Bipolar: Treatment

Medication is essential to the treatment of bipolar disorder, as is the involvement of the whole family. Psychotherapy can be of help in limiting and managing manic and depressive episodes and their consequences, which can severely affect a young person and all those around him. Even with an effective course of medication, people with bipolar can have “breakthroughs,” or relapses, so a support network of family, friends, and professionals who monitor the young person’s behavior is vital.

Psychotherapeutic: Bipolar is often treated with cognitive behavioral therapy in addition to medications. CBT helps children and adolescents with the disorder understand what triggers their episodes, how their thoughts influence their feelings, and how to control and manage them. Family therapy is often employed to engage parents and other family members in keeping track of symptoms and managing stress levels in the home, which can lead to episodes.

Some other therapies that have been shown to help include “prodrome detection,” which encourages early detection and prevention of a budding episode, and social rhythm therapy, which uses a codified daily schedule to head off mania or depression.

Pharmacological: The first-line medication used to treat bipolar disorder is often a mood stabilizer. This class includes lithium and various anticonvulsants, which are generally effective at treating manic symptoms and lowering the frequency and severity of both manic and depressive episodes. A young person diagnosed with bipolar disorder might take lithium for the rest of his life. Other drugs can be prescribed to treat symptoms like psychosis (antipsychotics) or trouble sleeping (anti-anxiety drugs). If a mood stabilizer does not adequately address depressive symptoms, a doctor may prescribe an antidepressant, but will do so with extreme caution and almost always in conjunction with a mood stabilizer, as antidepressants can trigger a manic episode.

Many people with bipolar disorder take more than one medication and the medications can have complex interactions, leading to significant side effects if they are not effectively monitored by an experienced clinician.

Electroconvulsive Therapy: In some cases where medication and therapy aren’t providing the hoped-for result, electroconvulsive therapy, or ECT may be considered. This is not the “shock therapy” of old; in ECT, the patient is anesthetized briefly while electrical current is passed through a part of the brain. This causes a seizure, though there are few, if any, external signs of a seizure, and no danger to the patient, who has also been given a muscle relaxant. ECT is rarely used in adolescents, and there is little information about its use in pre-pubertal children.