Wednesday, April 16, 2014

Treatment of Manic Depression (Bipolar Disorder)

There is psychotherapy available to treat Manic depression (Bipolar Disorder). They are usually aimed at treating core symptoms, reducing negative expressed emotions in relationships and recognizing prodromal symptoms before full blown recurrence. The types of treatment with the largest efficacy range is cognitive behavioral therapy, family-focused therapy and psychoeducation. For most individuals with bipolar disorder a good prognosis comes from good treatment, which comes from an accurate diagnosis. Bipolar disorder can be a severely disabling medical condition, but many people can live full lives. A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery. The following behaviors can lead to depressive or manic recurrence:

o Discontinuing or lowering one's dose of medication.
o Being under- or over-medicated. Generally, taking a lower dosage of a mood stabilizer can lead to relapse into mania. Taking a lower dosage of an antidepressant may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania.
o An inconsistent sleep schedule can destabilize the illness. Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania.
o Caffeine can cause destabilization of mood toward irritability, dysphoria, and mania. Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to mania-inducing.
o Inadequate stress management and poor lifestyle choices. If unmedicated, excessive stress can cause the individual to relapse. Medication raises the stress threshold somewhat, but too much stress still causes relapse.
o Often bipolar individuals are subject to self-medication, the most common drugs being alcohol, diazepam/sleeping tablets and marijuana. Studies show that tobacco smoking induces a calming effect on most bipolar people, and a very high percentage suffering from the prolonged use

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