Treatment

People with bipolar can be treated with drugs and non drug treatments. Non drug treatments include psychotherapy, psychoeducation, cognitive behavioural therapy, family-focused therapy and ECT. Although these treatments are effect in managing illness, they alone are not sufficient to treat bipolar disorder. They must be used along with medication to achieve optimum results. Therefore the focus of this project will be on drug therapy for bipolar disorder.

**Drug Therapy for Bipolar Disorder **

Drugs are commonly used to treat bipolar disorder. The drugs used for bipolar fall under four categories: Mood Stabilizers, Antidepressants, Antipsychotics and Anticonvulsants. This section will discuss each of the four categories and also list the medications from each category that could be prescribed to treat bipolar. 

**Antidepressants **  Antidepressants treat the symptoms of depression. They work by altering the levels of certain chemicals in the brain in a way that elevates a person's mood. For people with bipolar disorder, antidepressants must be used together with a mood stabilizer medication to prevent cycling into a manic episode. SSRIs and Bupropion are commonly prescribed to people with bipolar.

//Selective serotonin reuptake inhibitors (SSRIs) // SSRIs are antidepressants. They are used to treat depression, anxiety disorder and some personality disorders. SSRIs prevent the reuptake of serotonin which increases the level of serotonin in the brain. // Bupropion // Bupropion is used to treat depression and as an aid for quitting smoking. It works by affecting the balance of chemicals that occur naturally in the brain . For the treatment of depression, the full effects of the medication may not be seen for several weeks of treatment <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> **<span style="font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msobidifontsize: 12.0pt; msofareastfontfamily: 'Times New Roman'; text-transform: uppercase;">Antipsychotics **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0522f5; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msofareastfontfamily: 'Times New Roman';">Antipsychotics medications are used to help with the symptoms of mania. They are believed to work by regulating the activity of certain brain chemicals to stabilize mood. Antipsychotics are also used to manage psychotic symptoms, such as delusions and hallucinations. Many of these medications are also used to treat schizophrenia. Antipsychotics include Clozapine, Risperidone, Olanzapine, Quetiapine and Ziprasidone.

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Clozapine //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">This can be used to treat schizophrenia when other medications are not effective <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">.

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Risperidone //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Risperidone is an antipsychotic agents. Risperidone is also used for the short-term treatment of behavioural problems, such as verbal or physical aggression, suspiciousness, and agitation <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">risperidone is thought to work by correcting the function of nerve pathways in certain areas of the brain <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> //<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Olanzapine //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #2306ef; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Olanzapine is used to <span style="color: #2306ef; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">treat <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';"> <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-bidi-font-weight: bold; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">schizophrenia and related mental disorders, as well as bipolar disorder <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. Olanzapine may be used alone or in combination with other medication, to treat the manic or mixed episodes of bipolar disorder. It is not used for depressive episodes. Olanzapine is thought to work by correcting the balance of neurotransmitters in the brain. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';">

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Quetiapine //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msobidifontstyle: italicmsoBidiFontStyle; msofareastfontfamily: 'Times New Roman';">Quetiapine is used to treat symptoms of schizophrenia and manic and depressive episodes associated with bipolar disorder <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontstyle: italicmsoBidiFontStyle; msofareastfontfamily: 'Times New Roman';">. It works by affecting the actions of certain <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-bidi-font-style: italic; msoansilanguage: EN-US; msobidifontstyle: italicmsoBidiFontStyle; msofareastfontfamily: 'Times New Roman';">neurotransmitters. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';">

**<span style="font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msobidifontsize: 12.0pt; msofareastfontfamily: 'Times New Roman'; text-transform: uppercase;">Anticonvulsants **<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0a01da; font-family: 'Times New Roman',Times,serif;"> Anticonvulsants are used in the treatment of epileptic seizures but they are also increasingly being used in the treatment of bipolar disorder. It has been recently found that anticonvulsants can act as mood stabilizers and they have also been proven effective in treating anxiety. Anticonvulsants include Valproic acid, Divalproex, Carbamazepine, Oxcarbazepine, Topiramate and Lamotrigine.

<span style="font-family: Times New Roman; font-size: 10pt; mso-fareast-font-family: 'Times New Roman'; msofareastfontfamily: 'Times New Roman';"> //<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Valproic acid //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Valproic acid is used for the management and control of certain types of seizures and also bipolar  <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">. <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';"> It works on the central nervous system in the brain to reduce the number and severity of seizures. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';">

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Divalproex //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: boldmsoBidiFontWeight; msofareastfontfamily: 'Times New Roman';">Divalproex isused to <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-bidi-font-weight: bold; msoansilanguage: EN-US; msobidifontweight: boldmsoBidiFontWeight; msofareastfontfamily: 'Times New Roman';">manage and control certain types of seizures <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">. <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';"> It is also used for people 18 years of age and older with bipolar disorder to treat manic episodes <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman';"> //<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Carbamazepine //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Carbamazepine is used for the management of certain types of seizures alone or in combination with other medications <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">It is also used to treat the nerve pain of trigeminal neuralgia and for the treatment of acute mania and prevention of bipolar disorders. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';">

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Oxcarbazepine //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Oxcarbazepine is used to control epilepsy in adults and children over six years of age <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">. <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontstyle: italicmsoBidiFontStyle; msofareastfontfamily: 'Times New Roman';">It is used for a particular type of epilepsy called <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-bidi-font-style: italic; msoansilanguage: EN-US; msobidifontstyle: italicmsoBidiFontStyle; msofareastfontfamily: 'Times New Roman';">partial seizures <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';">

//<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msobidifontsize: 12.0pt; msobidifontweight: bold; msofareastfontfamily: 'Times New Roman';">Topiramate //<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msobidifontweight: boldmsoBidiFontWeight; msofareastfontfamily: 'Times New Roman';">Topiramate is used <span style="color: #0000ff; font-family: Times New Roman; font-size: 10pt; mso-bidi-font-weight: bold; msoansilanguage: EN-US; msobidifontweight: boldmsoBidiFontWeight; msofareastfontfamily: 'Times New Roman';">to treat epilepsy and to prevent migraine headaches <span style="color: #080cdd; font-family: Times New Roman; font-size: 10pt; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #3d4c53; font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';"> <span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; msoansilanguage: EN-USmso-fareast-font-family;">**<span style="font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman'; text-transform: uppercase;">Mood stabilizers **<span style="font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 'Times New Roman';"> <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> <span style="color: #090ef1; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msofareastfontfamily: 'Times New Roman';">Most of the medication listed above can also be called mood stabilizers. Any medication that stabilizes mood can be categorized under this category. Mood stabilizers are mostly antimanic and they also effective in treating mood cycling and shifting. They are not very effective in treating depressants. The expectation to these is lithium because it treats both mania and depression. Many medications classified as anticonvulsants above are also mood stabilizers. Combination therapy with two mood stabilizers is sometimes recommended for people who do not respond to or develop resistance to the use of one medication. The following section contains an in depth discuss of lithium carbonate as a mood stabilizer.

<span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; msoansilanguage: EN-USmso-fareast-font-family;">//<span style="font-family: Times New Roman; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-US; msofareastfontfamily: 'Times New Roman';">Lithium Carbobate // <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 10pt; msoansilanguage: EN-USmso-fareast-font-family; msofareastfontfamily: 'Times New Roman';">People with mood swings of bipolar disorder are often helped by carefully monitored dosage of lithium. Lithium is effective for bipolar patients when they are depressed as well as when they are manic. The effects of lithium occur gradually, therefore therapy typically begin with lithium and an antipsychotic medication which normally has an immediate effect. Lithium can have serious and even fatal side effects; therefore lithium treatment has to be prescribed and used very carefully. Lithium is very effective in eliminating manic episodes and prevents future episodes if it is taken regularly. But if use is discontinued, lithium actually increases the risk of recurrence of episodes. For patients who cannot withstand lithium’s side effects, Carbamazapine and divalproex sodium are both effective treatments. However, neither prevents future episodes if taken regularly. <span style="color: #f17a09; font-family: 'Times New Roman',Times,serif; font-size: 10pt; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman'; msoansilanguage: EN-USmso-fareast-font-family; msofareastfontfamily: 'Times New Roman';"> <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 10pt; msoansilanguage: EN-USmso-fareast-font-family; msofareastfontfamily: 'Times New Roman';">Lithium is unique for several reasons. It is a light metal ion that exists in nature as a salt. Although the ion is found in animal tissue, it plays no known physiological role. Therapeutic levels of lithium have almost no psychotropic effects in normal individuals. There are no sedative, depressant, stimulant, or euphoria effects in normal individual after taking lithium. Most importantly, it relieves manic symptoms without over-sedating the person or inducing depression, which is a common problem with antipsychotics and reserpine. Furthermore, as mentioned before, continued treatment with lithium can prevent or decrease the severity of future episodes of mania and depression.

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