Long term management of bipolar disorder includes: assessment of the illness, goals for treatment, cooperation between the doctor and patient, psycho-social education for the entire family, constant tabs on psychosocial factors and medication.
Assessment
The first and most important step in long term treatment of bipolar disorder is assessment of the illness. The assessment allows the doctor and patient deicide on goals for the treatment which include: symptom reduction, decrease and prevention of relapses and improvement of normal function.
Goals of Treatment and Maintenance
Acute Stage Treatment – the primary goal here is to have a positive response to the treatment which can take weeks or months of altering medications and trying various therapies. Once the patient has recovered from the episode they will continue treatment with a long term plan of medication and psychotherapy.
Maintenance Stage Treatment – this treatment’s goal is to prevent relapses. The patient may have to visit the psychotherapist two to four times each year as they learn to monitor symptoms to recognize and prevent a relapse. This helps the patient avoid a full relapse when it breaks through the medication and lessen its impact through medication adjustment.
Communication between the patient and doctor maintains the steady level in long term treatment. Even though the visits may be infrequent, it is important that this relationship be strong and handles any issues that may come up. Some issues can include: progression of the illness, a contact person who can keep tabs on the patient and provide information in case of a relapse, expectations, treatments and potential hospitalization in case of relapse.
Broader Effects
Bipolar disorder affects the patient’s family, friends and colleagues so it is important to understand and deal with problems that can come up on the job, with family and other interpersonal relationships in the long term treatment phase. Doctors typically include the family in the treatment plan and the patient can discuss their disorder with colleagues if they feel it would benefit their job performance.
Medication
Medication for bipolar disorder is a basic the constituent of any treatment, long or short term. Mood stabilizers are the usual form of long term medication for bipolar disorder with other medications used in the short term when necessary. The three primary medications used long term are lithium, carbamazepine (Tegretol), and valproate (Depakote). Lithium is the longest known and most widely used treatment because it is relatively safe and low cost. All of them can be tracked through blood tests which makes dosage adjustment easy.
These mood stabilizers reduce the relapses in number and severity; they can also offer mood stability between episodes. The doctor will take a medical history (particularly heart, liver, kidney and thyroid) and consider dietary habits, weight changes, exercise, recreational and sexual habits before prescribing medications. The doctor will also consider the patient’s use of prescription drugs, over the counter drugs, illicit drugs, alcohol, caffeine and nicotine. Other areas that need to be explored include.
Other medications have come into use for bipolar disorder in recent years. Carbamazepine is an anticonvulsant being used and continuing study for effectiveness as an alternative to lithium as it is as effective for the treatment of mania, rapid mood cycling and mixed mood states. Valproate is an anticonvulsant that is also a potential alternative to lithium. It is effective in treating mania and being considered as a treatment for acute depression from bipolar disorder.
Overall
All in all, more treatment options exist now than ever before and most people with this illness can be treated effectively. For many, a long term treatment plan including daily use of a mood stabilizer, practical psychotherapy and judicious use of other medications to quell minor mood swings provides a level of benefit superior to that of people treated for high blood pressure, diabetes or other common chronic or recurrent illnesses.
