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8 Must-Know Facts for Treating Bipolar Disorder

Here's what you should know if you're living with bipolar disorder–or know someone who is.

Fact #1: Getting the right diagnosis can take years. Bipolar disorder is a chronic, life-disrupting mental illness. It can be tricky to diagnose because it can look very different from one person to the next, explains Dr. Claudia Baldassano, assistant professor of psychiatry, and director of the Bipolar Disorders Clinic at the University of Pennsylvania. People often have symptoms for about a decade before they receive a proper diagnosis.

Fact #2: Treatment boosts quality of life. Bipolar disorder affects mood, energy and daily functioning, with extreme ups and downs. Coping without treatment can be very challenging: "Bipolar disorder can cause a lot of destruction and impairment in the person’s life and severely disrupt work and personal relationships," says Baldassano. People with bipolar disorder are four times more likely to lose their jobs. The divorce rate is almost 90%, compared to the 50% national average. People who don’t get treatment also have a higher suicide risk – about 15 to 20% compared to people in treatment whose risk is 5 to 7%. 

Fact #3: Drug therapy is the core treatment. The most common drug therapy for bipolar disorder involves mood stabilizers, such as valproic acid and lamotrigine. Lithium is also common. Atypical, or newer, antipsychotic drugs include olanzapine, aripiprazole, quetiapine, as well as risperidone and ziprasidone. Anticonvulsants are also used. Anticonvulsants stabilize brain cell membranes, and lithium may work the same way. Atypical antipsychotics modify levels of the brain chemicals serotonin, dopamine and glutamate that control mood, learning, memory and behavior.

Fact #4: Antidepressants are sometimes used, but not alone. Antidepressants may be added for extremely low mood. Not all antidepressants are used for bipolar disorder. The most common ones are fluoxetine, paroxetine, sertraline and bupropion. Antidepressants are usually combined with mood stabilizers, because on their own they can increase mood cycling and cause mania.

Fact #5: Some medications work faster than others. How quickly medications work depends on the symptoms they target and on the specific drug. It can take six to eight weeks before depressive symptoms get better with mood stabilizers (and possibly antidepressants). Manic symptoms treated with antipsychotics can ease up within two to three days.

Fact #6: Newer drugs have side-effects, but are usually more tolerable. Newer antipsychotics generally have fewer side-effects than the older, "first-generation" drugs that caused drowsiness, muscle stiffness and the risk of movement disorders. Significant weight gain is a common problem with newer drugs, as are cholesterol and blood sugar issues. Your doctor may prescribe medications to address these conditions.

Fact #7: Treatment is not one-size-fits-all. Treatment is tailored to the particular symptoms. But a medication that works for one person may not work for another. It can take weeks or months to find the right medication, dose or drug combination. Getting used to medication takes time: "All medications have side-effects," says Baldassano. "Effective treatment is about balancing efficacy and unwanted effects." Many side-effects eventually disappear, but do ask your doctor about common side-effects of your medication.

Fact #8: Behavioral counseling and psychotherapy enhance drug treatment. Counseling and psychotherapy are used along with medication. They help you learn ways to manage your illness and prevent relapse. Here are the most common and useful forms of therapy for bipolar disorder:

  • Cognitive-behavioral therapy (CBT) involves changing how you think about and evaluate yourself and what’s happening around you, to change how you feel and react," says Eric A. Youngstrom, professor of psychology and psychiatry at the University of North Carolina at Chapel Hill, and acting director of the Center of Excellence for Research and Treatment of Bipolar Disorder. CBT often involves keeping a mood and thought diary to track the patterns you want to change.
  • Family-focused therapy educates families about the disorder and helps them to support you and better cope with stress. It focuses on strengthening communication skills and developing problem-solving strategies to reduce the risk that you will relapse, says Youngstrom.
  • Interpersonal and social rhythm therapy helps you establish healthy daily routines, especially around sleep, because disruptions in routine can trigger mania, says Youngstrom. This therapy helps you schedule activities to keep your body’s internal clock in synch.
  • Psychoeducation teaches you and family members about the disorder, including symptoms, triggers and treatment options, says Youngstrom.

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