The bipolar depression treatment is different from that of major depression or unipolar depression treatment. The feelings of sadness and low mood that you experience in the bipolar depression are somewhat similar to those experienced in the major or unipolar depression but they do not have the same line of treatment.
You should not use antidepressants as the long term bipolar depression treatment option, Why? Because there is no benefit in it.
Long term use of antidepressants only increases the chances of switching to the mania and it does not prevent the relapse as well.
Then how do you control your mood in the long run? What is the long term bipolar depression treatment ? Mood stabilizers is the answer in short.
The term mood stabilizers is being replaced now-a-days with anti-manic agents and prophylactic agents. The anti-manic agents are the ones used in the treatment of the acute episode. The prophylactic agents are the one used in the long term treatment.
The anti-manic agents include lithium, risperidone,quetiapine, olanzapine and valproate. The prophylactic agents include lithium and olanzapine. If you do not respond to lithium prophylaxis, carbamazepine can be used.
In bipolar disorder the manic episode begins suddenly and can last for about 4 months on the average. The depressive episode lasts longer, it can last up to 6 months. In-between the episodes you may be partly normal or completely normal. As the time passes , the depressive episodes become common and last long. But do not worry, there is treatment and you can control the depressive and manic episodes and improve your quality of life.
When you are under treatment of your psychiatrist due to the depressive episode, you should visit your doctor frequently at the start of the therapy. I advise that you see your psychiatrist within the first week of your first assessment. After that every 2-3 weeks will be fine for the coming three moths and then depending on your progress. I hope your psychiatrist schedules your appointments the same way.
The treatment of bipolar depression is not identical to that of major depressive episode (unipolar depression). The use of antidepressants in bipolar depression can switch you to manic episode. So, antidepressants are used for only a brief duration and that too in combination with an anti-manic agent because it prevents you from switching.
Are You Already on Anti-Manic medicines or Not?
Are you already on anti-manic medicines and you are having a depressive episode now? Or you have to start an anti-manic medicine? The line of treatment is different for the two situations as I have discussed below, see what fits you best.
If you are not taking anti-manic medicines before and now you are having a depressive episode, the right combination for you is an antidepressant and an anti-manic agent. The anti-manic agent prevents you from switching to mania as I said earlier.
A combination of fluoxetine and olanzapine ( Symbyax) has been effectively used in the treatment of acute bipolar depression without the risk of switching to mania.
If you are already taking anti-manic medicines in the treatment of your bipolar disorder and now you have a depressive episode, you should check the dose of your anti-manic agent and get it adjusted by your doctor.
If the depressive episode is mild and it has not affected your routine, it needs observation only. Observe the development of the depressive episode. You should visit your doctor and inform him about the developing changes. He will observe you for any further changes.
If the previous depressive episode you had was also mild and it did not progress to moderate or severe depression, the chances are that this episode will also not worsen. If you are deteriorating and the depression is getting severe ,treatment should be started.
If you were not taking anti-manic medicines and now you have moderate to severe depressive episode?
As I mentioned earlier, an antidepressant and an anti-manic agent are started. SSRIs ( selective serotonin reuptake inhibitors are used ( tricyclic antidepressants have a higher risk of switching you to mania). The anti-manic agent added is quetiapine, it is an antipsychotic.
What if you do not improve after this treatment?
If you do not respond to the treatment options mentioned, the next step is to integrate psychological interventions in the treatment. The psychological intervention will focus on your depressive symptoms, your problem solving skills, improving your social functioning and educating you about the medicines used in the treatment .
Together the psychological interventions and the medicines will bring you out of the depressive phase.
Antidepressants are Not for Everyone
Starting treatment with antidepressants is not for everyone. In some situations it may put you at risk. Antidepressants should not be given :
If you fall in any of the above category then antidepressants are not the treatment of choice for your as your bipolar depression treatment. Then what is the treatment in this case? You need to increase the dose of the anti-manic agent you are already taking. Obviously you Must not do that yourself, your doctor or psychiatrist will do that for you. Or add another anti-manic agent which means now you will be on a combination of anti-manic agents.
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