|
Most people with manic-depressive illness can be helped with treatment. - Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings.
- One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
- Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.
- Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.
- Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
- Valproate has recently been approved by the Food and Drug Administration for treatment of acute mania.
- The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia.
- Thyroid augmentation may also be of value.
- For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate.
- Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
- As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
- Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally.
- Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.
|
