Showing posts with label Treatment of Bipolar Disorder (Manic-depressive illness). Show all posts
Showing posts with label Treatment of Bipolar Disorder (Manic-depressive illness). Show all posts

Tuesday, September 2, 2008

Spectrum of various Experiences, Treatment and Coping Means helpful for Bipolar Disorder (manic-depressive illness)

In my first Mission 4 Monday post yesterday, I republished an excerpt "Trust during rough times" from my friend, Marja's book "A Firm Place to Stand."

I am thankful to my friends who took time to stop by, read my post and share your thoughts. One of my readers, Rob, wrote a comment which I would like to share in this post. Rob has bipolar disorder. Thankfully his condition is stable and he is able to go off medication now.

Bipolar Disorder or previously known as manic-depressive illness is a mood disorder with extreme mood swings ie. manic/hypomanic and depression.

Rob wrote on 2nd September 2008,

Hi Nancie,

Let me share a very weird, but also very interesting and I hope illuminating experience I had recently. In a way, although I am not a believer (nor a 100% complete disbeliever), this anecdote will, I hope, be interesting to you and your regular readers, and will be supportive of your theme today.

It has now been almost 2 years since I began reducing lithium, and more than a year and a half since I stopped it completely. I'm proud that I am totally drug-free for the first time in my adult life, but I am also very aware that my good fortune could end at any time. Anyway, I had a physical exam (after more than 2 years), and then a week or so later, I had a visit to my psychiatrist, for the very first time since stopping all drugs. I really like my psychiatrist, and I do not fault him on any decision he (and I) made over the years. I went there hoping to perhaps thank him for his efforts, and to show him that I'd had a clean physical checkup and was feeling "great" (no, not *that* great :-)). My family doctor sent my report to my psychiatrist. I like the fact that they work closely together, and they share information about me. All the minor complaints I'd had seemed to have pretty much disappeared, though there is much more than just a lack of lithium to credit for that.
My family doctor is cynical about psychiatry, and has always wondered why I was clinging to lithium, in spite of all my minor physical complaints, that seemed to just be getting worse as I aged.

Anyway, I entered my psychiatrist's interview room (after waiting one hour). I felt a bit sorry for him because he is now aged 72, and has not retired yet. I wanted to say something to the effect of "thanks for your efforts over the years". He first apologized for making me wait, and I said "oh it's nothing" or something like that. Then, to my total surprise, he acted like no other time in my entire 30 year history with him. Rather than having our usual calm, peaceful, friendly discussion, with him saying not too much, but encouraging me to speak my mind, it was the TOTAL OPPOSITE! I didn't know what to make of it. He was acting extremely hypomanic, while I was trying to stick to my agenda, of asking a few practical tips regarding sleeping, new drugs I might possibly take, etc. in the future etc. He wouldn't shut up. Even when he opened the door of the office to show me out (after 15 minutes), he kept talking and talking, even with other people listening! He made no mention of lithium, and no mention of when I might see him again. I finally managed to squeeze in "I guess I might pop in to see you again in a year or so", to which he didn't answer. He kept on talking about trivial stuff like tennis hurting knee joints or some such nonsense. He was also suggesting that "Oh, I guess you know everything now, and don't need your family doctor or me", to which I replied, "no, not at all". My wife was in the waiting room, and I said he could talk to her if he wanted, but he said he wasn't interested. Finally my wife and I left, both of us scratching our heads...

I later thought, Oh, I get it. He was just doing his job as my doctor. He's not really my friend. He was pulling out all the stops to try to destabilize me and "prove" that I was actually manic, and he was obviously failing to do so, so the end result was to make me somewhat more confident. Good. I feel better... But, I don't completely accept that theory either. A more cynical theory would say:
1. He is worried about a malpractice lawsuit
2. He is going to lose income without me
3. He is embarassed that he finally "lost" the argument with my family doctor
4. He worries that he might retire "in shame" at having kept someone on drugs needlessly, for almost their entire adult life
5. Just before seeing me, I think he took someone else who seemed to be in bad condition, and perhaps that rattled his nerves (I think he may have actually bumped me, in favor of that other person, who my wife later told me, looked quite sick.
6. I partly went to him because I tried to get a prescription for Stelazine filled (as a safety precaution) and it got held up at the pharmacy, because he happened to be on vacation. I then checked if my family doctor could fix that for me. I also then took some Stelazine, with my wife's knowledge, because I'd had some poor sleep recently, and I wanted to verify if I could count on Stelazine to fix that (minor) sleeping issue that had dragged on for a few days, for various reasons
7. Who knows what? Your guess is as good as mine. It just doesn't completely make sense. I still like the guy, but I wanted to share this with other sufferers of mental disorders.

By the way, I'm beginning to seriously believe that peaceful meditation actually works better for me than Stelazine, and has *zero side-effects!*

This is something you might want to consider (briefly), when you decide where to put your "faith".

Thanks for listening -- a slightly puzzled, but still doing OK Rob

I am thankful to Rob for writing in to share his experiences and thoughts with me and my readers. I am thankful that Rob makes time to come by every now and then, and I greatly value his friendship.

As I do have my own personal experiences and opinions pertaining to what Rob has shared, I have decided to write a separate post in answer to Rob. So here's my response to Rob:

Hi Rob,

Thank you for your 2 comments! I delayed in publishing your first comment because I needed time to digest what you wrote and also to think of an appropriate response :-) Thanks for writing again. I have decided to publish your first comment here as a separate post so that I can response and share my personal experiences and opinions too.

Your recent experience with your psychiatrist is truly rather weird :-) I am thankful that you are able to be medicine free and I hope you continue to stay stable!

In my personal opinion, I think there is actually a rather wide spectrum of experiences for those who suffer from bipolar disorder and therefore a wide spectrum of wellness or coping means that suits different individuals.

In my own personal experiences, I have found that Finding a Good Doctor/Psychiatrist is very crucial for me. I am thankful that God has provided a very good and helpful psychiatrist for me. I am newly diagnosed with bipolar disorder last March and still very new on the journey of understanding and managing bipolar disorder. My Doctor's help has been invaluable in my recovery journey!

I have come across several very different experiences among my fellow bloggers.

I know of people who are being helped my medication just like myself. Our mood-stabilisers helped to stabilise our moods in longer run. Some of us are on anti-psychotic medications which helps to manage our manic/hypomanic and sometimes we need anti-depressants to lift us up to a functional level when we have a relapse of depression. So medication does help some of us to be more functional. It would be wonderful to be so stable and functional one day that some of us can be off medication eventually! But that is a case by case basis.

Some of us may have to be on life-long maintenance medication for the sake of stabilising our mood. Medication however is only a part of our treatment and recovery plan. Medicine helps to lift us up to a functional level when we are depressed or helps to calm us down to a functional level when we are too manic, but we also needs to live a balance lifestyle that will contribute to our mental stability and physical as well as spiritual well-being. We need to know what may trigger off relapses, how to recognize early symptoms and what we can do to get better or prevent our conditions from deteriorating. Depending on our makeup and our bipolar condition, what works for us may differ one from another.

I have also known of others who are medicine resistant and who suffer more side effects than benefits from their medications. These have suffered much throughout the years due to unsuitable medications. Some have found help now through alternative medicine or therapy. There are some who have learned to manage their condition so well that they do not need medication at all. Perhaps their condition are also milder than some others. I also have some friends who benefited from ECT treatments when nothing else is helpful and their sufferings were relentless. Thank God for providing something that helps these friends. But again ECT may not be suitable for everyone. I think it is a case by case basis. It may take time to find out our own conditions and what is best to help us maintain stability and enable us to be functional and of maximum benefit to our family and society.

I have shared about some of My Coping Strategies in my previous posts. Personally, I benefitted from Medical Help and Medications. Anti-depressant medication helps to lift me up to a functional level when I am depressed and anti-psychotic medication helps to calm me down to a functional level when I am too manic/hypomanic.

I am learning to use Mood Diary to track my moods and learn to recognize early symptoms of possible relapses or impending relapses or worsening symptoms. I work closely with my psychiatrist on how best to troubleshoot and manage my condition. I hope to share more about this in future post.

I have found that getting enough sleep and sleeping at regular hours is very crucial. Insufficient sleep can cause my relapses or may be symptoms that I am going through relapses.

For some months last year I benefited from several counseling sessions with a lady Christian counselor who uses Cognitive Behavioural Therapy(CBT) to help me identify and correct some faulty thinking patterns. I do have some faulty thinking patterns that can either trigger off my relapses or worsened my condition. In particular I learn to understand some of the myths and facts on mental illness so that I have a more realistic view of my condition. Learning to coping with false guilt during depression is also very crucial to me as there is still such a terrible stigma associated with mental illness even among Christians.

I also found reducing stress and learning to manage stress to be very crucial in my own management of my condition. From past experiences, I am discovering that mismanagement of stress or excessive stress will trigger off my relapses. So I am now prayerfully learning to recognize signs that I am getting stressed up or overly stress, and how best to reduce it to a level I can manage. I learn to pray and commit things to God, and seek His wisdom to manage the various challenges in my life. I also learn to share with my family and friends when I am troubled, stressed or perplexed. In the multitude of counselors there is safety (proverbs)! I find brain-storming and discussing with family and friends helped me to see things from a better perspective and learn to manage the various challenges in my life better.

I am also aware that one of the great source of stress I often experience actually comes from myself! I am some kind of a perfectionist. So in some ways my expectation of myself and others can at times be rather high and unrealistic. The problem is I am not always conscious of this. But this can cause much stress and harm to me in my own life as well as my relationships with others or my works. So I am learning now to be more aware of my unrealistic expectations of myself, of others or of the world in general. I am learning to be kinder to myself :-) and to others :-)

In other words, I am learning to me more aware of my limitations! The problem with bipolar disorder is that whenever I am well, I am a little hypomanic. So I have more energy, more creativity and tend to want to do more things. I tend to take on more projects that I can manage without realizing it. I also tend to want to help as many people as possible without realizing that I am over-stretching myself and trying to do too much! That is why I often suffer burn-out and then clinical depression. The tricky thing for me now is to learn how to estimate how much I can do or I should do. There seemed to be 101 things that I think I should do or I can do! But in reality this is not the case :-) So I am still learning now to pace myself more moderately and prayerfully.

Personally I do not practice meditation. I have a friend whose sister is bipolar and found it put her in a dissociative state whenever she practiced meditation.

For me meditating on God's Words help me. My quiet times in the mornings and evenings are most precious to me. I am learning to pray and commit each day unto God. I spend the time in prayer, reading of the Bible, singing of Psalms and journalling. I find that writing down my thoughts and experiences help me to see things from a more realistic perspective. Prayers help me to unburden and cast my cares on God. As I pray and commit all things to God, I find peace in knowing that He will guide me in the paths He wants me to go. Though God may not always answer my prayers according to my desires, I am learning to submit to His will which is always the best, because He is sovereign, mighty and all-knowing, and He loves me. I find much comfort, direction and encouragements from God's Words daily. I learn to wait upon God to speak to me through His Words and providence, and He is faithful to answer my prayers daily. Filling my mind with the Word of God and meditating on these precious Truths gives me peace, comforts and directions. God's Words strengthens me and help me to cope with various challenges in my life in association with bipolar as well as other aspects of my life. For me this works very well. And this quiet time becomes a very important recovery tool as well as in my management of my condition.

I found that one good way of reducing stress is to be more organized. I have the tendency to want to do too many things at one time. Now I find that if I list down the things I need to do and plan on how to break them down into manageable tasks, I can cut down on stress and get more things done. So now I use a Diary to plan my days.

I have also found exercise to be very crucial to me in my recovery process. I read that the good chemicals that are released during exercise helps with depression. Personally, I enjoy Brisk Walking and have found that it helps to strengthen my body and mind. I feel very refreshed after my exercise and my mood is lifted up. But I understand that not everyone is able to participate in exercise. We need to assess our health and our medical conditions. It is good to consult a physician first if we are unsure. This is to prevent unnecessary injuries and harm due to inappropriate exercises.

I am learning that relaxation and recreations are important to me in my management of bipolar disorder. I also have several therapeutic hobbies which I enjoy very much and helped me to relax. I derive much joy and satisfaction in Photography, Making Bookmarks, making homemade Calendar and Blogging.

I am learning to eat more healthy meals and I also benefit from Omega 3 Fish Oil Supplements.

I realize through this illness, the importance of having the support and prayers of my family and friends, besides professional helps from Doctors, Counsellors and Support Group. The people I love, and who love me, will see me at my best. When my symptoms reappear, they may see me at my worst.

Whenever possible, I will share with them my illness. I give them articles, pamphlets and books to read about bipolar disorder so that they will understand that my behaviour is not always under my control. It will also help them to understand why I am sometimes so different.

For me, I have found blogging to be therapeutic to me and is an important tools in my recovery. It has been a joy and privilege for me to be acquainted with many blogging friends who are suffering from depression, bipolar and other physical or mental conditions. To be able to share and support one another as we seek to learn to understand and manage our conditions has a great impact upon my life. I felt I have grown much over the last half year of blogging through my acquaintance with such dear friends and learning from various people's experiences. I am learning to understand my condition better and to manage it better. Ever since I joined Word-Filled Wednesday(WFW) and Thankful Thursday (TT), God has helped me to grow spiritually. I am greatly blessed by the many encouraging posts many friends shared on WFW and TT. And now that I newly joined Mission 4 Monday I am also greatly blessed and encouraged. I am so thankful that I can get to know you and so many others through blogging! But I am learning to pace myself moderately as I tend to get carried away with blogging as I enjoyed it so much and I can over strain myself unknowingly :-)

I am thankful to God that in this generation there are many resources and helps available to cope with depression, bipolar and other health conditions. I am still learning and discovering what is helpful for myself and how best to manage my condition. I am thankful to God that I can share helpful resources with my readers on this blog as I journey on.

As there is a wide spectrum to the experiences as well as treatment of bipolar disorder, I do not recommend my own coping strategies as the best for everyone. I think it is a case by case basis. I believe many of my coping strategies are those being used by many people and it is helping them. But others might not find them useful. I think we each need to take time to understand our condition and what is most helpful to keep us stable and functional. Most of us will need our physician's help or therapies or counselors help in understanding and managing our conditions.

For me personally, ultimately my faith is not in myself, anyone or anything, but in God and my Lord and Saviour Jesus Christ, Who can restore me using various means or without means. I have survived some 10 or more severe clinical depressive episodes over the last 20 years without medication because I didn't know that it is a medical condition. I realized that without medication I can still recover from clinical depression but with medication my sufferings have been lessened as well as shortened. Without medications, I used to endure at least 3 to 6 months of clinical depression or sometimes longer. Those were very difficult, painful and confusing time. Thank God for preserving and restoring me in those years. Now I am thankful that I am more functional and able to live a more productive life with medical and various other helps. Knowing that my depression is clinical and not due to weakness of my character or lack of faith in God, helps me to banish false guilt and seek medical and other helps. As my depression episodes have become more and more frequent and more and more severe in these recent years with terrible temptation of death, I appreciate the way medication and other helps are helping me. I know there are side-effects with any medication but I have prayed and weighed the matter. It is better for me at this point of time to bear whatever side-effects of medication so that I can be more functional rather than to risk dying from suicide during severe depression relapses. And besides medication, I prayerfully use as many of my other Coping Strategies as possible so that my medication is kept as minimum as necessary.

Thanks again for writing, Rob. I hope your condition continue to remain stable and you can continue to find wellness activities that helps you! You and your wife are in my thoughts and prayers. Take care and keep in touch.

With appreciation,

And thanks, friends and visitors, for stopping by. Do share your thoughts and opinions with me by leaving a comment, if you can. I will greatly appreciate it!

Take care and have a blessed day!

Tuesday, February 12, 2008

Treatment for Bipolar

This article is taken from the website of National Institute of Mental Health (NIMH). NIMH said "NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated."

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

What Is the Course of Bipolar Disorder?
Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below—"How Is Bipolar Disorder Treated?"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

How Is Bipolar Disorder Treated?
Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
• Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania.
• Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.

• Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.
• Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician.
• Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression
Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications.
• Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18
• If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead.
• Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication.
• Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions.
• To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function
People with bipolar disorder often have abnormal thyroid gland function.4 Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects
Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments
As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

• Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness.
• Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members.
• Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms.
• Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
• As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments
• In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19
• Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications.20 In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21
• Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes. Do Other Illnesses Co-occur with Bipolar Disorder? Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar Disorder?
Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at:
• University—or medical school—affiliated programs
• Hospital departments of psychiatry
• Private psychiatric offices and clinics
• Health maintenance organizations (HMOs)
• Offices of family physicians, internists, and pediatricians
• Public community mental health centers

People with bipolar disorder may need help to get help.
• Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness.
• A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional.
• Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment.
• A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes.
• Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual.
• In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse.
• Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers.
• Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors.
• Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations. For contact information, see the "For More Information" section at the back of this booklet.

This publication, written by Melissa Spearing of NIMH, is a revision and update of an earlier version by Mary Lynn Hendrix. Scientific information and review were provided by NIMH Director Steven E. Hyman, M.D., and NIMH staff members Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D. Editorial assistance was provided by Clarissa K. Wittenberg, Margaret Strock, and Lisa D. Alberts of NIMH. NIH Publication No. 3679
Printed 2002
NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated. However, using government materials inappropriately can raise legal or ethical concerns, so we ask you to use these guidelines:
• NIMH does not endorse or recommend any commercial products, processes, or services, and publications may not be used for advertising or endorsement purposes.
• NIMH does not provide specific medical advice or treatment recommendations or referrals; these materials may not be used in a manner that has the appearance of such information.
• NIMH requests that non-Federal organizations not alter publications in a way that will jeopardize the integrity and "brand" when using publications.
• Addition of Non-Federal Government logos and website links may not have the appearance of NIMH endorsement of any specific commercial products or services or medical treatments or services.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or at

Updated: 01/24/2007