When Bipolar Mania Gets Out of Control

Fine-Tuning Treatment for Bipolar Disorder continued...

Even with medication, some people continue to have manic or depressive episodes, says Harvey. "As with any mental illness, stress can be a trigger. If you're taking lithium, profuse sweating can affect your lithium level -- especially if you're very sensitive to medication."

Insomnia is often the first sign that a manic episode is looming, she says. "I give patients a small sedating dose of non-addictive medication that they can take to help them sleep, to try to squash that problem. It's usually an antipsychotic, because if they were becoming manic, that's what we would use anyway."

Patients need to learn about their bipolar disorder, Harvey says. "They need to understand the disorder itself, the medications and side effects that might occur, why different types of medications are important, the importance of taking medications on a regular basis."

The Ripple Effect of Bipolar Disorder

Treatment should be more than just taming mania and depression. "Just getting rid of symptoms doesn't help with finding a job," Harvey says. "You may need to see a case manager for work rehabilitation. Getting back to work and social functioning should be part of treatment."

Indeed, bipolar disorder has "a huge ripple effect in your social relationships, occupational functioning, everything else," says Bearden. "People need programs that provide structure and help people get back to functioning."

At Menninger, Harvey's team works intensely with patients in relapse prevention, she tells WebMD. "Rehab specialists are important. This has been extremely disruptive in their lives. How does it affect their families? Will they still have their jobs? What kind of treatment support do they need? What support groups or resources do they need?"

For some patients, depression is difficult to treat, says Bearden. "It's hard to make the depression completely go away. In between manic episodes, they still have some residual depression."

That's why a close relationship with a psychiatrist is critical, she says. "If the doctor is trying different medications, adjusting dosages, it gives them a sense they are being listened to. It gives them hope that things can get better ... and that improves participation in treatment."

If you live anywhere near a university that is conducting clinical trials, that's a good way to get free medications and free treatment, Bearden advises. Look for studies that are comparing medications that are already FDA-approved, comparing one medication against another, so you won't get a placebo.

"A clinical trial is a great way to get good-quality treatment," Bearden tells WebMD. "A lot of people are wary about participating in a trial, but if it's done by an academic institution, it's generally high-quality. And they'll get frequent follow-up visits, which, regardless of the type of treatment, is one of the major factors in success."