The National Institute for Health and Care Excellence (NICE) produces guidelines for how health professionals should treat certain conditions.
Medical Practitioners don’t have to follow these recommendations. But they should have a good reason for not following them.
Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.
• Lithium
• Certain antipsychotic medication
• Certain anticonvulsive medication
• Certain benzodiazepine medication
Medication is important but it won't work on it's own...
Depressive symptoms are eased with Antidepressant or Anticonvulsant medication.
Medication alone won’t fix Bipolar Disorder, sufferers need mental and emotional support
Successful treatment normally includes Mood Stabiliser or Antipsychotic medication
Sadly there is no ‘Wonder-Drug’ medication for Bipolar. Your doctor will suggest different dosages and combinations to you depending on what works best for you. This applies to treating all symptoms of Bipolar Disorder. On diagnosis, your doctor should offer you medication to treat your depressive symptoms.
You may be offered the following medication:
Fluoxetine is an antidepressant. Lamotrigine is an anticonvulsant.
Often taking just a single type of medication won’t alleviate your symptoms. If this is the case, your doctor may prescribe the following additional medication:
Sodium Valproate an anticonvulsive drug, shouldn’t be given to young women who might want to get pregnant. Your own preferences should be listened to.
You should be offered a mood stabiliser to help manage your mania or hypomania. Doctors may refer to them as ‘antimanic’ medication. If you are taking antidepressants your doctor will advise you to withdraw from taking them as this could exasperate symptoms.
You will usually be offered an antipsychotic medication at first. Common antipsychotics used for bipolar disorder treatment are:
As mentioned, not all drugs are affective on all sufferers therefore you may be offered an alternative. As with depression, if an antipsychotic drug alone doesn’t work, you may be offered lithium or Sodium valproate to take alongside it.
Remember, doctors will use different dosages and combinations depending on what works best for you and Sodium Valproate shouldn’t be given to young women who might want to get pregnant. Your personal preferences should be listened to.
You should be offered a psychological therapy that is specially designed for bipolar disorder. You could have individual or group therapy.
The aim of your therapy is to stop you from becoming unwell again. This is known as ‘relapse’.
Your therapy should help you to:
understand your condition,
think about the effect that your thoughts and behaviour have onyour mood,
monitor your mood, thoughts and behaviour,
think about risk and distress,
make plans to stay well,
make plans to follow if you start to become unwell,
be aware of how you communicate,
manage difficulties you may have in day to day life.
If you live with your family or are in close contact with them, you should also be offered ‘family intervention.’
Family intervention is where you and your family work with mental health professionals to help to manage relationships. This should be offered to people who you live with or who you are in close contact with.
The support that you and your family are given will depend on what problems there are and what preferences you all have. This could be group family sessions or individual sessions. Your family should get support for 3 months to 1 year and should have at least 10 planned sessions.
IPT is a form of psychotherapy that focuses on relieving symptoms by improving interpersonal functioning. It addresses current problems and relationships rather than childhood or developmental issues. Therapists are active, non-neutral, supportive and hopeful, and they offer options for change.
IPT is delivered in one-to-one and group formats.
The average IPT duration is 16 sessions. A doctor may recommend it in addition to medication and other therapy or treatments.
Research notes that because medication treatment alone is not effective, the need for psychosocial interventions is undeniable. IPT is ideal as an additional treatment after medication and CBT.
A central idea in IPT is that psychological symptoms can be understood as a response to current difficulties in everyday relationships with other people.
When people learn effective strategies for dealing with their relationship problems, their symptoms often improve.
Understanding exactly how life events effect me should help...
The time necessary to produce results varies. However, research states that the average IPT treatment regimen consists of 16 sessions.
The opening sessions (1-3) focus on collecting information and making decisions about the focus of therapy. The therapist helps the patient create a list of all the key relationships in the patient’s life (interpersonal inventory). These relationships are grouped according to the four main problem areas.
In the middle sessions (4 – 14) the patient concentrates on trying to improve the chosen problem area or areas with the support of the therapist. The patient and therapist work to develop solutions to the problems, and the patient tries to implement those between sessions.
The final sessions (15 – 16) focus on dealing with any sense of loss associated with the end of therapy as well as reviewing the issues that were identified in the interpersonal inventory and the progress made in dealing with them.
There is no standard length of IPT because it depends on the severity and subtype of bipolar, along with other factors. Some people see an improvement following a few sessions, but others frequently need several months of treatment.
An older review from 2007 explains that interpersonal and social rhythm therapy (IPSRT) seeks to reduce the erratic nature of someone’s daily routines, involving:
Simultaneously, IPSRT aims to enhance the performance of primary social roles and foster an improved quality of interpersonal relationships. A 2020 clinical trial with 44 participants who had bipolar disorder suggests that it may improve symptoms. However, more research is necessary to confirm the results.
Family-focused therapy (FFT) is an intervention for adults and children with bipolar and their supporters. It involves education about the condition and training in problem-solving and communication skills.
A review from 2016 examined research on the value of FFT for bipolar. The authors found that in eight clinical trials, the combination of FFT with mood stabiliser medications may offer benefits over shorter programs of psychoeducation and medication. Benefits included quicker recovery and decreased symptom severity, frequency of mood episodes, and recurrences.
Interpersonal therapy (IPT) for bipolar disorder starts with education about the condition and follows with sessions to collect information, assess that information, then plan and implement solutions.
A central idea in IPT is that psychological symptoms can be understood as a response to current difficulties in everyday relationships with other people.
The average number of IPT sessions is 16.
Alternative psychotherapies to IPT include cognitive behavioural therapy, interpersonal and social rhythm therapy and family-focused therapy. Limited research suggests that both may offer benefits for the condition.
The following are questions a person may wish to ask a doctor or healthcare practitioner: