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What are the treatments and drugs used to treat bipolar disorder?

Bipolar disorder treatment includes medication and non-drug therapy. The good news is that most patients respond to treatment and are able to control their illness.

Psychotherapy helps patients cope with the cyclical nature of the disease and can lead to better compliance with bipolar disorder medication. In addition to psychotherapy, some doctors prescribe bright-light therapy as a bipolar disorder treatment. In a recent study, this treatment was found to help with bouts of winter depression experienced by many bipolar disorder patients. Bipolar disorder patients experience seasonal affective disorder-an illness that causes depression during winter months.

Bipolar disorder medications are used two ways. The first way is to control symptoms that are out-of-control and need immediate attention. These medications are known as acute phase medications. They are used to treat severe depression or suicidal behavior during depressive episodes and they help control dangerous, psychotic behavior that accompanies some manic episodes. First line medications for the acute phase of bipolar disorder include lithium, valproate, carbamazepine, lamotrigine, and olanzapine. The medications function to stabilize mood and are also known as "mood stabilizers."

The second way bipolar disorder medication is used is to prevent future episodes of mania or depression. When used for this purpose, these medications are known as chronic phase or preventative medications. The top three medications for this purpose are lithium, valproate, and carbamazepine. These are often the same medications that are given during acute or severe episodes of bipolar disorder, but they are given in smaller doses. Bipolar disorder in children and adolescents is generally treated with lithium, but valproate and carbamazepine also are used.

Some patients take antidepressants, but antidepressant medications should be used with caution among bipolar patients. Several antidepressant medications, and in particular SSRIs--such as Prozac, Zoloft or Paxil, have been shown to cause manic episodes in some bipolar disorder patients.

With proper medication and treatment, patients with bipolar disorder can lead normal, productive lives.

References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Washington, DC, American Psychiatric Association, 1994: 350-366.

Balderassini RJ, Tondo L: Suicide risk and treatment for patients with bipolar disorders, JAMA 290:1517, 2003.

Bipolar Disorder (DSM-IV-TR #296.0-296.89). In: Moore and Jefferson: Handbook of Medical Psychiatry, 2nd ed. St. Louis, MO: Mosby, Inc; 2004: 147-155.

Rif S. El-Mallakh M.D., Bipolar Disorder (PTG). In: Ferri. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. 2005 ed. St. Louis, MO: Mosby, Inc; 2005: 122.

Youngstrom EA. Comparing the diagnostic accuracy of six potential screening instruments for bipolar disorder in youths aged 5 to 17 years. J Am Acad Child Adolesc Psychiatry. July 2004; 43(7): 847-58.

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