Bipolar disorder is a mental health illness that has no known cure and is typically not completely controllable with medication. It manifests in patients cycling between periods of mania (overly joyful or excited) and depression. As such, a bipolar patient will always struggle to control the destructive symptoms of the illness and may experience some of the symptoms of both manic and depressive phases.
Instead of trying to cure bipolar disorder, however, doctors now take a more realistic approach by focusing on reducing the severity and frequency of the episodes. Successful bipolar treatment includes preventing the patient from completely cycling from mania to depression, avoiding the need for in-patient hospital treatment, preventing self-destructive behavior (including suicide), and helping the patient lead as normal and productive a life as possible.
During the course of bipolar treatment, the doctor will attempt to discover which situations trigger the patient to enter either a manic or depressive phase and will also try to pinpoint any physical or emotional problems that could complicate or interfere with treatment. Since substance abuse commonly presents in bipolar patients, addiction treatment may be administered concurrently. If the patient has struggled even with outpatient treatment, they may need a period of residential treatment to stabilize. This type of treatment can range from acute hospitalization to intensive therapy within a home-like setting.
Although medical professionals will likely employ some type of counseling or “talk” therapy when treating someone with bipolar disorder, pharmaceuticals have come to play a large role in standard bipolar therapy. Because the primary goal of medical intervention is to eliminate the destructive mood swings suffered by the patient, mood stabilizers (including Lithium) are employed in the majority of bipolar cases. Because patients often respond to the same medication in different ways, a doctor may have to try several medications or combinations before finding something that works.
Although not as common as pharmaceutical therapies, electroconvulsive therapy (ECT) is sometimes used in treating a patient when the manic or depressive phase of the disease is not responding to drugs. In fact, it is the most effective form of treatment for a depressed patient who is not responding to pharmaceutical intervention. ECT is a type of mental health treatment that uses electrical current to cause a momentary seizure in the patient’s central nervous system; the patient is typically under anesthesia during an ECT administration. The theory is that the seizure “resets” the brain and puts it back into a more normal state. As a last resort, doctors may also employ transcranial magnetic stimulation (TMS), which uses high frequency magnetic pulses to target the areas of brain believed to be involved in bipolar disorder.
Once health care professionals have gotten the patient to the most stable place that he or she can be medically, the patient must still learn the skills necessary to be able to function day to day. For instance, a person with bipolar disorder must be able to cope with the symptoms that medication cannot address and may need assistance remembering to take their medication. He or she will be encouraged to adopt a healthier lifestyle, including getting plenty of sleep and avoiding illicit drugs that could counteract a prescription regime or trigger set backs. Getting the proper amount of sleep is another essential element in maintaining control over bipolar symptoms, as lack of sleep can trigger a manic episode. Most importantly, the patient must be taught how to identify relapses and what to do when they occur. For doctors, one of the most frustrating aspects of the disease is the inability to know whether improvement of the condition is the result of proper treatment or the ending of a particular mood cycle.
Because bipolar patients typically have trouble self-reporting or recognizing their own bipolar symptoms, participation in a support group comprised of other bipolar patients may play an essential role in identifying relapses quickly enough to avoid regression back to pre-treatment behavior.
Doctors have also found that psychotherapy (individual, group or family), can be useful during the depressive phase of bipolar disorder. In addition, cognitive behavioral therapy (CBT) can assist patients with bipolar disorder by teaching them to change harmful or negative thoughts and behaviors.
Caretakers and medical providers must always be on the lookout for signs that the patient has either forgotten to take the prescribed medicine or thinks that the medication is no longer needed because the symptoms have retreated. Other patients will stop taking drugs in order to experience the productivity or creativity associated with the manic phase.
Because there are so many variables with regard to how a particular patient will be affected by bipolar disorder, it is recommended that patients or caregivers keep a chart of daily mood symptoms, ongoing treatments, sleep patterns, and life events. This information may help the doctor zero-in on the best treatment model in a particular case.