Bipolar disorder treatments evolve constantly because bipolar disorder is one of the most common reasons for disability in the word and thus area of ongoing research for better patient care.
The disorder affects women more than men. However, men tend to manifest the symptoms at greater magnitude.
The treatment for bipolar disorder is very complex because several drugs are used to overcome it.
Occasionally, doctors choose to start with mono-therapy but in most cases, duo and triple therapies are required to put the patient in remission.
The treatment of the patients must be revised depending on their condition. The bipolar disorder consists of two periods- manic period and depressive periods. That is why the treatment has to be adjusted upon the changes happening in the patient. The current bipolar disorder treatment includes: valproate, atypical antipsychotic drugs and carbamazepine.
Lithium is part of the group of drugs known as “mood stabilizers”. Usually the starting dose of this drug is 300mg, two or three times a day.
The maintenance dose is about 900 mg to 1200 mg each day. 0.8 to1.2 meq/L is the quantity of lithium in the blood required to manage the acute manic phase. For maintenance of the current condition, the quantity of lithium in the blood is much lower- 0.6 to 0.7 meq/L.
Before the doctor gives Lithium to the patient, a set of different tests must be carried out to ensure that the patient is capable of handling the drug. Creatinine levels are measured and BUN (Blood Urea Nitrogen) test is conducted. Also, undergoing pregnancy test is recommended for all women that are about to start the treatment.
Creatinine levels and BUN test show the doctor how well the kidneys are handling the lithium. There are many side effects of the drug, including: behavior and mental changes, tremor (flapping)and weight gain.
Lithium dosage has to be regulated each day because lithium has very low therapeutic index. This means that the dose used to cure the disorder is pretty close to the toxic dose. However, Lithium is the drug of first choice during a bipolar disorder treatment.
Valproate is another drug that influences the manic periods. The dosage of valproate is 20 mg/kg/day. The possible side effects are: tremor, hair loss, vomiting and nausea.
Carbamazepine is one of the most effective drugs for dealing with the bipolar disorder. The blood levels of carbamazepine must be around 4 to 12 µg/ml.
Typical antipsychotics - Haloperidol is a typical representative of the group. The drug has very good effect but the side effects are notable. Extrapyramidal symptoms will worse the patient’s quality of life. This makes this drug not a drug of first choice.
However, the overall therapy with Haloperidol has the same effect as the therapy with lithium, carbazepine and valproate.
Atypical antipsychotics (olanzapine- 10mg to 30mg each time before you go to bed; risperidone -1 to 4 mg, taken twice a day; quetiapine – maximum dosage:150 to 400 mg taken twice a day) are representatives of this group. They are capable of handling both the depressive and manic episodes. However, the side effects of this group include: extrapyramidal symptoms, weight gain and diabetes (peripheral insulin resistance) . That is why these drugs are not quite often included in the bipolar disorder treatment.
Maintenance therapy is used to make the patients stay in remission. Typical drugs used in the maintenance therapy are: lithium, carbamazepine, valproate. The clinical trials have confirmed that if the patient is undergoing a therapy with lithium, the risk for committing a suicide is tremendously reduced. This contributes to the reduction of mortality rate.
Lamotrigine is another drug used in the maintenance therapy in dosage of 100mg/day to maximum 400 mg/day. Atypical antipsychotics play important part of the maintenance therapy, too.
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