Understanding Bipolar Disorder -- Treatment
While antidepressants remain widely prescribed for bipolar depression, most antidepressants have not been adequately studied in patients with bipolar depression. Of the larger studies that have been done, however, a combination of the antidepressant Prozac (fluoxetine) and the antipsychotic drug Zyprexa (olanzapine) improved symptoms of bipolar depression. Other FDA-approved treatments for the depressed phase of bipolar disorder include Seroquel or Seroquel XR and Latuda.
In general, your doctor may try to keep the use of antidepressants limited and brief. Long-term treatment with antidepressants in bipolar disorder tends to be recommended only when the initial response is clear-cut and there are no current or emerging signs of mania or hypomania. Some antidepressants -- given alone or in combination with other drugs -- may trigger a manic episode or cause cycles between depression and mania to be more rapid. If an antidepressant is not clearly having a beneficial effect for bipolar depression, there is usually little reason to continue it.
The family or spouse of a patient should be involved with any treatment. Having full information about the disease and its manifestations is important for both the patient and loved ones.
Nondrug Treatments of Depression
Whilemedications are usually the cornerstone of treatment for bipolar disorder, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. Several specific forms of psychotherapy have been shown to help speed recovery and improve functioning in bipolar disorder, including cognitive-behavioral therapy, interpersonal/social rhythm therapy, family therapy, and group therapy. In addition, because denial is often a problem -- sticking with medications can be especially tricky in adolescence -- routine psychotherapy helps patients stay on their medications.
Electroconvulsive therapy (ECT) is sometimes used for severely manic or depressed patients and for those who don't respond to medication or for those women who, while pregnant, experience symptoms. Because it can act quickly, it may be especially helpful for severely ill patients who are at high risk for attempting suicide. ECT fell out of favor in the 1960s partly due to distorted, negative portrayals of its use in the media. But modern procedures have been shown to be both safe and highly effective. The patient is first anesthetized and a muscle relaxant is given. Then, while the patient is asleep, a small electric current is passed through electrodes placed on the scalp to produce a grand mal seizure of short duration -- less than one minute. A course of treatment usually involves 6-12 treatments, typically administered three times per week. During the course of ECT treatments -- usually two to four weeks -- lithium and other mood stabilizers are sometimes discontinued to minimize side effects.They are then resumed after completion of the treatment.