Treatment of Mania An adequate review of effective, evidenced-based psychosocial interventions for bipolar disorder is beyond the scope of this column.
Lithium pharmacology Lithium salts have been used for centuries as a first-line treatment for bipolar disorder. In ancient times, doctors would send their mentally ill patients to drink from "alkali springs" as a treatment. Although they were not aware of it, they were actually prescribing lithium, which was present in high concentration within the waters.
Its exact mechanism of action is uncertain, although there are several possibilities such as inhibition of inositol monophosphatasemodulation of G proteins or regulation of gene expression for growth factors and neuronal plasticity.
It can also be effective in bipolar depressionalthough the evidence is not as strong. As a result, kidney function and blood levels of lithium are monitored in patients being treated with lithium.
Thyroid hormones should also be monitored periodically, as lithium can increase the risk of hypothyroidism. It has proven to be effective for treating acute mania. It has not been extensively studied in bipolar depression.
It is effective in preventing the recurrence of both mania and depressionbut it has not proved useful in treating acute mania. Valproic acid can frequently cause sedation or gastrointestinal upset, which can be minimized by giving the related drug divalproexwhich is available in an enteric-coated tablet.
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Therefore, young female patients taking valproate should be monitored carefully by a physician. Several studies have shown atypical antipsychotics to be effective both as single-agent and adjunctive treatments.
Taking antipsychotics for long periods or at high doses can also cause tardive dyskinesia - a sometimes incurable neurological disorder resulting in involuntary, repetitive body movements. The risk of tardive dyskinesia appears to be lower in second-generation antipsychotics than in first-generation antipsychotics but as with first-generation drugs, increases with time spent on medications and in older patients  New treatments[ edit ] A variety of other agents have been tried in bipolar disorder, including benzodiazepinescalcium channel blockersL-methylfolateand thyroid hormone.
Among bipolar patients taking anticonvulsants, those on lamotrigine have a better cognitive profile than those on carbamazepine, valproate, topiramate, and zonisamide. Lithium may be protective of cognitive function in the long term since it promotes neurogenesis in the hippocampus and increases grey matter volume in the prefrontal cortex.
Saint John's Wortalthough a naturally occurring compound, is thought to function in a fashion similar to man-made antidepressants, and so unsurprisingly, there are reports that suggest that it can also induce mania.
Side effects vary greatly among different classes of antidepressants. Antidepressants are helpful in preventing suicides in people suffering from bipolar disorder when they go in for the depressive phase.
From 40 minutes following intravenous injection of ketamine hydrochloride 0. One patient showed signs of hypomania following ketamine administration and two experienced low mood. This study demonstrates a rapid-onset antidepressant effect of ketamine in a small group of patients with bipolar depression.
The authors acknowledged the study's limitations, including the dissociative disturbances in patients receiving ketamine that could have compromised the study blindingand they emphasised the need for further research. A more recent double-blind, placebo-controlled study by the same group found that ketamine treatment resulted in a similarly rapid alleviation of suicidal ideation in 15 patients with bipolar depression.
Dopamine agonists[ edit ] In a single controlled study of twenty one patients, the dopamine D3 receptor agonist pramipexole was found to be highly effective in the treatment of bipolar depression.
Treatment was initiated at 0. The final average dosage was 1. The incidence of hypomania in the treatment group was no greater than in the control group.
Psychotherapy Certain types of psychotherapyused in combination with medication, may provide some benefit in the treatment of bipolar disorders. Psychoeducation has been shown to be effective in improving patients' compliance with their lithium treatment.May 06, · Bipolar disorder, bipolar disorder, or manic-depressive illness (MDI), is a common, severe, and persistent mental illness.
This condition is a serious lifelong struggle and challenge.  Other mental disorders and general medical conditions are more prevalent in patients with bipolar disorders than in patients in the general population. .
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1. Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks. Symptoms of bipolar disorder can be severe. They are different from the normal ups and downs that everyone goes through.
Abstract. Previous research on functional outcome in bipolar disorder (BD) has uncovered various factors that exacerbate psychosocial disability over the course of illness, including genetics, illness severity, stress, anxiety, and cognitive impairment.
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