Goals of Treatment for Bipolar Disorder

It is critical for the person with bipolar to seek appropriate treatment as quickly as possible in order to return to a normal functioning level and to reduce the morbidity associated with this condition. An atmosphere of trust and open communication between the patient and physician is highly beneficial since it promotes effective management of the patient's immediate and ongoing treatment goals that include:

• Evaluating and treating acute episodes
• Minimizing functional disruption
• Preventing episode recurrences
• Establishing and maintaining a therapy protocol
• Monitoring the patient's psychiatric condition
• Providing education, support and assistance to the patient and their families
• Helping the patient reestablish daily functioning and sleep patterns during and between episodes
• Identifying stressors that can trigger episodes
• Recognizing the onset of an episode as early as possible

By reducing the frequency, severity, and social consequences of bipolar disorder, the patient is able to function as effectively as possible.

There are two stages of treatment for bipolar disorder:

• Treatment of an acute phase which stabilizes or ends the current episode.
• Treatment for the preventive or maintenance phase over the long term to prevent or minimize future episode

Each phase of bipolar is treated with a combination of drug therapy, psychotherapy, and under certain circumstances, electroconvulsive therapy.

Drug Therapy for Bipolar Disorder

Drug therapy is usually the first-line of therapy used in treating acute episodes of bipolar disorder.

Medications chosen for treatment of bipolar disorder are usually determined by:

• Treatment history
• Type of bipolar disorder
• Severity and current state of mood
• Side effects of each drug

Women who are trying to conceive, who are pregnant, or who are nursing should discuss with their doctors the benefits and risks involved in continuing treatment with any medication.

There are three types of medications utilized in the treatment of bipolar disorder.

• Mood stabilizers
• Antipsychotics
• Antidepressants

Mood stabilizers are drugs that provide acute relief from mania, provide acute relief from depression, and prevent recurrences of mania or depression.

With the exception of lithium, many of the commonly used mood stabilizers for bipolar disorder are anticonvulsant (antiepileptic) medications examples of which include:

• Divalproex sodium (Depakote)
• Carbamazepine (Tegretol, Carbatrol)
• Oxcarbazepine (Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Neurontin)
• Topiramate (Topomax)

Lithium is a naturally occurring element. Its efficiency for treatment was discovered in the 1950's and it was approved by the U.S. Food and Drug Administration (FDA) for treating mania in 1995. It is very effective for pure mania and depression and can be combined with other medications for enhanced effect. It is less effective for rapid cycling or mixed episodes. Lithium has also been shown to reduce the risk of suicide.