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Treatment of Bipolar Disorder
Bipolar disorder (BD) is a severe chronic mood condition that manifests itself with strongly pronounced shifts in mood and activity (Vieta, 2013). A person diagnosed with bipolar disorder experiences the so-called “mood episodes,” when his behavior and emotions change unexpectedly, undermining the ability to perform routine tasks. The severity and duration of these episodes of high and low moods depend on an individual’s condition, environment, and treatment adherence (WebMD, 2017). Treatment of BD requires a patient’s willingness and determination to keep the regimen, as well as ongoing family and community support. In this paper, the researcher intends to discuss various treatment options for individuals presented with this disease and review some recent studies regarding the most effective therapies.
Researchers provide several definitions and types of BD. The International Classification of Disease defines this condition as a disorder manifesting itself with two or more episodes in which the mood and activity levels change unexpectedly and prevent a person from normal functioning (as cited in Vieta, 2013, p. 1). The American Psychiatric Association, however, maintains that BD can be diagnosed even when a single period of unexpected mood change occurs, which cannot be explained with some medical condition, stress, or substance abuse (Vieta, 2013, p. 2). Both sources clarify that bipolar disorder is characterized by repeated shifts from mania (hypomania) to depression. Moreover, researchers distinguish four types of bipolar disorder including bipolar I disorder, bipolar II disorder, cyclothymic disorder, and unspecified bipolar disorder, which differ in severity and symptoms (NIH, 2016).
Because bipolar disorder is a lifelong condition, it requires ongoing treatment directed at managing symptoms (Mayo Clinic, 2017). Pharmacological treatment is the key to successful management of this disease. Medications may include various antidepressants, mood stabilizers, and atypical antipsychotics. However, because of the side effects of these drugs, practitioners are required to evaluate a patient’s condition carefully and consult the list of approved medications provided by the U.S. Food and Drug Administration (FDA) before prescribing any agent (McCormick et al., 2015). Additionally, sleep medications are prescribed to patients, because those diagnosed with BD often have sleep problems that aggravate their condition (NIH, 2016).
Scholars continue to explore the effectiveness of existing interventions and seek safer treatment options that would work in different situations and with different patients. Thus, for example, Geddes and Miklowitz (2013) reviewed recent developments in the treatment of bipolar disorder. The researchers argued that antipsychotic drugs may be more appropriate for short-term treatment than lithium, although the latter is still the best agent for continued therapy. They also stressed that antidepressants have limited effectiveness in treating bipolar disorder and that further clinical trials are required to investigate their tolerability and efficacy (Geddes & Miklowitz, 2013). Additionally, some atypical antipsychotics have also demonstrated their short-term effectiveness in reducing manic and depressive symptoms. However, the scholars noted that some patients do not respond to these first-line treatments well and that more research is needed to understand what therapeutic approaches will work best for these individuals (Geddes & Miklowitz, 2013).
Researchers tend to agree that lithium is by far the most effective drug for prolonged treatment of BD (Geddes & Miklowitz, 2013; Joas et al., 2017; Washburn, West, & Heil, 2011). It is the most prescribed medication because it proved its effectiveness in preventing recurrence of manic episodes and reducing the risk of suicide. However, the scholars continue seeking a safer alternative to lithium because of its adverse effects on the kidneys, parathyroid glands, and thyroid gland, as well as associated cognitive impairment and uncontrolled weight gain (Gitlin, 2016).
Pharmacological treatment for BD is the most effective when it is complemented by relevant psychosocial interventions, such as psychotherapy (Malhi, Adams & Berk, 2010). Therapy may include numerous approaches to assessing and altering an individual’s beliefs and behaviors so that to create a favorable attitude to treatment. These approaches are better used in combination to achieve positive, prolonged health outcomes. Briefly, therapy is aimed at reducing the negative effects of family issues and stressful life events on a patient’s symptomatic state (Geddes & Miklowitz, 2013). A recent systematic review performed by Chatterton et al. (2017) showed that psychoeducation can positively affect relapse rates and treatment non-adherence. In severe cases when other treatment options do not bring positive results, electroconvulsive therapy (ECT) may be used, but it is a rather aggressive procedure with many side effects. Evidence shows that ECT may cause short-term effects, such as partial memory loss, disorientation and confusion, numbing, and so on; therefore, all risks and benefits should be assessed before initiating treatment (NIH, 2016).
Thus, bipolar disorder is a serious condition that impairs a person’s cognitive abilities and adversely affects the quality of life. Effective treatment of this condition is the key to successful lifelong management of its symptoms. The best approach to managing BD is to combine pharmacological treatment and psychotherapy. Some drugs including lithium, quetiapine, olanzapine, and fluoxetine have demonstrated their effectiveness in reducing the symptoms, especially in combination with various psychotherapeutic interventions adjusted to each patient’s condition and needs. However, side effects associated with some agents necessitate further clinical trials to develop a less traumatic treatment for bipolar disorder.