Length of Treatment
Professional therapy and treatment is necessary
in treating bipolar affective disorder. Treatment is usually supervised
by a psychiatrist, a medical doctor with extra education in diseases of
the mind. Medication is the primary treatment, although psychotherapy plays a crucial part in helping individuals to understand their illness
and rebuild their lives.
Bipolar Affective Disorder is a recurrent illness
and maintenance treatment is a life long affair.
Without maintenance therapy the risk for recurrence
of illness is high. In one study, as many as half the individuals
developed new episodes of bipolar illness within five months after discontinuation.
In addition, some psychiatrists report that, in people who suffered recurrences of illness after discontinuing lithium, the drug was no longer as effective
for them as it had once been.
Medication - Self Medicating and Non Compliance
See the section "Treatment - Medications" on this
web site for information about medications prescribed by doctors for the
treatment of bipolar disorder.
Non compliance with medication orders is a
common trait among bipolars. Once an episode is over and they are
feeling well they no longer see the need for taking medicine. Even
when they recognize the need for it some people simply don't like taking
medication and will discontinue it. Bipolars need to realize that
taking medication for maintenance purposes is similar to that of a diabetic
taking insulin to maintain health.
Self medicating with alcohol or other drugs
is common in bipolars and leads to mood instability. It makes long-term
treatment of bipolar affective disorder difficult, if not impossible to
achieve.
Physical Treatment
There are many vegetative or bodily symptoms associated
with Bipolar Affective Disorder. In addition, physical illness may
mimic the symptoms of bipolar disorder. A physician will be able
to assess these symptoms, make a diagnoses and prescribe treatment when
required.
Psychotherapy
Psychotherapy by itself - no matter what kind
- cognitive, behavioral, or psychodynamic has not been proven effective
in the treatment of bipolar affective disorder. The illness is a
biochemical one requiring the use of medication to stabilize the basic
mood disorder.
However, psychotherapy is a useful adjunctive
treatment and helps bipolars to understand their illness and the stresses
of their everyday lives that may trigger an episode. It will also
help restore lost self esteem and teach ways to prevent relapses.
Psychotherapy also can help bipolars improve
relationships with others, learn to recognize early signs of mood swings
and manage the ups and downs of the illness. Coping skills, learned
through psychotherapy, enable the bipolar to handle the mood swings.
Like any normal person, bipolars sometimes
have various psychological symptoms requiring the intervention of a skilled
therapist, and these needs should be met.
Electroconvulsive Therapy (ECT)
ECT is a treatment used mainly for those bipolars
who are unable to safely wait until medication becomes effective, who cannot
tolerate the medications, who have been unresponsive to medication, or
who prefer ECT.
ECT is considered to be an extremely effective
treatment for both manic and depressed phases of bipolar disorder.
It is the treatment of choice for pregnant women, particularly in the first
trimester.
Maintenance ECT may be useful in preventing
future manic episodes.
Some experts believe that ECT is underutilized
as a treatment for acute mania, and it may become more widely used for
this purpose in the future.
Francis M. Mondimore writes this interesting
tid-bit in his book Depression: The Mood Disease: "I find
it fascinating that both ECT, a treatment that causes seizures, and anticonvulsants,
medications to prevent seizures, can both be effective treatments for the
manic state. No one knows why this should be. It only serves
to remind us how mysterious and complicated an illness Bipolar Affective
Disorder is."
Hospitalization
Hospitalization may be required for the following
individuals in the depressed state:
Again, the length of the hospital stay varies,
according to the severity of the mania and response to treatment.
Self Help
Self help groups are springing up all over the
country. Many of them are members of The National Depressive and
Manic Depressive Association or The National Alliance for the Mentally
Ill.
Professional help is always needed in
the treatment of Bipolar Illness, but the understanding, fellowship and
support of fellow-sufferers can make an invaluable contribution to recovery.
Education is important in self help groups and often experts come in to
lecture on appropriate topics.
Members help themselves by helping each other,
sharing problems, variations in cycling or symptoms, tips for easing the
side effects of medications and different ways of coping with the disorder.
Most important of all, they reach out to others
who truly understand, as no one else can, exactly how frightening, isolating
and upsetting bipolar affective disorder can feel.
Outlook for Treated Bipolars
Bipolar Illness tends to be chronic and recurrent.
Without treatment, a manic episode can last as long as three months, and
a depressive episode much longer. With treatment the prognosis for
any given episode is good but many bipolars continue to have persistent mood swings, particularly recurrent or mild depression. Even
those receiving maintenance treatment with lithium and other mood stabilizers
may have "breakthrough" episodes of mania or depression, sometimes provoked
by stress.
However, with treatment episodes will prove
to be less severe and of much shorter duration.
Dealing With Stigma
We have Bipolar Affective Disorder.....a mental
illness!!!
Each one of us has felt the painful sting of
stigma...the friend who no longer calls, the sister who won't visit a psychiatric
hospital (even though she'd be the first one there at another hospital),
the looks from people...the prolonged silences...the people who talk to
you like you've just reached your 3rd birthday...and those who won't talk
at all. Sound familiar? That is stigma.
I've come to realize that anyone who really
matters to me will make the effort to understand me and the illness, and
how it has affected me. I no longer try to convince anyone I am normal....I
am not. But I am a good person with an illness, and I feel sorry
for anyone who can not understand. I have not only lost them, they
have lost me.
