Thursday, January 28, 2010

Bipolar Disorder Part 3

I have been talking about bipolar disorder the past two days and want to look at what it takes for effective treatment. There are three main things that must be done to prevent relapses and avoid the devastating consequences of both the mania and depression. The first is adequate medication. The second is avoidance of alcohol and drugs, and the third is management of stress and anxiety. Chances of full and long lasting recovery are slim if one of these things are left out of treatment.

First is adequate medication. Unlike non bipolar depression bipolar disorder cannot be treated with cognitive behavioral and other psychosocial treatments alone. Medications are required and need to be taken lifelong. Bipolar disorder is a progressive disease with deterioration over time if left untreated. There are problems though with the medications that are available to treat bipolar disorder. Many have significant side effects and are associated with long term health risks. I will discuss the bipolar medication dilemma tomorrow.

Second is avoidance of alcohol and drugs. Unfortunately over 50% of individuals with bipolar disorder have an alcohol or other substance abuse problem. There tends to be a continuous negative cycle in which the alcoholism worsens the disorder and the disorder reduces chances of long term abstinence. Except for non adherence to medication alcohol abuse and dependence are the number one reason for failure of adequate treatment or so called treatment resistance. I cannot overemphasize this. Bipolar disorder cannot be stabilized in the presence of an active substance abuse problem and co-occurring treatment is required.

The third main pillar of treatment is management of stress and anxiety. High levels of stress can trigger either manic or depressed episodes as well as times of interpersonal conflict. Persistent insomnia which often accompanies stress can trigger manic episodes. Regular sleep, good diet, and exercise are helpful in this regard.

Thought for the day

"God is our refuge and strength, an ever present help in times of trouble"

The Psalmist

1 comment:

  1. Your blogs have been a great insight for me. I have a friend that has been thru 12 treatment centers and I don't think one of them have diagnosed her with Bipolar. I definitely think she has it. She is an alcoholic. Her moods are extreme. What you describe is her exactly. Grandiosity. Insomnia. Suicidal.
    I was driving her to a treatment center three months ago and she was in the back seat and tried to jump out.
    Thank you for your blogs. I will keep reading.
    Thank you
    I own sober living


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