BIPOLAR DISORDER TREATMENT IN SCOTTSDALE

 

Treatment for bipolar disorder has been one of my focuses at my office in Scottsdale AZ for over 20 years. Bipolar disorder or manic depression is a medical illness that causes extreme mood swings between mania and depression. These changes may be subtle and hard to identify, or dramatic and typically vary greatly over the course of a person’s life. Mood swings or cycling can be as frequent as hourly or as infrequent as annually. Sometimes this disorder includes psychosis or psychotic features. Changes in mood throughout life are common, assuming our circumstances justify our moods. Bipolar disorder is something altogether different and must be treated.

The DSM-V has identified at least two forms of bipolar disorder, and schizoaffective disorder and seasonal depression may be a form of bipolar disorder as well. This disorder often begins in adolescence or early adulthood, and occasionally in children. Most people generally require some sort of maintenance-treatment. While medication is a key element in successful treatment, psychotherapy, support, and education about the condition are essential components of the treatment. Medications are greatly improving, with fewer side effects, enabling individuals to live a normal happy life.

Some people self-medicate bipolar disorder with opiates such as Oxycontin and a benzodiazepine in an effort to control the mood swings. This should be an indicator that a mood stabilizer is necessary. Additionally, anesthesia such as Ketamine may be used to treat bipolar disorder, albeit in a very controlled environment.

Symptoms of Bipolar Disorder

Mania is the word that describes the activated phase of bipolar disorder.

Mania may include:

  • Elated, happy mood or an irritable, angry, unpleasant mood
  • Increased physical and mental activity and energy
  • Racing thoughts and flight of ideas
  • Increased talking, more rapid speech than normal
  • Ambitious, often grandiose plans
  • Risk taking, gambling, shopping binges
  • Impulsive activity such as spending sprees, hyper-sexual indiscretion, and alcohol abuse
  • Decreased sleep without experiencing fatigue

Depression may include:

  • Loss of energy
  • Prolonged sadness
  • Decreased activity and energy
  • Restlessness and irritability
  • Inability to concentrate or make decision
  • Increased feelings of worry and anxiety
  • Less interest or participation in, and less enjoyment of activities normally enjoyed
  • Feelings of guilt and hopelessness
  • Thoughts of suicide
  • Change in appetite (either eating more or eating less)
  • Change in sleep patterns (either sleeping more or sleeping less)
  • Seasonal depression brought on by the changing of the seasons SAD or Seasonal Affective Disorder

Causes of Bipolar Disorder

The exact cause of this mood disorder is not known. Scientists believe that bipolar disorder is a spectrum of disorders and hard to pinpoint. Most scientists believe that bipolar is likely caused by multiple factors that produce a chemical imbalance affecting certain parts of the brain, and possible damage to these areas. The three primary neurotransmitters serotonin, norepinephrine, and dopamine are not functioning properly. Too much dopamine causes mania and psychosis; too little causes lethargy and depression. Similar effects are experienced with the other two neurotransmitters. Bipolar often runs in families and is an agreed upon fact. 60%-80% of the cases are hereditary. One study claims if one parent has it, there is a 10% change of a child developing it. If both parents have the disorder, a 40% chance of a child developing bipolar disorder exists. These studies strongly suggest a genetic component to bipolar disorder.

A stressful environment that is repeated from one generation to the next may play a role in the genetic-change component, or negative life events may interact with an underlying genetic or biological predisposition to manifest bipolar disorder. There are other possible triggers of bipolar disorder episodes such as stress and substance abuse. Low levels of GABA in the bloodstream might be an indicator of bipolar disorder.

Treatment for Bipolar Disorder

Vraylar (cariprazine) has worked well in many cases put the client into remission from all the symptoms. Sometimes a mood stabilizer alone will not be adequate and need the augmentation of an antidepressant. This must be done with great caution because in some cases, the antidepressant can cause the patient to go into mania. Other times patients are treated for anxiety and depression; so they are given an anti-anxiety medication and an antidepressant. This is not the ideal course medication management. Mood stabilizers are among the best therapy. Seasonal Depression is a specific form of bipolar disorder, though temporary episode recur with the changing of the seasons.

As with many other mental illnesses, there is no cure for bipolar disorder, although this disorder is a treatable and manageable illness. After an accurate diagnosis and treatment, most people can achieve an optimal level of wellness and quality of life. Medication is an essential element of successful treatment for people with bipolar. Psycho-social therapies including cognitive-behavioral therapy, interpersonal therapy, family therapy, and psycho-education are important to help people understand the illness and to internalize skills to cope with the stresses that can trigger episodes.

Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of bipolar disorder. It is useful to know whether the mood stabilizing medication prescribed has been approved by the FDA for use in bipolar disorder or if it is being used off label. Sometimes it might take several medications before the right one is found, treating bipolar disorder is a bit more difficult than clinical depression.

Antidepressant Treatment

Standard SSRI antidepressant medications (those approved for the treatment of unipolar depression) have not yet been proven effective for bipolar depression. Although the evidence supporting their use for bipolar depression is limited to small or less rigorous studies, these medications remain the most commonly used treatment for bipolar depression. The data from larger studies finds neither evidence of benefit nor evidence that these agents cause large numbers of depressed patients to switch into mania.

Anti-psychotic Medications and Mood Stabilizers

To control acute episodes, anti-psychotic medications may be used alone (monotherapy), or added to anti-convulsant medications (combination therapy). Medication guidelines for bipolar disorder now recommend the combination of these two medications as most effective for acute manic episodes. Because the older typical anti-psychotic medications run the risk of causing a permanent movement disorder and have been associated with depression when used over the long term, the new atypical anti-psychotics are now preferred for this purpose. All the new A-typicals are effective in the treatment of acute and mixed mania. Vraylar has shown fantastic results for treating bipolar disorder. Lithium has been the gold standard for decades. If someone is having suicidal thoughts; lithium will alleviate these thoughts in just minutes. Vraylar (cariprazine) has been working very well with few side effects.

Other Treatments for Bipolar Disorder

Lithium has always been the gold standard of treatment; however, Ketamine therapy is also quite successful in treating bipolar disorder. Ketamine works very well in treating acute episodes and suicidal thoughts brought on by depressive episodes. TMS might be another possibility for acute bipolar depression. If you are seeking treatment for bipolar disorder, please contact my office. Read more on bipolar disorder treatment

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