Types of therapy available

Types of therapy available

Lithium for Bipolar Disorder
Lithium (brand names Eskalith, Lithobid, Lithonate, and Lithotabs) is the most widely used and studied medication for treating bipolar disorder. Lithium helps reduce the severity and frequency of mania. It may also help relieve bipolar depression.

Studies show that lithium can significantly reduce suicide risk. Lithium also helps prevent future manic episodes. As a result, it may be prescribed for long periods of time (even between episodes) as maintenance therapy.

Lithium acts on a person’s central nervous system (brain and spinal cord). Doctors don’t know exactly how lithium works to stabilize a person’s mood. However, it helps people with bipolar disorder have more control over their emotions and reduce the extremes in behavior.

It usually takes one to two weeks for lithium to begin working. Your doctor will want to take regular blood tests during your treatment because lithium can affect kidney or thyroid function. Lithium works best if the amount of the drug in your body is kept at a constant level. It is important that the lithium level in your body not be too low or too high. Your doctor will also probably suggest you drink eight to12 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it’s important to consume a steady amount every day.

The dose of lithium varies among individuals and as phases of their illness change. Although bipolar disorder is often treated with more than one drug, some people can control their condition with lithium alone.

Lithium Side Effects
About 75% of people who take lithium for bipolar disorder have some side effects, although they may be minor. They may become less troublesome after a few weeks as your body adjusts to the drug. Sometimes side effects of lithium can be relieved by tweaking the dose. However, never change your dose or drug schedule on your own. Do not change the brand of lithium without checking with your doctor or pharmacist first. If you are having any problems, talk to your doctor about your options.
Common side effects of lithium can include:
* Hand tremor (If tremors are particularly bothersome, an additional medication can help.)
* Increased thirst
* Increased urination
* Diarrhea
* Vomiting
* Weight gain
* Impaired memory
* Poor concentration
* Drowsiness
* Muscle weakness
* Hair loss
* Acne
* Decreased thyroid function (which can be treated with thyroid hormone)

Notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate.

Tell your doctor about history of cancer, heart disease, kidney disease, epilepsy, and allergies. Make sure your doctor knows about all other drugs you are taking. Avoid products that contain sodium, such as certain antacids. While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.

If you miss a dose of lithium, take it as soon as you remember it — unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not “double up” the dose to catch up.

There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to birth defects and is not recommended for pregnant women, especially during the first three months. Breastfeeding isn’t recommended if you are taking lithium. Also, in a few people, long-term lithium treatment can interfere with kidney function.

Anticonvulsant Medication for Bipolar Disorder

Increasingly, anticonvulsant medications are used as mood stabilizers to treat mania in bipolar disorder. Lamictal and Depakote are used to treat bipolar depression as well. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.
Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling — four or more episodes of mania and depression in a year.

Anticonvulsants used to treat bipolar disorder include:
* Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
* Tegretol (carbamazepine)
* Lamictal (lamotrigine)
* Trileptal (oxcarbazepine)
Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking the drug for a couple of weeks.

Anticonvulsant Side Effects
Your doctor may want to take regular blood tests to monitor your health while taking an anticonvulsant. Some anticonvulsants can cause liver or kidney damage or decrease the amount of platelets in your blood. Your blood needs platelets to clot.
Each anticonvulsant may have slightly different side effects. Common side effects include:
* Dizziness
* Drowsiness
* Fatigue
* Nausea
* Tremor
* Rash
* Weight gain

Most of these side effects lessen with time. Long-term effects vary from drug to drug. In general:
* Pregnant women should not take anticonvulsants without consulting with their doctor because they may increase the risk of birth defects.

* Anticonvulsants can cause problems with the liver over the long term, so your doctor should monitor your liver closely.

Also, anticonvulsants can interact with other drugs — even aspirin — to cause serious problems. Be sure to tell your doctor about any drugs, herbs, or supplements you take. Don’t take any other substance during treatment without talking with your doctor.

Antipsychotic Medication for Bipolar Disorder
Antipsychotic medications are used in those with dipolar disorder as a short-term treatment to control psychotic symptoms such as hallucinations or delusions. These symptoms may occur during acute mania or severe depression.

In people with bipolar disorder, antipsychotics are also used as sedatives, for insomnia, for anxiety, and/or for agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect. Some antipsychotic drugs may also help lessen bipolar depression.

Some of the newer antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don’t tolerate or respond to lithium and anticonvulsants.

Antipsychotic drugs help balance certain brain chemicals called neurotransmitters. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.
The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a week.

Antipsychotics used to treat bipolar disorder include:

* Abilify (aripiprazole)
* Clozaril (clozapine)
* Geodon (ziprasidone)
* Risperdal (risperidone)
* Saphris (asenapine)
* Seroquel (quetiapine)
* Zyprexa (olanzapine)

Side Effects of Antipsychotic Drugs
Certain antipsychotic drugs cause rapid weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should first be screened for their risk of heart disease, stroke, and diabetes, according to a study published in Diabetes Care. The study specifically recommended that doctors screen people taking Risperdal, Seroquel, or Zyprexa for diabetes, prediabetes, and high cholesterol.

Abilify does not cause weight gain but may increase the risk of diabetes.

Common side effects of antipsychotic medications include:
* Blurred vision
* Dry mouth
* Drowsiness
* Muscle spasms or tremor
* Involuntary facial tics
* Weight gain

Note: Clozaril is not used often, despite its effectiveness, for bipolar disorder. The drug can cause a rare, potentially fatal side effect affecting the blood that requires weekly or biweekly blood test monitoring.

Older antipsychotic drugs are generally not used to treat bipolar disorder. However, they may be helpful if a person has troublesome side effects or doesn’t respond to the newer drugs. Older antipsychotics include Thorazine (chlorpromazine), Haldol (haloperidol), and Trilafon (perphenazine). These drugs may cause serious long-term side effects called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing.

Antidepressants for Bipolar Disorder
Antidepressants can help relieve depression and boost mood in those with bipolar disorder. It typically takes three to four weeks for most people to respond to the treatment. Sometimes a doctor will try several different antidepressants and doses before finding one that works for a patient.
There are three different types of antidepressants used to treat depression among people with bipolar disorder:

* Selective serotonin reuptake inhibitors (SSRIs)
* Monoamine oxidase inhibitors (MAOIs)
* Tricyclic antidepressants (less commonly used)

Newer “atypical” antidepressants are also being tested for use in treating bipolar depression.
Note: In October 2004, the FDA determined that antidepressant medications can increase the risk of suicidal thinking and behavior in children and adolescents with depression and other psychiatric disorders. If you have questions or concerns, discuss them with your health care provider.

Treating a depressive episode in bipolar disorder is controversial and challenging. Using antidepressant medication alone is not recommended because the drugs may flip a person into a manic or hypomanic episode. Hypomania is a more subdued version of mania. Antidepressants alone also may lead to rapid cycling. In rapid cycling, a person may recover more quickly from depression — but may experience mania and then another episode of depression.

Benzodiazepines for Bipolar Disorder
Benzodiazepines rapidly help control certain manic symptoms in bipolar disorder until mood-stabilizing drugs can take effect. They are usually taken for a brief time, up to two weeks or so, with other mood-stabilizing drugs. They may also help restore normal sleep patterns in people with bipolar disorder.
Benzodiazepines slow the activity of the brain. In doing so, they can help treat mania, anxiety, panic disorder, insomnia, and seizures.

Benzodiazepines prescribed for bipolar disorder include (among others):
* Ativan (lorazepam)
* Klonopin (clonazepam)
* Valium (diazepam)
* Xanax (alprazolam)

Benzodiazepine Side Effects
Benzodiazepines act quickly and bring on a sense of calmness. They can sometimes cause lightheadedness, slurred speech, or unsteadiness.

Possible benzodiazepine side effects include:
* Drowsiness or dizziness
* Lightheadedness
* Fatigue
* Blurred vision
* Slurred speech
* Memory loss
* Muscle weakness

Benzodiazepines can be habit-forming and addictive.

If you have been taking the benzodiazepines in high doses or for a long time, you may suffer withdrawal symptoms if you stop the drug suddenly. Talk with your doctor about whether you still need the medication and, if not, how to taper off the drug.

Calcium Channel Blockers for Bipolar Disorder
Sometimes a doctor may prescribe calcium channel blockers for mania in bipolar disorder. Traditionally, calcium channel blockers are used to treat high blood pressure or heart problems. These drugs are not as effective as others in treating bipolar disorder and are not used often.

These drugs block calcium channels, which are the small pores in cells that allow calcium to move in and out, which widens your blood vessels. It’s not clear exactly how the drugs work, but they are used to lower blood pressure, improve irregular heartbeats, and treat migraines. They may also help stabilize moods.

Calcium channel blockers used in bipolar disorder include:
* Diltiazem
* Nifedipine
* Nimodipine
* Verapamil

Side Effects of Calcium Channel Blockers
Sometimes, a headache can develop after taking certain calcium channel blockers. These headaches should gradually disappear once you have been taking the medication for a while. Talk to your doctor if headaches continue. Some people also report tenderness, swelling, or bleeding of the gums when starting to take calcium channel blockers. Regular brushing, flossing, and gum massages along with routine dental visits can help lessen this effect. As with any medication, it is important to see your doctor regularly to make sure the drug is working properly.

Calcium channel blockers tend to cause fewer serious side effects than some other drugs used to treat bipolar disorder. However, they are also less effective.

Common calcium channel blocker side effects include:
* Slowed heart rate or irregular heart rhythm
* Flushing, a pounding sensation in the head, dizziness, headache
* Leg swelling
* Decreased blood pressure
* Tingling sensations in the arms or legs
* Weakness
* Constipation
Talk to your doctor if you are pregnant or could become pregnant during treatment. It isn’t known if these drugs could harm the fetus.

Anticonvulsant Medication for Bipolar Disorder
Increasingly, anticonvulsant medications are used as mood stabilizers to treat mania in bipolar disorder. Lamictal and Depakote are used to treat bipolar depression as well. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.
Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling — four or more episodes of mania and depression in a year.

Anticonvulsants used to treat bipolar disorder include:
* Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
* Tegretol (carbamazepine)
* Lamictal (lamotrigine)
* Trileptal (oxcarbazepine)

Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking the drug for a couple of weeks.

Anticonvulsant Side Effects
Your doctor may want to take regular blood tests to monitor your health while taking an anticonvulsant. Some anticonvulsants can cause liver or kidney damage or decrease the amount of platelets in your blood. Your blood needs platelets to clot.

Each anticonvulsant may have slightly different side effects. Common side effects include:
* Dizziness
* Drowsiness
* Fatigue
* Nausea
* Tremor
* Rash
* Weight gain

Most of these side effects lessen with time. Long-term effects vary from drug to drug. In general:
* Pregnant women should not take anticonvulsants without consulting with their doctor because they may increase the risk of birth defects.

* Anticonvulsants can cause problems with the liver over the long term, so your doctor should monitor your liver closely.

Also, anticonvulsants can interact with other drugs — even aspirin — to cause serious problems. Be sure to tell your doctor about any drugs, herbs, or supplements you take. Don’t take any other substance during treatment without talking with your doctor.

Alternative treatments for depression are as follows:

  • Acupuncture – The World Health Organization lists depression among the conditions for which acupuncture is effective. Some studies have shown it markedly lessens symptoms. Acupuncture can be a valuable alternative if you are unable to take antidepressants or have not found them helpful.
  • Biofeedback
  • Homeopathy
  • Ayurveda
  • Dietary factors – Because depressive symptoms can be exacerbated by nutritional deficiencies, good nutrition is important. Pay attention to eating a well-balanced diet. Quitting smoking is also advised.
  • Aromatherapy – an alternative treatment for depression – Aromas can lower stress levels, affect mood, and even change perceptions of pain. The simple scents of fruits and flowers may lighten mild depression; try inhaling the aromas of jasmine, rose, or clary sage to ease your symptoms. Frankincense and sweet marjoram, inhaled or used topically, may be helpful in reducing stress, while lavender and German chamomile oils can bring on a relaxed state.
  • Vitamins and Depression: like Vitamin-B(folic acid) and other supplements
  • Colour Therapy
  • Diet and Depression – it affects physical health and many aspects of mental health. A vitamin or herbal supplement might promote recovery of physical or mental health and/or help manage symptoms.

Colour Therapy, for example – Warm colors of yellow, orange, and red stimulate mood in color baths, lighting, room decor and clothing. People with hypertension should avoid too much red. These same colors in food provide anti-oxidants that reduce the effects mood swings brought on by allergies. Other research has found that using a negative air ionizer to lessen indoor allergies helps reduce mood swings.

Faith and spirituality have always been important in mental and physical healing. Today many spiritual leaders incorporate psychotherapy, offering professional counseling tailored to a belief system.

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6 thoughts on “Types of therapy available”

  1. Guten tag! Hahaha! I’m not German, but had ya worried! Great site neway, I get what you wrote.

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