are experiencing severe symptoms of depression or mania
• You have been diagnosed with bipolar disorder and your symptoms have returned or you are having any new symptoms