Overview of bipolar disorder treatments including medications for bipolar disorder, psychotherapy, hospitalization, ECT and self-help and the importance of medication compliance.

Introduction ~ Psychotherapy ~ Hospitalization ~ Medications ~ ECT ~ Self-Help

Introduction

Individuals who present with bipolar disorder will be in one phase of the disorder, either a major depressive episode or a degree of a manic episode. This episode of either acute major depression or mania should be the focus of initial treatment. Since the treatment of this disorder nearly always involves medication (usually lithium, a mood stablizer and/or an antipsychotic), evaluation of the patient and proper prescription of an appropriate psychopharmacological agent is necessary. Usually the episodes will not be severe enough to warrant hospitalization, although partial hospitalization may be considered to stabilize the individual on the medication. Suicidality should always be assessed, especially for those suffering from a major depressive episode.

One of the central reasons a patient presents with this disorder, after having been previously treated, is because he or she has stopped taking prescribed bipolar medication. Medication compliance should always be an aspect of any treatment in bipolar disorder and compared with other life-long maladies, such as diabetes, where the removal of medication can result in death. Maintenance of the client on medication over a long period of time is common, resulting in a good prognosis. Most people can lead active, healthy lives with this disorder, if in proper treatment.

When an individual presents to a clinician while suffering from an acute episode of either mania or depression, the therapist should seek to stabilize the client quickly. This means treating the episode with the appropriate pharmacologic agent and scheduling followup sessions with a psychotherapist or case management. Closely monitoring lithium levels (if appropriate) can prevent future relapses into mania or depression. The physician should be acutely aware of the roller-coaster-like emotional states experienced by someone with bipolar disorder and follow the patient carefully while in treatment.

While there appears to be a genetic component to bipolar disorder (as with most mental disorders), the research is still clear that there is no known single cause for the disorder. Many theories are proposed, ranging from the psychological to the biomedical. As is the case with all mental disorders, it is likely an important combination of factors which lead to someone having this disorder and treatment should reflect that combination appropriately. Emphasis on one form of treatment over another will likely lead to future relapses for the patient.

Psychotherapy for Bipolar Disorder

Psychotherapy can be a valuable component of treatment for someone suffering from bipolar disorder. Some psychological theories exist which implicate various environmental or psychological factors that significantly contribute to bipolar disorder. These are often overlooked in treatment of bipolar disorder, but should be carefully considered.

Both individual or group therapy are appropriate and recommended for someone with this disorder. Therapy is usually supportive in nature, helping the client with increased coping skills and education about the disorder. With specific episodes of depression or mania, additional therapy can focus on the treatment of those disorders. Helping the client learn to better predict his or her own fluctuations in mood (which may be related to situational or seasonal changes) can decrease the likelihood of relapse in the future. Prevention of future relapses should be a focus of therapy, with medication compliance as an important topic. This is especially true with individuals who may be experiencing a manic episode (or may be more predisposed to being on the manic side), but is can also be an issue for those who are experiencing no specific episodes of mania or depression.

Therapy should be flexible in its approach, since the needs of people who suffering from bipolar disorder are diverse. Often bringing in a family member or close friend (or spouse) who keeps track of the patient can be beneficial to touch base with and ensure that everyone is clear about appropriate behavior and treatment. People with bipolar disorder can sometimes wreak havoc in their own personal lives when in a manic stage. This sometimes spills over to the person's family or friends and should be an aspect of treatment in psychotherapy. Education of family members or significant others can help them better manage the patient at home and ensure medication compliance.

Followup care for someone with bipolar disorder is imperative. Whether this takes the form of regular group therapy sessions, case management, medication appointments, or the like, touching base with a professional will help ensure the patient remains compliant in medication and retains mood stability. Discharge planning should take these factors into account; failure of the patient to appear for the next scheduled appointment can be an ominous sign. Unfortunately, many such individuals easily fall between the cracks in the mental health system because followup is either not conducted or not conducted in a timely manner. This is especially true when the client is moving from an inpatient or day-treatment program to an outpatient program.

Hospitalization for Bipolar Disorder

Hospitalization may be needed if the person is suffering from a severe episode of major depression or suicidal intent, or from a manic episode. Partial hospitalization should be considered as a viable alternative as well. As soon as the patient has been stabilized on the appropriate medication, though, the individual should be discharged. Day treatment programs, which allow for greater flexibility in the patient's life while maintaining close support and contact with mental health professionals, is often an appropriate treatment choice.