Bipolar disorder (BD): Bipolar I and Bipolar II are related conditions, but there also are some significant differences. Both cause severe depressive episodes. BD I also presents with manic episodes: marked hyperactivity, agitation, rapid speech, decreased need for sleep and either euphoria or dysphoric mania. Dysphoric mania includes the symptoms noted above, but rather than euphoria, the mood changes include intense irritability and/or depressionand increased risk for suicide. BD II has severe depressions but no mania; rather it has brief periods of hypomania (increased self-confidence, up-beat mood, and decreased need for sleep).
Life style management is equally important for BD I and II: including getting good quality sleep and sleeping 7-9 hours every night, avoiding excessive caffeine and alcohol use (e.g. only one cup of coffee per day, and very little if any alcohol), waking up at the same time each day, avoiding sleep deprivation, never using illicit drugs such as methamphetamine and cocaine. I must strongly emphasize that these strategies may seem simple, but are high yield interventions.
Psychiatric medication treatment is absolutely necessary to treat BD and to prevent reoccurrences. Standard treatments for BD I and II include mood stabilizers (lithium, Depakote, Tegretol, Trileptal and often antipsychotic drugs, such as Zyprexa, Seroquel, and Abilify). All of these drugs treat mania and can help to prevent recurrences of mania. Lithium can be effective in preventing depressive episodes. Bipolar depression (seen in BD I and II) is treated with the following: Seroquel, Lamictal, Symbyax, and lithium (for lithium to be effective it generally requires reaching a lithium blood level of 0.8 or higher). The most important difference in treating BD I and II is the use of antidepressants (ADs). All experts agree that with BD I ADs carry significant risks (risks of provoking mania and in general, causing the disorder to become more severe over time) and should rarely if ever be used. ADs are also not first line treatments for BD II. However in people who have not responded to the drugs mentioned above, ADs may be used, but only along with a mood stabilizer. Antidepressants used alone have 2 negative consequences: most commonly, they just don’t work. Secondly, the use of ADs may, over time, increase the frequency of mood episodes. It is important to note that these are not my personal recommendations; they come from established “best practices” treatment guidelines. The use of ADs alone to treat BD is, unfortunately, a common mistake.
More Answers from John Preston, PsyD