Bipolar Disorder Lecture - not original material
Benzodiazepine Abuse:
Please note that the information contains original and previously published data and as such is not attributed. Writer takes no responsibility for originality of the content, it is purely for the purpose of education of healthcare individuals. If you have any questions about the content or would like the information presented by a qualified psychiatric nurse practitioner and naturopathic practitioner please contact me at naturalpsych@hotmail.com
Respectfully,
Dr. Eric Malz
Bipolar Disorder:
What Is Bipolar Disorder?
Bipolar disorder used to be known as manic depression. It's a serious illness, one that can lead to risky behavior, damaged relationships and careers, even suicidal tendencies -- if it's not treated.
Bipolar disorder is characterized by extreme changes in mood (poles) -- from mania to depression. Between these mood swings, a person with Bipolar disorder may experience normal moods.
"Manic" describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can be irresistible. Then, at some point, this high-flying mood can spiral into something darker -- irritation, confusion, anger, feeling trapped.
"Depression" describes the opposite mood -- sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems.
But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disease to diagnose. For some people, mania or depression can last for weeks or months, even for years. For other people, bipolar disorder takes the form of frequent and dramatic mood shifts.
"There's a whole spectrum of symptoms and mood changes that have been found in bipolar disorder," says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. "It's not always dramatic mood swings. In fact, some people seem to get along just fine. The manic periods can be very, very productive. They think things are going great."
The danger comes, he says, when the mania grows much worse. "The change can be very dramatic, with catastrophic results. People can get involved in reckless behavior, spend a lot of money, there may be sexual promiscuity, sexual risks."
The depressed phases can be equally dangerous: A person may have frequent thoughts of suicide.
If you or someone you know has thoughts of death or suicide, contact a health-care professional, loved one, friend, or call 911 immediately.
Bipolar disorder is equally difficult for families of those affected. The condition is the most difficult mental illness for families to accept, Aronson tells WebMD. "Families can more easily accept schizophrenia, to understand that it is an illness. But when a person is sometimes very productive, then becomes unreasonable or irrational, it wreaks more havoc on the family. It seems more like bad behavior, like they won't straighten up."
If this rings true -- either for you or a loved one -- the first step in tackling the problem is to see a psychiatrist. Whether it's bipolar disorder or another mood-related problem, effective treatments are available. What's most important is that you recognize the problem, and start looking for help.
Bipolar Disorder:
What Causes Bipolar Disorder?
Doctors don't completely understand the causes of bipolar disorder. But they've gained greater understanding in the past 10 years.
Bipolar disorder often runs in families, and researchers believe there is a genetic component. There is also growing evidence that environment and lifestyle have an affect on the disorder's severity. Stressful life events -- or alcohol or drug abuse -- can make bipolar disorder more difficult to treat.
Experts believe bipolar disorder is caused by an underlying problem with the balance of brain chemicals. When the levels are too high, mania occurs; when the levels are low, there is depression.
Bipolar Disorder:
Hypomania and Mania Symptoms
The dramatic mood swings of bipolar disorder do not follow a set pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time -- before suddenly having the opposite mood. Also, the severity of mood phases can differ from person to person.
Hypomania is a less severe form of mania. Hypomania is a mood that many don't perceive as a problem. It actually may feel pretty good. You have a greater sense of well-being and productivity. However, for someone with bipolar disorder, hypomania can evolve into mania -- or can switch into serious depression.
The experience of these manic stages has been described this way:
Hypomania: At first when I'm high, it's tremendous ... ideas are fast ... like shooting stars you follow until brighter ones appear... . All shyness disappears, the right words and gestures are suddenly there ... uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria ... you can do anything ... but somewhere this changes.
Mania: The fast ideas start coming too fast and there are far too many ... overwhelming confusion replaces clarity ... you stop keeping up with it … memory goes. Infectious humor ceases to amuse. Your friends become frightened ... everything is now against the grain ... you are irritable, angry, frightened, uncontrollable, and trapped.
If you have three or more of the mania symptoms below most of the day -- nearly every day -- for one week or longer, you may be having a manic episode:
· Excessive happiness, hopefulness, and excitement
· Sudden changes from being joyful to being irritable, angry, and hostile
· Restlessness, increased energy and less need for sleep
· Rapid talk, talkativeness
· Distractibility
· Racing thoughts
· High sex drive
· Tendency to make grand and unattainable plans
· Tendency to show poor judgment, such as deciding to quit a job
· Inflated self-esteem or grandiosity -- unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
· Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs or ill-advised business decisions)
Some people with bipolar disorder become psychotic, hearing things that aren't there. They may hold onto false beliefs, and cannot be swayed from them. In some instances, they see themselves as having superhuman skills and powers -- even consider themselves to be god-like.
Bipolar Disorder:
Depression Symptoms
The dramatic mood swings of bipolar disorder do not follow a set pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time -- before suddenly having the opposite mood. Also, the severity of mood phases can differ from person to person.
The depressive periods can be equally intense. Sadness and anxiety affect every aspect of life -- thoughts, feelings, sleeping, eating, physical health, relationships, ability to function at work. If depression is not treated, it only grows worse. There may seem to be no way out of this overwhelming mood.
These depressive feelings have been described this way:
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless... . [I am] haunt[ed] ... with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but, of course, they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?
A depressive episode involves five or more of these symptoms most of the day -- nearly every day -- for two weeks or longer:
Symptoms of depression:
· Sad, anxious, irritability
· Loss of energy
· Feelings of guilt, hopelessness, or worthlessness
· Loss of interest or enjoyment from things that were once pleasurable
· Difficulty concentrating
· Uncontrollable crying
· Difficulty making decisions
· Irritability
· Increased need for sleep
· Insomnia
· Change in appetite causing weight loss or gain
· Thoughts of death or suicide
· Attempting suicide
When a person with psychosis is in a depressive stage, there may be delusions of guilt or worthlessness -- perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime.
If untreated, depressive episodes tend to come closer together and are harder to treat. They may switch into mania. But treatment can prevent this from happening. With medication and therapy, its possible to live normally -- to have a happy, productive life.
Bipolar Disorder:
What Are the Treatments for Bipolar Disorder?
The most effective treatment for bipolar disorder is a combination of medication and psychotherapy. Most people take more than one medication, like a mood-stabilizing drug and an antidepressant. However, it's important that treatment be ongoing -- even after you feel better -- to keep mood swings under control.
One note of caution: The FDA has determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
After remission from an acute episode of bipolar disorder, a person is at high risk for relapse for about six months. Thus, maintenance (ongoing) therapy is often recommended.
Anyone who has experienced two to three episodes of bipolar disorder is considered a long-term -- if not lifetime -- bipolar patient. That person should have maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), drug therapy is continued indefinitely -- often at lower doses.
Remember this: Even if you have been without bipolar symptoms for several months, do not stop taking your medications. Your doctor may lower your doses, but discontinuation of medications will put you at risk for recurrence of bipolar symptoms.
Bipolar Disorder:
Diagnosis of Bipolar Disorder
Diagnosis is made only by taking careful note of symptoms, including their severity, length, and frequency. The most telling symptoms include severe mood swings (going from extreme highs to extreme lows) that don't follow a set pattern.
The psychiatrist will ask questions about personal and family history of mental illness. The doctor will also ask detailed questions about symptoms, including how long they last and how frequently they occur. Other questions will focus on reasoning, memory, ability to express oneself, and ability to maintain relationships.
Blood and urine tests -- such as a toxicology screening -- may be done to rule out other causes of symptoms. In a toxicology screening, blood, urine, or hair are examined for the presence of drugs. Blood tests also include a check of thyroid stimulating hormone (TSH) level, since depression is sometimes linked to thyroid function.
Bipolar Disorder:
Can Bipolar Disorder Be Prevented?
There is no known way to prevent bipolar disorder. Because its exact cause has not yet been determined, the best attack is to know its symptoms and get treatment early. Also, because some people with bipolar disorder become suicidal if they don't get effective treatment, it's especially essential to get treatment.
Bipolar Disorder:
Convincing Someone to See a Doctor for Bipolar Disorder
Very often, people with hypomania may not realize it's a problem. They may even enjoy it, finding it to be a productive time. Others struggle with depression, not getting the help that could relieve their suffering.
Yet for various reasons, they don't get help from a doctor. They shrug off a friend or family member's concern. Others view their illness as a distraction or a weakness, and they don't want to give in to it. Still others put their health at a very low priority compared with other things in their lives.
However, fear is often the reason for not seeing a doctor. That's especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortably in their everyday routines -- even though relationships and careers can be at stake.
If you're concerned about a loved one, talk to him or her about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it's best to be direct about your concern regarding a mood disorder. Include these points in the discussion:
· It's not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
· Millions of Americans have bipolar disorder. It can develop at any point in a person's life, and is responsible for enormous suffering.
· Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
· There's a medical explanation for bipolar disorder. Disruptions in brain chemistry are involved. The brain circuits -- those that control emotion -- are not working the way they should. Because of this, people experience certain moods more intensely, for longer periods of time, and more frequently.
· Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
· By not getting treatment, you risk having worse mood swings -- even becoming suicidal. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.
Trust is crucial in shaking someone's denial, in motivating him or her to get help. Trust is also important once treatment starts. Through the eyes of a trustworthy friend or family member, a bipolar patient can know when treatment is working -- when things are getting better, and when they're not. If your interest is sincere, you can be of great help to your friend or family member.
Bipolar Disorder:
Bipolar Disorder Treatment Overview
No one knows exactly what causes bipolar disorder. While genetic vulnerability and life stress are involved in triggering it, experts believe that an underlying imbalance of brain chemicals produces the symptoms. When levels of these chemicals are too high, mania occurs. When levels are low, there is depression.
This biological understanding of the disorder has opened doors for targeted treatments.
The best treatment is a combination of medication and counseling, although electroconvulsive therapy (ECT) is often successful for people who don't respond to traditional therapy or who can't take the medications.
Doctors often treat the mania symptoms with one set of drugs, and use other drugs to treat depression. Certain drugs are also used for "maintenance" -- to maintain a steady mood over time. Antidepressants are not often used alone, because they may cause rapid cycling between depression and mania.
Most people respond well to medications for bipolar disorder. For many others, the symptoms do not completely disappear despite therapy. The moods may become less intense and more manageable, however.
Remember, getting your diagnosis should come as a relief. Now you know what the problem has been and you're on the road to getting the right treatment.
Mania
If you are suffering from mania, your doctor initially may treat you with an antipsychotic drug and/or a benzodiazepine to quickly control hyperactivity, sleeplessness, hostility, and irritability.
Your doctor will also likely prescribe a mood stabilizer. Mood stabilizers help control mood swings, prevent recurrences of mood swings, and reduce the risk of suicide. They are usually taken for a long time, sometimes years. Examples include lithium and certain anticonvulsant drugs.
Treatment of mania often requires hospitalization because there is high risk for unpredictable, reckless behavior and noncompliance with treatment. For people with extreme mania, pregnant women with mania, or those people whose mania can't be controlled with mood stabilizers, doctors sometimes also recommend electroconvulsive therapy (ECT).
If mania occurs while on maintenance therapy, your doctor may simply change your medication dose. Or you may start taking an antipsychotic drug to lessen symptoms.
Nondrug treatments, such as psychotherapy, and establishing a well-ordered routine may help patients in their maintenance phase. This is often suggested along with medication.
Depression
Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania and then another episode of depression.
Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
In April 2002, the American Psychiatric Association suggested using lithium or the anticonvulsant drug Lamictal as an initial treatment for people in the acute depressive phase of bipolar disorder who were not already taking a mood stabilizing medication. Sometimes Lamictal is added to lithium as well.
For more severely ill patients, some doctors may prescribe lithium and an antidepressant -- usually either Wellbutrin or Paxil, though other drugs can be used.
There are other options for treating bipolar depression.
The antipsychotic drug Zyprexa is also approved to treat bipolar depression when used with the antidepressant Zoloft. Other antipsychotic medications have also been studied and found effective in varying degrees.
If all else fails, doctors may recommend electroconvulsive therapy (ECT). It helps nearly 75% of the patients who try it.
In addition, psychotherapy may be beneficial when added to drug therapy. Once depression has resolved, mood stabilizers are the best proven treatments to prevent future depression. If psychotic symptoms occur during an acute depressive episode, the doctor may recommend antipsychotic medicine.
Nondrug treatments -- such as psychotherapy and establishing a well-ordered routine -- may help patients in their maintenance phase. They are often suggested along with medication. Psychotherapy alone is not considered sufficient to treat bipolar depression.
Bipolar Disorder:
Lithium for Bipolar Disorder
Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression.
Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy.
Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior.
It usually takes one to two weeks for lithium to begin working. Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney function. Lithium works best if the amount of the drug in your body is kept at a constant level. Your doctor will also probably suggest you drink eight to12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it's important to consume a steady amount every day.
The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.
Lithium Side Effects
About 75% of people who take lithium have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects can be relieved by tweaking the dose of lithium. However, never change your dose or drug schedule on your own. Do not the change brand of this medication without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.
Common side effects can include:
· Hand tremor (If tremors are particularly bothersome, an additional medication can help.)
· Increased thirst
· Increased urination
· Diarrhea
· Vomiting
· Weight gain
· Impaired memory
· Poor concentration
· Drowsiness
· Muscle weakness
· Hair loss
· Acne
· Decreased thyroid function (which can be treated with thyroid hormone)
Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate.
Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.
If you miss a dose, take it as soon as you remember it -- unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not "double up" the dose to catch up.
There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn't recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.
Bipolar Disorder:
Anticonvulsant Medications for Bipolar Disorder
Increasingly, anticonvulsant medications are used as mood stabilizers to treat mania. Lamictal is used to treat bipolar depression as well. Occasionally, Depakote is also used to treat bipolar depression. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.
Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling -- four or more episodes of mania and depression in a year.
Anticonvulsants used to treat bipolar disorder include:
· Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
· Tegretol (carbamazepine)
· Lamictal (lamotrigine)
· Trileptal (oxcarbazepine)
Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking the drug for a couple of weeks.
Anticonvulsant Side Effects
Your doctor may want to take regular blood tests to monitor your health. Some anticonvulsants can cause liver or kidney damage or decrease the amount of platelets in your blood. Your blood needs platelets to clot.
Each anticonvulsant may have slightly different side effects. Common side effects include:
· Dizziness
· Drowsiness
· Fatigue
· Nausea
· Tremor
· Rash
· Weight gain
Most of these side effects lessen with time. Long-term effects vary from drug to drug. In general:
· Pregnant women should not take anticonvulsants because they increase the risk of birth defects.
· Anticonvulsants can cause problems with the liver over the long term, so your doctor should monitor your liver closely.
Also, anticonvulsants can interact with other drugs -- even aspirin -- to cause serious problems. Be sure to tell your doctor about any drugs, herbs, or supplements you take. Don't take any other substance during treatment without talking with your doctor.
Bipolar Disorder:
Antipsychotic Medications for Bipolar Disorder
Antipsychotic medications are used as a short-term treatment to control psychotic symptoms such as hallucinations or delusions. These symptoms may occur during acute mania or severe depression.
In people with bipolar disorder, antipsychotics are also used as sedatives, for insomnia, for anxiety, and/or for agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect. Some antipsychotic medications may also help lessen bipolar depression.
Some of the newer antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don't tolerate or respond to lithium and anticonvulsants.
Antipsychotic drugs help balance certain brain chemicals called neurotransmitters. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.
The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a week.
Antipsychotics used to treat bipolar disorder include:
· Abilify (aripiprazole)
· Clorazil (clozapine)
· Geodon (ziprasidone)
· Risperdal (risperidone)
· Seroquel (quetiapine)
· Zyprexa (olanzapine)
Antipsychotics Side Effects
Certain antipsychotics cause rapid weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should first be screened for their risk for heart disease, stroke, and diabetes, according to a study published in the February 2004 issue of Diabetes Care. The study specifically recommended that doctors screen people taking Risperdal, Seroquel, or Zyprexa for diabetes, prediabetes, and high cholesterol.
Abilify does not cause weight gain but may increase the risk of diabetes.
Common side effects of antipsychotic medications include:
· Blurred vision
· Dry mouth
· Drowsiness
· Muscle spasms or tremor
· Involuntary facial tics
· Weight gain
Note: Clorazil is not used often, despite its effectiveness, for bipolar disorder. The drug can cause a rare, potentially fatal side effect affecting the blood that requires weekly or biweekly blood test monitoring.
Older antipsychotic drugs are generally not used to treat bipolar disorder. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs. Older antipsychotics include Thorazine (chlorpromazine), Haldol (haloperidol), and Trilafon (perphenazine). These drugs may cause serious long-term side effects called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing.
Bipolar Disorder:
Calcium Channel Blockers for Bipolar Disorder
Sometimes a doctor may prescribe for mania a group of drugs traditionally used to treat high blood pressure or heart problems called calcium channel blockers. These drugs are not as effective as others and are not used often.
These drugs block calcium channels, which are the small pores in cells that allow calcium to move in and out, which widens your blood vessels. It's not clear exactly how the drugs work, but they are used to lower blood pressure, improve irregular heartbeats, and treat migraines. They may also help stabilize moods.
Calcium channel blockers used to treat mania include:
· Diltiazem
· Nifedipine
· Nimodipine
· Verapamil
Calcium Channel Blockers Side Effects
Sometimes, a headache can develop after taking certain calcium channel blockers. These headaches should gradually disappear once you have been taking the medication for a while. Talk to your doctor if headaches continue. Some people also report tenderness, swelling, or bleeding of the gums when starting to take calcium channel blockers. Regular brushing, flossing, and gum massages along with routine dental visits can help lessen this effect. As with any medication, it is important to see your doctor regularly to make sure the drug is working properly.
Calcium channel blockers tend to cause fewer serious side effects than some other drugs used to treat bipolar disorder. However, they are also less effective.
Common side effects include:
· Slowed heart rate or irregular heart rhythm
· Flushing, a pounding sensation in the head, dizziness, headache
· Leg swelling
· Decreased blood pressure
· Tingling sensations in the arms or legs
· Weakness
· Constipation
Talk to your doctor if you are pregnant or could become pregnant during treatment. It isn't known if these drugs could harm the fetus.
Bipolar Disorder:
Benzodiazepines for Bipolar Disorder
Benzodiazepines rapidly help control certain manic symptoms until mood-stabilizing drugs can take effect. They are usually taken for a brief time, up to two weeks or so, with other mood-stabilizing drugs. They may also help restore normal sleep patterns in people with bipolar disorder.
Benzodiazepines slow the activity of the brain. In doing so, they can help treat mania, anxiety, panic disorder, insomnia, and seizures.
Benzodiazepines prescribed for bipolar disorder include (among others):
· Ativan (lorzepam)
· Klonopin (clonazepam)
· Valium (diazepam)
· Xanax (alprazolam)
Benzodiazepine Side Effects
The drugs act quickly and bring on a sense of calmness. They can sometimes cause lightheadedness, slurred speech, or unsteadiness.
Possible side effects include:
· Drowsiness or dizziness
· Lightheadedness
· Fatigue
· Blurred vision
· Slurred speech
· Memory loss
· Muscle weakness
Benzodiazepines can be habit-forming and addictive.
If you have been taking the benzodiazepines for a long time, you may suffer withdrawal symptoms if you stop the drug suddenly. Talk with your doctor about whether you still need the medication and, if not, how to taper off the drug.
Bipolar Disorder:
Electroconvulsive Therapy (ECT) for Bipolar Disorder
Electroconvulsive therapy (ECT), also known as electroshock therapy, is used as an acute treatment for hospitalized patients who are suicidal, psychotic, or dangerous to others. It is effective in nearly 75% of patients who have the procedure.
In electroconvulsive therapy, an electric current is sent through the scalp to the brain. It is used to treat people who are suffering from severe depression or other mental illness. ECT is one of the fastest ways to relieve symptoms in people who suffer from mania or severe depression. ECT is generally used as a last resort when the illness does not respond to medication or psychotherapy. It is also used when patients pose a severe threat to themselves or others and it is dangerous to wait until drugs take effect.
Prior to ECT treatment, a person is given a muscle relaxant and put under general anesthesia. ECT, when done correctly, will cause the patient to have a seizure, and the muscle relaxant is given to limit the size of the episode.
Electrodes are placed on the patients scalp and a finely controlled electric current is applied that causes a brief seizure in the brain. Because the muscles are relaxed, the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding the treatment, and is often confused.
This confusion typically lasts for only a short period of time. ECT is given up to three times a week for two to four weeks.
In extremely rare cases, ECT can cause heart attack, stroke, or death. People with certain heart problems usually are not good candidates for ECT. Short-term memory loss is the major side effect, although this usually goes away one to two weeks after treatment.
Other possible side effects include:
· Confusion
· Nausea
· Headache
· Jaw pain
These effects may last from several hours to several days.
A third of people who have ECT report some long-term memory loss, but few studies have been done on this side effect
Bipolar Disorder:
Antidepressants for Bipolar Disorder
Antidepressants can help relieve depression and boost mood. It typically takes three to four weeks for most people to respond to the treatment. Sometimes a doctor will try several different antidepressants and doses before finding one that works for a patient.
There are three different types of antidepressants used to treat depression among people with bipolar disorder:
· Selective serotonin reuptake inhibitors (SSRIs)
· Monoamine oxidase inhibitors (MAOIs)
· Tricyclic antidepressants (less commonly used).
Newer "atypical" antidepressants are also being tested for use in treating bipolar depression.
Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania and then another episode of depression.
Bipolar Disorder:
Bipolar Disorder and Going to Work
Bipolar disorder can have a big effect on your career. In a survey of people with depression and bipolar disorder conducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.
But don't get alarmed. Being diagnosed with bipolar disorder doesn't necessarily mean that you can't keep your job. Plenty of people with bipolar disorder work and live normal lives.
Should I Tell My Boss?
You don't have to talk to your boss or coworkers about your condition. Your health is your business. But if your condition has been affecting your performance at work, being open may be a good idea. Your boss and coworkers may have noticed the changes in your behavior. If you explain what's going on, they may be more sympathetic than you expect.
Making Changes
Some people with bipolar disorder find their current job just isn't a good fit. Maybe it's too stressful or the schedule is too inflexible. Maybe it doesn't let them get enough sleep. If you think your job is hurting your health, it's time to make some changes. Here are some things to consider.
· Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day to reduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
· Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job -- both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health-care provider.
· Look into financial assistance. If you do need to take time off, see if your employer has disability insurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
· Go slowly. Returning to work after you've taken time off can be stressful. Think about starting in a part-time position, at least until you're confident that your condition has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.
Bipolar Disorder Stigma
Unfortunately, you may still run into people who treat you unfairly because of your bipolar disorder. Often, their behavior stems from ignorance. They might see you as "crazy" or think your condition is "all in your head." You might be able to head off problems by teaching people a little about bipolar disorder.
But that's not always enough, and the stigma of mental illness can hold you back. Some people with bipolar disorder feel they're treated unfairly at work; they might be passed over for promotions or raises, for instance.
If you think you're being treated unfairly, there are things you can do. The Americans with Disabilities Act can protect some people who are discriminated against because of a health condition. But don't do anything rash. Research the law, and talk your situation over with friends, family, your therapist, and your health-care provider before taking action.
Bipolar Disorder:
Talking to Your Friends and Family About Bipolar Disorder
Bipolar disorder can put an enormous strain on relationships with your family and friends. When you're depressed, you may isolate yourself from the people who care about you. When you're manic or hypomanic, you might frighten or alienate them.
But your relationships with your friends and family are crucial to staying healthy. You need to keep the lines of communication open. Here are some suggestions.
· Educate your family and peers. Your friends and family may not know much about bipolar disorder, or they may have a lot of wrong impressions. Explain what it is and how it affects you. Talk about your bipolar treatment. Unfortunately, some people may be skeptical or unsympathetic. Back yourself up with brochures or printouts that you can give them. Tell them you need their help to stay well.
· Create a support team. Obviously, you don't need to tell everyone you know about your condition. But you also shouldn't rely on only one person. It's much better to have a number of people you can turn to in a crisis. Placing all the responsibility on one person is simply too much.
· Make a plan. You need to accept that during a mood swing, your judgment might be impaired. You could really benefit from people looking out for you. But your loved ones also need to be careful not to push too hard. You don't want to feel like every move you make is being scrutinized.
So work out distinct boundaries. Decide how often your friends and family should check in and what to do if things are getting out of control. If you become manic, you might agree that your loved ones should take away your car keys or credit cards so you don't do anything reckless. If you become suicidal, they certainly need to get emergency help. Coming up with an explicit plan will make everyone feel better.
· Listen. After all that you've been through, you may not want to hear the concerns of your family and friends. But the fact is that your condition does affect the people around you. During a manic or depressive phase, you may have upset people whom you care about. So try to hear them out and see things from their point of view. If you've hurt people, apologize. Reassure them that you didn't mean to act the way you did, and emphasize that you're getting treatment.
· Talk to your children. If you have kids, you should find a way to tell them what's happening. They're likely to sense that something is wrong anyway; keeping them in the dark might just make it scarier. Explain your condition in a way that's appropriate for their age. Say that it's a disease that affects your mood, but that you're getting treatment for it.
· Reach out. Bipolar disorder can make relationships hard. When you're depressed, you may want to retreat from the world. If you've just come out of a manic phase, you may not want to face people whom you treated badly. Either way, it's easy to let some friendships slip away. Don't let it happen. Force yourself to get together with other people, even if it may be hard at first. Isolating yourself is the worst thing you can do.
Bipolar Disorder:
Convincing Someone to See a Doctor for Bipolar Disorder
Very often, people with hypomania may not realize it's a problem. They may even enjoy it, finding it to be a productive time. Others struggle with depression, not getting the help that could relieve their suffering.
Yet for various reasons, they don't get help from a doctor. They shrug off a friend or family member's concern. Others view their illness as a distraction or a weakness, and they don't want to give in to it. Still others put their health at a very low priority compared with other things in their lives.
However, fear is often the reason for not seeing a doctor. That's especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortably in their everyday routines -- even though relationships and careers can be at stake.
If you're concerned about a loved one, talk to him or her about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it's best to be direct about your concern regarding a mood disorder. Include these points in the discussion:
· It's not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
· Millions of Americans have bipolar disorder. It can develop at any point in a person's life, and is responsible for enormous suffering.
· Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
· There's a medical explanation for bipolar disorder. Disruptions in brain chemistry are involved. The brain circuits -- those that control emotion -- are not working the way they should. Because of this, people experience certain moods more intensely, for longer periods of time, and more frequently.
· Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
· By not getting treatment, you risk having worse mood swings -- even becoming suicidal. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.
Trust is crucial in shaking someone's denial, in motivating him or her to get help. Trust is also important once treatment starts. Through the eyes of a trustworthy friend or family member, a bipolar patient can know when treatment is working -- when things are getting better, and when they're not. If your interest is sincere, you can be of great help to your friend or family member.
Please note that the information contains original and previously published data and as such is not attributed. Writer takes no responsibility for originality of the content, it is purely for the purpose of education of healthcare individuals. If you have any questions about the content or would like the information presented by a qualified psychiatric nurse practitioner and naturopathic practitioner please contact me at naturalpsych@hotmail.com
Respectfully,
Dr. Eric Malz
Bipolar Disorder:
What Is Bipolar Disorder?
Bipolar disorder used to be known as manic depression. It's a serious illness, one that can lead to risky behavior, damaged relationships and careers, even suicidal tendencies -- if it's not treated.
Bipolar disorder is characterized by extreme changes in mood (poles) -- from mania to depression. Between these mood swings, a person with Bipolar disorder may experience normal moods.
"Manic" describes an increasingly restless, energetic, talkative, reckless, powerful, euphoric period. Lavish spending sprees or impulsive risky sex can be irresistible. Then, at some point, this high-flying mood can spiral into something darker -- irritation, confusion, anger, feeling trapped.
"Depression" describes the opposite mood -- sadness, crying, sense of worthlessness, loss of energy, loss of pleasure, sleep problems.
But because the pattern of highs and lows varies for each person, bipolar disorder is a complex disease to diagnose. For some people, mania or depression can last for weeks or months, even for years. For other people, bipolar disorder takes the form of frequent and dramatic mood shifts.
"There's a whole spectrum of symptoms and mood changes that have been found in bipolar disorder," says Michael Aronson, MD, a clinical psychiatrist and consultant for WebMD. "It's not always dramatic mood swings. In fact, some people seem to get along just fine. The manic periods can be very, very productive. They think things are going great."
The danger comes, he says, when the mania grows much worse. "The change can be very dramatic, with catastrophic results. People can get involved in reckless behavior, spend a lot of money, there may be sexual promiscuity, sexual risks."
The depressed phases can be equally dangerous: A person may have frequent thoughts of suicide.
If you or someone you know has thoughts of death or suicide, contact a health-care professional, loved one, friend, or call 911 immediately.
Bipolar disorder is equally difficult for families of those affected. The condition is the most difficult mental illness for families to accept, Aronson tells WebMD. "Families can more easily accept schizophrenia, to understand that it is an illness. But when a person is sometimes very productive, then becomes unreasonable or irrational, it wreaks more havoc on the family. It seems more like bad behavior, like they won't straighten up."
If this rings true -- either for you or a loved one -- the first step in tackling the problem is to see a psychiatrist. Whether it's bipolar disorder or another mood-related problem, effective treatments are available. What's most important is that you recognize the problem, and start looking for help.
Bipolar Disorder:
What Causes Bipolar Disorder?
Doctors don't completely understand the causes of bipolar disorder. But they've gained greater understanding in the past 10 years.
Bipolar disorder often runs in families, and researchers believe there is a genetic component. There is also growing evidence that environment and lifestyle have an affect on the disorder's severity. Stressful life events -- or alcohol or drug abuse -- can make bipolar disorder more difficult to treat.
Experts believe bipolar disorder is caused by an underlying problem with the balance of brain chemicals. When the levels are too high, mania occurs; when the levels are low, there is depression.
Bipolar Disorder:
Hypomania and Mania Symptoms
The dramatic mood swings of bipolar disorder do not follow a set pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time -- before suddenly having the opposite mood. Also, the severity of mood phases can differ from person to person.
Hypomania is a less severe form of mania. Hypomania is a mood that many don't perceive as a problem. It actually may feel pretty good. You have a greater sense of well-being and productivity. However, for someone with bipolar disorder, hypomania can evolve into mania -- or can switch into serious depression.
The experience of these manic stages has been described this way:
Hypomania: At first when I'm high, it's tremendous ... ideas are fast ... like shooting stars you follow until brighter ones appear... . All shyness disappears, the right words and gestures are suddenly there ... uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria ... you can do anything ... but somewhere this changes.
Mania: The fast ideas start coming too fast and there are far too many ... overwhelming confusion replaces clarity ... you stop keeping up with it … memory goes. Infectious humor ceases to amuse. Your friends become frightened ... everything is now against the grain ... you are irritable, angry, frightened, uncontrollable, and trapped.
If you have three or more of the mania symptoms below most of the day -- nearly every day -- for one week or longer, you may be having a manic episode:
· Excessive happiness, hopefulness, and excitement
· Sudden changes from being joyful to being irritable, angry, and hostile
· Restlessness, increased energy and less need for sleep
· Rapid talk, talkativeness
· Distractibility
· Racing thoughts
· High sex drive
· Tendency to make grand and unattainable plans
· Tendency to show poor judgment, such as deciding to quit a job
· Inflated self-esteem or grandiosity -- unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
· Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs or ill-advised business decisions)
Some people with bipolar disorder become psychotic, hearing things that aren't there. They may hold onto false beliefs, and cannot be swayed from them. In some instances, they see themselves as having superhuman skills and powers -- even consider themselves to be god-like.
Bipolar Disorder:
Depression Symptoms
The dramatic mood swings of bipolar disorder do not follow a set pattern. Depression does not always follow mania. A person may experience the same mood state several times -- for weeks, months, even years at a time -- before suddenly having the opposite mood. Also, the severity of mood phases can differ from person to person.
The depressive periods can be equally intense. Sadness and anxiety affect every aspect of life -- thoughts, feelings, sleeping, eating, physical health, relationships, ability to function at work. If depression is not treated, it only grows worse. There may seem to be no way out of this overwhelming mood.
These depressive feelings have been described this way:
Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless... . [I am] haunt[ed] ... with the total, the desperate hopelessness of it all. Others say, "It's only temporary, it will pass, you will get over it," but, of course, they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think, or care, then what on earth is the point?
A depressive episode involves five or more of these symptoms most of the day -- nearly every day -- for two weeks or longer:
Symptoms of depression:
· Sad, anxious, irritability
· Loss of energy
· Feelings of guilt, hopelessness, or worthlessness
· Loss of interest or enjoyment from things that were once pleasurable
· Difficulty concentrating
· Uncontrollable crying
· Difficulty making decisions
· Irritability
· Increased need for sleep
· Insomnia
· Change in appetite causing weight loss or gain
· Thoughts of death or suicide
· Attempting suicide
When a person with psychosis is in a depressive stage, there may be delusions of guilt or worthlessness -- perhaps there is an inaccurate belief of being ruined and penniless, or having committed a terrible crime.
If untreated, depressive episodes tend to come closer together and are harder to treat. They may switch into mania. But treatment can prevent this from happening. With medication and therapy, its possible to live normally -- to have a happy, productive life.
Bipolar Disorder:
What Are the Treatments for Bipolar Disorder?
The most effective treatment for bipolar disorder is a combination of medication and psychotherapy. Most people take more than one medication, like a mood-stabilizing drug and an antidepressant. However, it's important that treatment be ongoing -- even after you feel better -- to keep mood swings under control.
One note of caution: The FDA has determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
After remission from an acute episode of bipolar disorder, a person is at high risk for relapse for about six months. Thus, maintenance (ongoing) therapy is often recommended.
Anyone who has experienced two to three episodes of bipolar disorder is considered a long-term -- if not lifetime -- bipolar patient. That person should have maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), drug therapy is continued indefinitely -- often at lower doses.
Remember this: Even if you have been without bipolar symptoms for several months, do not stop taking your medications. Your doctor may lower your doses, but discontinuation of medications will put you at risk for recurrence of bipolar symptoms.
Bipolar Disorder:
Diagnosis of Bipolar Disorder
Diagnosis is made only by taking careful note of symptoms, including their severity, length, and frequency. The most telling symptoms include severe mood swings (going from extreme highs to extreme lows) that don't follow a set pattern.
The psychiatrist will ask questions about personal and family history of mental illness. The doctor will also ask detailed questions about symptoms, including how long they last and how frequently they occur. Other questions will focus on reasoning, memory, ability to express oneself, and ability to maintain relationships.
Blood and urine tests -- such as a toxicology screening -- may be done to rule out other causes of symptoms. In a toxicology screening, blood, urine, or hair are examined for the presence of drugs. Blood tests also include a check of thyroid stimulating hormone (TSH) level, since depression is sometimes linked to thyroid function.
Bipolar Disorder:
Can Bipolar Disorder Be Prevented?
There is no known way to prevent bipolar disorder. Because its exact cause has not yet been determined, the best attack is to know its symptoms and get treatment early. Also, because some people with bipolar disorder become suicidal if they don't get effective treatment, it's especially essential to get treatment.
Bipolar Disorder:
Convincing Someone to See a Doctor for Bipolar Disorder
Very often, people with hypomania may not realize it's a problem. They may even enjoy it, finding it to be a productive time. Others struggle with depression, not getting the help that could relieve their suffering.
Yet for various reasons, they don't get help from a doctor. They shrug off a friend or family member's concern. Others view their illness as a distraction or a weakness, and they don't want to give in to it. Still others put their health at a very low priority compared with other things in their lives.
However, fear is often the reason for not seeing a doctor. That's especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortably in their everyday routines -- even though relationships and careers can be at stake.
If you're concerned about a loved one, talk to him or her about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it's best to be direct about your concern regarding a mood disorder. Include these points in the discussion:
· It's not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
· Millions of Americans have bipolar disorder. It can develop at any point in a person's life, and is responsible for enormous suffering.
· Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
· There's a medical explanation for bipolar disorder. Disruptions in brain chemistry are involved. The brain circuits -- those that control emotion -- are not working the way they should. Because of this, people experience certain moods more intensely, for longer periods of time, and more frequently.
· Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
· By not getting treatment, you risk having worse mood swings -- even becoming suicidal. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.
Trust is crucial in shaking someone's denial, in motivating him or her to get help. Trust is also important once treatment starts. Through the eyes of a trustworthy friend or family member, a bipolar patient can know when treatment is working -- when things are getting better, and when they're not. If your interest is sincere, you can be of great help to your friend or family member.
Bipolar Disorder:
Bipolar Disorder Treatment Overview
No one knows exactly what causes bipolar disorder. While genetic vulnerability and life stress are involved in triggering it, experts believe that an underlying imbalance of brain chemicals produces the symptoms. When levels of these chemicals are too high, mania occurs. When levels are low, there is depression.
This biological understanding of the disorder has opened doors for targeted treatments.
The best treatment is a combination of medication and counseling, although electroconvulsive therapy (ECT) is often successful for people who don't respond to traditional therapy or who can't take the medications.
Doctors often treat the mania symptoms with one set of drugs, and use other drugs to treat depression. Certain drugs are also used for "maintenance" -- to maintain a steady mood over time. Antidepressants are not often used alone, because they may cause rapid cycling between depression and mania.
Most people respond well to medications for bipolar disorder. For many others, the symptoms do not completely disappear despite therapy. The moods may become less intense and more manageable, however.
Remember, getting your diagnosis should come as a relief. Now you know what the problem has been and you're on the road to getting the right treatment.
Mania
If you are suffering from mania, your doctor initially may treat you with an antipsychotic drug and/or a benzodiazepine to quickly control hyperactivity, sleeplessness, hostility, and irritability.
Your doctor will also likely prescribe a mood stabilizer. Mood stabilizers help control mood swings, prevent recurrences of mood swings, and reduce the risk of suicide. They are usually taken for a long time, sometimes years. Examples include lithium and certain anticonvulsant drugs.
Treatment of mania often requires hospitalization because there is high risk for unpredictable, reckless behavior and noncompliance with treatment. For people with extreme mania, pregnant women with mania, or those people whose mania can't be controlled with mood stabilizers, doctors sometimes also recommend electroconvulsive therapy (ECT).
If mania occurs while on maintenance therapy, your doctor may simply change your medication dose. Or you may start taking an antipsychotic drug to lessen symptoms.
Nondrug treatments, such as psychotherapy, and establishing a well-ordered routine may help patients in their maintenance phase. This is often suggested along with medication.
Depression
Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania and then another episode of depression.
Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
In April 2002, the American Psychiatric Association suggested using lithium or the anticonvulsant drug Lamictal as an initial treatment for people in the acute depressive phase of bipolar disorder who were not already taking a mood stabilizing medication. Sometimes Lamictal is added to lithium as well.
For more severely ill patients, some doctors may prescribe lithium and an antidepressant -- usually either Wellbutrin or Paxil, though other drugs can be used.
There are other options for treating bipolar depression.
The antipsychotic drug Zyprexa is also approved to treat bipolar depression when used with the antidepressant Zoloft. Other antipsychotic medications have also been studied and found effective in varying degrees.
If all else fails, doctors may recommend electroconvulsive therapy (ECT). It helps nearly 75% of the patients who try it.
In addition, psychotherapy may be beneficial when added to drug therapy. Once depression has resolved, mood stabilizers are the best proven treatments to prevent future depression. If psychotic symptoms occur during an acute depressive episode, the doctor may recommend antipsychotic medicine.
Nondrug treatments -- such as psychotherapy and establishing a well-ordered routine -- may help patients in their maintenance phase. They are often suggested along with medication. Psychotherapy alone is not considered sufficient to treat bipolar depression.
Bipolar Disorder:
Lithium for Bipolar Disorder
Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression.
Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy.
Lithium acts on a person's central nervous system (brain and spinal cord). Doctors don't know exactly how lithium works to stabilize a person's mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior.
It usually takes one to two weeks for lithium to begin working. Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney function. Lithium works best if the amount of the drug in your body is kept at a constant level. Your doctor will also probably suggest you drink eight to12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it's important to consume a steady amount every day.
The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.
Lithium Side Effects
About 75% of people who take lithium have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects can be relieved by tweaking the dose of lithium. However, never change your dose or drug schedule on your own. Do not the change brand of this medication without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.
Common side effects can include:
· Hand tremor (If tremors are particularly bothersome, an additional medication can help.)
· Increased thirst
· Increased urination
· Diarrhea
· Vomiting
· Weight gain
· Impaired memory
· Poor concentration
· Drowsiness
· Muscle weakness
· Hair loss
· Acne
· Decreased thyroid function (which can be treated with thyroid hormone)
Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate.
Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.
If you miss a dose, take it as soon as you remember it -- unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not "double up" the dose to catch up.
There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn't recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.
Bipolar Disorder:
Anticonvulsant Medications for Bipolar Disorder
Increasingly, anticonvulsant medications are used as mood stabilizers to treat mania. Lamictal is used to treat bipolar depression as well. Occasionally, Depakote is also used to treat bipolar depression. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.
Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling -- four or more episodes of mania and depression in a year.
Anticonvulsants used to treat bipolar disorder include:
· Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
· Tegretol (carbamazepine)
· Lamictal (lamotrigine)
· Trileptal (oxcarbazepine)
Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking the drug for a couple of weeks.
Anticonvulsant Side Effects
Your doctor may want to take regular blood tests to monitor your health. Some anticonvulsants can cause liver or kidney damage or decrease the amount of platelets in your blood. Your blood needs platelets to clot.
Each anticonvulsant may have slightly different side effects. Common side effects include:
· Dizziness
· Drowsiness
· Fatigue
· Nausea
· Tremor
· Rash
· Weight gain
Most of these side effects lessen with time. Long-term effects vary from drug to drug. In general:
· Pregnant women should not take anticonvulsants because they increase the risk of birth defects.
· Anticonvulsants can cause problems with the liver over the long term, so your doctor should monitor your liver closely.
Also, anticonvulsants can interact with other drugs -- even aspirin -- to cause serious problems. Be sure to tell your doctor about any drugs, herbs, or supplements you take. Don't take any other substance during treatment without talking with your doctor.
Bipolar Disorder:
Antipsychotic Medications for Bipolar Disorder
Antipsychotic medications are used as a short-term treatment to control psychotic symptoms such as hallucinations or delusions. These symptoms may occur during acute mania or severe depression.
In people with bipolar disorder, antipsychotics are also used as sedatives, for insomnia, for anxiety, and/or for agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect. Some antipsychotic medications may also help lessen bipolar depression.
Some of the newer antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don't tolerate or respond to lithium and anticonvulsants.
Antipsychotic drugs help balance certain brain chemicals called neurotransmitters. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.
The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a week.
Antipsychotics used to treat bipolar disorder include:
· Abilify (aripiprazole)
· Clorazil (clozapine)
· Geodon (ziprasidone)
· Risperdal (risperidone)
· Seroquel (quetiapine)
· Zyprexa (olanzapine)
Antipsychotics Side Effects
Certain antipsychotics cause rapid weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should first be screened for their risk for heart disease, stroke, and diabetes, according to a study published in the February 2004 issue of Diabetes Care. The study specifically recommended that doctors screen people taking Risperdal, Seroquel, or Zyprexa for diabetes, prediabetes, and high cholesterol.
Abilify does not cause weight gain but may increase the risk of diabetes.
Common side effects of antipsychotic medications include:
· Blurred vision
· Dry mouth
· Drowsiness
· Muscle spasms or tremor
· Involuntary facial tics
· Weight gain
Note: Clorazil is not used often, despite its effectiveness, for bipolar disorder. The drug can cause a rare, potentially fatal side effect affecting the blood that requires weekly or biweekly blood test monitoring.
Older antipsychotic drugs are generally not used to treat bipolar disorder. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs. Older antipsychotics include Thorazine (chlorpromazine), Haldol (haloperidol), and Trilafon (perphenazine). These drugs may cause serious long-term side effects called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing.
Bipolar Disorder:
Calcium Channel Blockers for Bipolar Disorder
Sometimes a doctor may prescribe for mania a group of drugs traditionally used to treat high blood pressure or heart problems called calcium channel blockers. These drugs are not as effective as others and are not used often.
These drugs block calcium channels, which are the small pores in cells that allow calcium to move in and out, which widens your blood vessels. It's not clear exactly how the drugs work, but they are used to lower blood pressure, improve irregular heartbeats, and treat migraines. They may also help stabilize moods.
Calcium channel blockers used to treat mania include:
· Diltiazem
· Nifedipine
· Nimodipine
· Verapamil
Calcium Channel Blockers Side Effects
Sometimes, a headache can develop after taking certain calcium channel blockers. These headaches should gradually disappear once you have been taking the medication for a while. Talk to your doctor if headaches continue. Some people also report tenderness, swelling, or bleeding of the gums when starting to take calcium channel blockers. Regular brushing, flossing, and gum massages along with routine dental visits can help lessen this effect. As with any medication, it is important to see your doctor regularly to make sure the drug is working properly.
Calcium channel blockers tend to cause fewer serious side effects than some other drugs used to treat bipolar disorder. However, they are also less effective.
Common side effects include:
· Slowed heart rate or irregular heart rhythm
· Flushing, a pounding sensation in the head, dizziness, headache
· Leg swelling
· Decreased blood pressure
· Tingling sensations in the arms or legs
· Weakness
· Constipation
Talk to your doctor if you are pregnant or could become pregnant during treatment. It isn't known if these drugs could harm the fetus.
Bipolar Disorder:
Benzodiazepines for Bipolar Disorder
Benzodiazepines rapidly help control certain manic symptoms until mood-stabilizing drugs can take effect. They are usually taken for a brief time, up to two weeks or so, with other mood-stabilizing drugs. They may also help restore normal sleep patterns in people with bipolar disorder.
Benzodiazepines slow the activity of the brain. In doing so, they can help treat mania, anxiety, panic disorder, insomnia, and seizures.
Benzodiazepines prescribed for bipolar disorder include (among others):
· Ativan (lorzepam)
· Klonopin (clonazepam)
· Valium (diazepam)
· Xanax (alprazolam)
Benzodiazepine Side Effects
The drugs act quickly and bring on a sense of calmness. They can sometimes cause lightheadedness, slurred speech, or unsteadiness.
Possible side effects include:
· Drowsiness or dizziness
· Lightheadedness
· Fatigue
· Blurred vision
· Slurred speech
· Memory loss
· Muscle weakness
Benzodiazepines can be habit-forming and addictive.
If you have been taking the benzodiazepines for a long time, you may suffer withdrawal symptoms if you stop the drug suddenly. Talk with your doctor about whether you still need the medication and, if not, how to taper off the drug.
Bipolar Disorder:
Electroconvulsive Therapy (ECT) for Bipolar Disorder
Electroconvulsive therapy (ECT), also known as electroshock therapy, is used as an acute treatment for hospitalized patients who are suicidal, psychotic, or dangerous to others. It is effective in nearly 75% of patients who have the procedure.
In electroconvulsive therapy, an electric current is sent through the scalp to the brain. It is used to treat people who are suffering from severe depression or other mental illness. ECT is one of the fastest ways to relieve symptoms in people who suffer from mania or severe depression. ECT is generally used as a last resort when the illness does not respond to medication or psychotherapy. It is also used when patients pose a severe threat to themselves or others and it is dangerous to wait until drugs take effect.
Prior to ECT treatment, a person is given a muscle relaxant and put under general anesthesia. ECT, when done correctly, will cause the patient to have a seizure, and the muscle relaxant is given to limit the size of the episode.
Electrodes are placed on the patients scalp and a finely controlled electric current is applied that causes a brief seizure in the brain. Because the muscles are relaxed, the seizure will usually be limited to slight movement of the hands and feet. Patients are carefully monitored during the treatment. The patient awakens minutes later, does not remember the treatment or events surrounding the treatment, and is often confused.
This confusion typically lasts for only a short period of time. ECT is given up to three times a week for two to four weeks.
In extremely rare cases, ECT can cause heart attack, stroke, or death. People with certain heart problems usually are not good candidates for ECT. Short-term memory loss is the major side effect, although this usually goes away one to two weeks after treatment.
Other possible side effects include:
· Confusion
· Nausea
· Headache
· Jaw pain
These effects may last from several hours to several days.
A third of people who have ECT report some long-term memory loss, but few studies have been done on this side effect
Bipolar Disorder:
Antidepressants for Bipolar Disorder
Antidepressants can help relieve depression and boost mood. It typically takes three to four weeks for most people to respond to the treatment. Sometimes a doctor will try several different antidepressants and doses before finding one that works for a patient.
There are three different types of antidepressants used to treat depression among people with bipolar disorder:
· Selective serotonin reuptake inhibitors (SSRIs)
· Monoamine oxidase inhibitors (MAOIs)
· Tricyclic antidepressants (less commonly used).
Newer "atypical" antidepressants are also being tested for use in treating bipolar depression.
Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health-care provider.
Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression -- but may experience mania and then another episode of depression.
Bipolar Disorder:
Bipolar Disorder and Going to Work
Bipolar disorder can have a big effect on your career. In a survey of people with depression and bipolar disorder conducted by the Depression and Bipolar Support Alliance, 88% said their condition affected their ability to work.
But don't get alarmed. Being diagnosed with bipolar disorder doesn't necessarily mean that you can't keep your job. Plenty of people with bipolar disorder work and live normal lives.
Should I Tell My Boss?
You don't have to talk to your boss or coworkers about your condition. Your health is your business. But if your condition has been affecting your performance at work, being open may be a good idea. Your boss and coworkers may have noticed the changes in your behavior. If you explain what's going on, they may be more sympathetic than you expect.
Making Changes
Some people with bipolar disorder find their current job just isn't a good fit. Maybe it's too stressful or the schedule is too inflexible. Maybe it doesn't let them get enough sleep. If you think your job is hurting your health, it's time to make some changes. Here are some things to consider.
· Decide what you really need from your job. Do you need to reduce your responsibilities? Do you need extra breaks during the day to reduce stress? Would you rather work independently or in a group? Do you need to work shorter hours or take time off? Or do you need a different job altogether?
· Make decisions carefully. People with bipolar disorder are prone to acting impulsively. Think through the effects of quitting your job -- both for yourself and possibly for your family. Talk over your feelings with your family, therapist, or health-care provider.
· Look into financial assistance. If you do need to take time off, see if your employer has disability insurance, or look into Social Security Disability Insurance, which will provide some income while you recover. You can also look into the Family and Medical Leave Act. Ask your doctor or therapist for advice.
· Go slowly. Returning to work after you've taken time off can be stressful. Think about starting in a part-time position, at least until you're confident that your condition has stabilized. Some people find that volunteer work is a good way to get back into the swing of things.
Bipolar Disorder Stigma
Unfortunately, you may still run into people who treat you unfairly because of your bipolar disorder. Often, their behavior stems from ignorance. They might see you as "crazy" or think your condition is "all in your head." You might be able to head off problems by teaching people a little about bipolar disorder.
But that's not always enough, and the stigma of mental illness can hold you back. Some people with bipolar disorder feel they're treated unfairly at work; they might be passed over for promotions or raises, for instance.
If you think you're being treated unfairly, there are things you can do. The Americans with Disabilities Act can protect some people who are discriminated against because of a health condition. But don't do anything rash. Research the law, and talk your situation over with friends, family, your therapist, and your health-care provider before taking action.
Bipolar Disorder:
Talking to Your Friends and Family About Bipolar Disorder
Bipolar disorder can put an enormous strain on relationships with your family and friends. When you're depressed, you may isolate yourself from the people who care about you. When you're manic or hypomanic, you might frighten or alienate them.
But your relationships with your friends and family are crucial to staying healthy. You need to keep the lines of communication open. Here are some suggestions.
· Educate your family and peers. Your friends and family may not know much about bipolar disorder, or they may have a lot of wrong impressions. Explain what it is and how it affects you. Talk about your bipolar treatment. Unfortunately, some people may be skeptical or unsympathetic. Back yourself up with brochures or printouts that you can give them. Tell them you need their help to stay well.
· Create a support team. Obviously, you don't need to tell everyone you know about your condition. But you also shouldn't rely on only one person. It's much better to have a number of people you can turn to in a crisis. Placing all the responsibility on one person is simply too much.
· Make a plan. You need to accept that during a mood swing, your judgment might be impaired. You could really benefit from people looking out for you. But your loved ones also need to be careful not to push too hard. You don't want to feel like every move you make is being scrutinized.
So work out distinct boundaries. Decide how often your friends and family should check in and what to do if things are getting out of control. If you become manic, you might agree that your loved ones should take away your car keys or credit cards so you don't do anything reckless. If you become suicidal, they certainly need to get emergency help. Coming up with an explicit plan will make everyone feel better.
· Listen. After all that you've been through, you may not want to hear the concerns of your family and friends. But the fact is that your condition does affect the people around you. During a manic or depressive phase, you may have upset people whom you care about. So try to hear them out and see things from their point of view. If you've hurt people, apologize. Reassure them that you didn't mean to act the way you did, and emphasize that you're getting treatment.
· Talk to your children. If you have kids, you should find a way to tell them what's happening. They're likely to sense that something is wrong anyway; keeping them in the dark might just make it scarier. Explain your condition in a way that's appropriate for their age. Say that it's a disease that affects your mood, but that you're getting treatment for it.
· Reach out. Bipolar disorder can make relationships hard. When you're depressed, you may want to retreat from the world. If you've just come out of a manic phase, you may not want to face people whom you treated badly. Either way, it's easy to let some friendships slip away. Don't let it happen. Force yourself to get together with other people, even if it may be hard at first. Isolating yourself is the worst thing you can do.
Bipolar Disorder:
Convincing Someone to See a Doctor for Bipolar Disorder
Very often, people with hypomania may not realize it's a problem. They may even enjoy it, finding it to be a productive time. Others struggle with depression, not getting the help that could relieve their suffering.
Yet for various reasons, they don't get help from a doctor. They shrug off a friend or family member's concern. Others view their illness as a distraction or a weakness, and they don't want to give in to it. Still others put their health at a very low priority compared with other things in their lives.
However, fear is often the reason for not seeing a doctor. That's especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortably in their everyday routines -- even though relationships and careers can be at stake.
If you're concerned about a loved one, talk to him or her about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it's best to be direct about your concern regarding a mood disorder. Include these points in the discussion:
· It's not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
· Millions of Americans have bipolar disorder. It can develop at any point in a person's life, and is responsible for enormous suffering.
· Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
· There's a medical explanation for bipolar disorder. Disruptions in brain chemistry are involved. The brain circuits -- those that control emotion -- are not working the way they should. Because of this, people experience certain moods more intensely, for longer periods of time, and more frequently.
· Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
· By not getting treatment, you risk having worse mood swings -- even becoming suicidal. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.
Trust is crucial in shaking someone's denial, in motivating him or her to get help. Trust is also important once treatment starts. Through the eyes of a trustworthy friend or family member, a bipolar patient can know when treatment is working -- when things are getting better, and when they're not. If your interest is sincere, you can be of great help to your friend or family member.
posted by Eric Malz at 4:28 AM
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