Bipolar Disorder Treatment

Bipolar disorder is also referred to as manic-depressive illness (MentalHealth). This is a brain disorder that triggers abnormal alterations in mood, activity levels, energy and the capacity to execute daily activities. The development of bipolar disorder is often during an individual’s late teens or early adult years. The disorder can also develop in early childhood or as late as the 40’s and 50’s. In addition, bipolar disorder can be found in all ages, social class, race and ethnic groups in both men and women.

Causes

Scientists are studying on the likely causes of bipolar disorder.  According to most scientists there is no individual cause, rather several factors likely work collectively to produce the disease or risk factors.  

i. Genetics

Bipolar disorder tends to be hereditary. Research is being conducted to find out the genes that may increase the likelihood of developing the disorder.  Children in a family where the parent or sibling have bipolar disorder are more likely to develop the disorder as compared to children in a family without a history of the disorder.  However, many children from a family which has a history of bipolar disorder will not develop it.

Advanced technology is assisting in the genetic research on bipolar disorder.  This has made the research faster and more far reaching as compared to the previous years.

ii. Brain structure and functioning

Brain imaging studies are assisting scientists in the study of what goes on in the brain of an individual with bipolar disorder. Modern brain imaging tools like positron emission tomography (PET) and functional magnetic resonance assist scientist in studying the structure and activity of the brain. According to some imaging studies the brain of a healthy individual may differ with that one of an individual with bipolar disorder or an individual with another brain disorder.

Symptoms

Individuals with bipolar disorder go through abnormally extreme emotional states that customarily come about in distinct episodes called “mood episodes”. An excessively happy or over excited state is referred to as a manic episode (Nierenberg AA1). An overly hopeless or sad condition is known as a depressive episode. At times, a mood episode involves the symptoms of both depression and mania. This state is referred to as the mixed state. In addition, during a mood episode, individuals’ with bipolar disorder may be short-tempered and explosive.

Changes in mood are accompanied by extreme changes in activity, energy, sleep and behavior. An individual with bipolar disorder also has the possibility of experiencing long-lasting period of unstable moods as opposed to distinct episodes of mania or depression (Gordon Parker).

Symptoms of mania or manic episodes

Mood changes

An extended time of feeling ‘high’ or outgoing mood or extremely happy

Exceedingly irritable mood anxiety, feeling ‘weird’ or ‘jumpy’

Behavioral changes

Restlessness

Impulsive behavior

Easily distracted

Talking very quickly, possessing racing thoughts and jumping from an idea to the next

Possessing impractical confidence in ones capabilities

Symptoms of depression or a depressive episode

Mood changes

Feeling worried or empty over a long time

Lack of appeal towards actions once taken pleasure in

Behavioral changes

Feeling exhausted

Lack of concentration, difficulty in making decisions and remembering

Restlessness or irritability

Change in sleeping, eating or other habits

Possessing thoughts about suicide, death or attempting suicide

Diagnoses

The initial stage of getting the right diagnosis is visiting a doctor. The doctor may perform an interview, physical assessment and laboratory tests. Currently, bipolar disorder cannot be detected through a blood test or brain scan. However, these tests can assist in ruling out contributing factors like a brain tumor or stroke.  The doctor may carry out a mental health evaluation if the issues are not as a result of other illnesses. In addition, the doctor may refer one to a trained mental health professional like a psychiatrist who is experienced in the diagnosis and treatment of bipolar disorder.

A complete diagnostic examination should be carried out by the mental health professional or doctor. This entails discussing the history of the symptoms as well as the family history of mental health illnesses. In addition, the mental health professional or doctor may discuss the symptoms of the individual with close relatives or the spouse to learn more on how they describe the symptoms and the family history (Perlick DA).   

People with bipolar disorder often seek help when they are experiencing depression rather than when they are experiencing mania.  It is therefore imperative to have a comprehensive family history so that the illness is not mistakenly diagnosed as unipolar depression which is a major depression disorder. People with unipolar depression do not experience mania like those with bipolar disorder.

Treatment

The

cure for bipolar disorder has not been discovered to date. However, most people with bipolar disorder to are able to have better control of their mood swings and related symptoms through proper treatment. In addition, long-term treatment is required for people with bipolar disorder to control the bipolar symptoms since the illness is lifelong and recurrent (Perlis RH). Medication and psychotherapy are included in an effective maintenance treatment plan for the reduction of the severity of symptoms and the prevention of a relapse. Psychotherapies try to supply patients with tools for conquering problems as well as enhance the patient’s feeling of wellbeing.

Bipolar disorder was not officially recognized by scientist till the late 19th

century. However, the treatment of symptoms dates back to ancient Greece and Rome. This was when water from northern- Italian spas, which contained a naturally occurring salt known as lithium, was used in the treatment of euphoric or agitated patients. In addition treatments like witchcraft and bloodletting were used but were very unsuccessful.

In the 1970’s lithium was mainly used for treating bipolar disorder. Lithium works as a mood stabilizer and also contains neuroprotective properties. It was used the most frequently used drug in treating bipolar disorder (Rybakowskia). However, this has changed in the last decade. Lithium may have a negative impact on the kidney and thyroid function; therefore there should be careful monitoring of blood vessels (M. Nederlof). Moreover, lithium levels in the blood are affected by numerous factors such as illness, season changes, hormones and other medication. The side effects of using lithium include lithium induces hypothyroidism, chronic thirst, drowsiness, tremor and gastrointestinal distress. However antidepressants may induce mania in some patients particularly when used for maintenance or alone.

Antipsychotics and antiepileptics prescriptions have outpaced those of lithium.  The most prescribed medication for bipolar disorder particularly depression and maintenance are antiepileptics. Antiepileptics neurotransmitters related to mood like dopamine, serotonin and norepinephrine as well as decrease the firing rate. These medications do not need monitoring of the blood level. However they have side effects such as drowsiness, tremor and weight alterations. Although, the side effects of these medications are considered to be less than the side effects of other medications for bipolar disorder (Raymond Pary).

Currently, the most prescribed medication for mania is Atypical antipsychotics. These drugs are recommended for psychotic episodes and acute manic. Fundamentally they are tranquilizers. They act on the neurotransmitters serotonin, dopamine and noradrenaline. They are very powerful drugs and side effects include sexual dysfunction, weight increase and extreme sleepiness. Glucose levels should also be monitored in patients.

The availability of a number of drug treatments for bipolar disorder is good. However, the trends in treatment do not confirm to general recommendations for treatment. In addition, lithium is until now acknowledged as the most effectual long-term treatment of bipolar disorder. However, the rates of its prescription continue to fall and it is often prescribed last to patients. Every individual has a different experience and requires trying out different medication to achieve the best outcome.

New therapies are being studied by doctors to assist patients who have been confirmed to be resistant to treatment. For example studies are being conducted on ketamine which is a medication that is being used for anesthesia currently. Several studies have shown that ketamine is more reliable and faster than other antidepressants (Sci.). As opposed to recent antidepressants which act on dopamine, norepinephrine and serotonin ketamine’s triumph would mean treating depression with effects on glutamate brain receptors.  

In the society, most people tend to view different mental disorders based on assumptions rather than knowledge on the illness. People with bipolar disorder are receiving less prejudicial attitudes from the public as compared to schizophrenia (Isabelle Durand-Zaleski). It is therefore important for the public to be made aware of the different mental disorders and reduce stigmatization.

References

Gordon Parker, Neville A. Gibson , Heather Brotchie ,Gabriella Heruc ,Anne-Marie Rees , Dusan Hadzi-Pavlovic , M.Psychol. ”Omega-3 Fatty Acids and Mood Disorders.” The American Journal of Psychiatry (2006).

Isabelle Durand-Zaleski, Jan Scott, Frédéric Rouillon, Marion Leboyercorresponding author. ”A first national survey of knowledge, attitudes and behaviours towards schizophrenia, bipolar disorders and autism in France.” PMC (2012 ).

M. Nederlof, E. R. Heerdink, A. C. G. Egberts, I. Wilting, L. J. Stoker, R. Hoekstra and R. W. Kupka. ”Monitoring of patients treated with lithium for bipolar disorder: an international survey.” International Journal of Bipolar Disorders

(n.d.): 2018.

MentalHealth, The National Institute of. NIHM. April 2016. .

Nierenberg AA1, Burt T, Matthews J, Weiss AP. ”Mania associated with St. John’s wort.” PubMed

(1999 ).

Perlick DA, Rosenheck RA, Clarkin JF, Maciejewski PK, Sirey J, Struening E, Link BG. ”Impact of family burden and affective response on clinical outcome among patients with bipolar disorder.” PubMed (n.d.): 2004.

Perlis RH, Ostacher MJ, Patel JK, Marangell LB, Zhang H, Wisniewski SR, Ketter TA, Miklowitz DJ, Otto MW, Gyulai L, Reilly-Harrington NA, Nierenberg AA, Sachs GS, Thase ME. ”Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).” PubMed

(n.d.): 2006.

Raymond Pary, MD,corresponding author Paul R. Matuschka, PharmD, Susan Lewis, ARNP, PhD, and Steven Lippmann, MD. ”Managing Bipolar Depression.” Psychiatry MMC ( 2006).

Rybakowskia, Janusz K. ”Recent advances in the understanding and management of bipolar disorder in adults.“ PMC ( 2017 ).

Sci., Ann N Y Acad. ”The promise of ketamine for treatment-resistant depression: current evidence and future directions.” PMC (2016 ).