Bipolar disorder is a difficult and key clinical point in psychiatry, with diverse clinical manifestations and difficult treatment, requiring individualized treatment plans based on the patient’s condition, coupled with the episodic nature of the disorder, which can easily fluctuate and recur if medication is not systematically administered. I hope this article can help you solve some confusion on bipolar disorder.
I. What is bipolar disorder?
It is an affective disorder with the clinical manifestation of alternating manic episodes or depressive episodes.
Sometimes patients show manic episodes: high emotion, talk a lot, speak fast, love to lose temper, love to be nosy, feel good about themselves, good brain, exaggerate. In severe cases, the patient is extremely excited and incoherent.
Sometimes it is also manifested as depressive episodes: depressed mood, feeling that living is meaningless, less talkative, less active, less interested, less appetite, brain has become stupid, and often waking up early. In severe cases, suicidal behavior may occur.
Patients are in two extremes of mood: manic state and depressive state, both of them can alternate, sometimes manic is the main, sometimes melancholy is the main, also can be depressed after the episode can also be followed by manic, and vice versa, also can be cured after an episode into intermittent period, completely back to normal, all kinds of reasons caused in an episode.
The cause is unknown, but it is generally believed to be caused by various factors, such as pre-morbid personality, bad life and work events, genetic factors, stress, etc. These factors lead to the imbalance of neuroendocrine neurotransmitters in the brain, resulting in the appearance of depressive or manic symptoms, and medication can normalize the imbalanced neuroendocrine neurotransmitters, thus restoring the mood to normal. Add a sentence: The functions of the brain are transmitted through neurotransmitters, which are like letter carriers to transmit information and perform physiological functions.
Second, the performance type of bipolar disorder: the performance type determines the development of the treatment plan.
1, heavy mania + heavy depression type: the patient manic and depressive episodes, the condition are relatively heavy.
2.Heavy manic + light depressive type: the condition is heavy when manic attack, and the condition is light when depressive attack.
3.Light mania + heavy depression type: the condition is light when manic attack, and the condition is heavy when depressive attack.
Several special cases.
1.Rapid cycle type: a total of 4 or more manic or depressive episodes within a year is called rapid cycle. It is tricky to treat and often requires combined medication.
2. With psychotic symptoms: It refers to whether manic or depressive episodes appear with psychotic symptoms such as hallucinations and delusions. Need to take antipsychotic drugs.
3, seasonal affective disorder: these patients are prone to mania in spring and depression in autumn. It is recommended to take relevant medications in advance.
4.Symptoms of mania appear at the end of antidepressant treatment when depressed, and symptoms of depression appear at the end of antimanic treatment when manic, and mania and depression are transformed back and forth.
5, antidepressants induced mania: If it is depression, taking antidepressants to appear manic symptoms, it is generally considered to be bipolar affective disorder and not considered to be pharmacogenic. If it is not depression, such as anxiety disorder, or somatization disorder patients, taking antidepressants appear manic symptoms, this is the pharmacogenic mania, stopping the drug can disappear.
6.Mixed type: In one episode, there are both depressive and manic manifestations.
Third, the drug treatment of bipolar disorder.
1, emotion stabilizer: is the basic drug of bipolar affective disorder medication, whether you are manic or depressed or in remission, you have to take emotion stabilizer, this kind of drug firstly has the role of treatment and relapse prevention for mania, and secondly has a certain role of treatment and prevention for depression. Currently recognized: lithium carbonate, sodium valproate, carbamazepine, lamotrigine is also currently considered as a mood stabilizer. Sodium valproate, carbamazepine, and lamotrigine are also classical antiepileptic drugs.
2, atypical antipsychotic drugs: there are olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, these drugs mainly have better therapeutic effect on manic seizures, commonly used are olanzapine, quetiapine.
3, antidepressants: preliminary understanding of the drug treatment of depression, for patients with bipolar disorder, depressive episodes are recommended to choose SSRI drugs: fluoxetine, paroxetine, fluvoxamine, citalopram, sertraline or bupropion, because these two types of drugs are not easy to induce mania. Do not take tricyclic drugs: such as amitriptyline, doxorubicin, etc., easily induced mania.
Third, the treatment principles of bipolar disorder:
1, a long time to take medication treatment principle: biaxial affective disorder is a characteristic of the episodes, only take medication for as long as possible to better control the episodes, to maintain a good mental state, many patients have a great resistance to take medication, in fact, biaxial affective disorder and hypertension, diabetes, like, need drug maintenance treatment, otherwise prone to fluctuations in the condition, so for your health Please adhere to the medication.
2, the principle of individualization: the principle of individualization of drug treatment means that different patients, even if the diagnosis is the same, the same age and gender, physical condition is similar, there will be significant differences in the effect of drug treatment, the dose of drugs that work, the side effects of drugs will also use a great difference. There is another layer of meaning: each patient’s seizure form may have its own characteristics, and the specific treatment plan should be formulated according to his condition and the characteristics of the seizure.
Pharmacological treatment in manic episodes: according to the condition, emotion stabilizers, atypical antipsychotics, tranquilizers: clonidine intramuscular injection, traditional antipsychotics: haloperidol or chlorpromazine intramuscular injection are given. Intramuscular medications are used to control arousal quickly, as most of the affect stabilizers take 2-3 weeks to take effect. Olanzapine is a good drug in controlling mania, with good effect and small side effects; quetiapine is also available. As for other atypical antipsychotics: risperidone, aripiprazole tablets, ziprasidone, I have used them less and have not enough experience.
Medication for depressive episodes: It is generally believed that if the depressive condition is mild, antidepressants are not needed to avoid inducing mania. If the patient is heavy in depressive episodes and light in mania, it is recommended to take antidepressants early, after all, depressive episodes will have the risk of suicide, and mild mania will not be too dangerous.
Treatment in remission: insist on taking the emotion stabilizer, personally I think for the episodes with many times you can add small dose of olanzapine or quetiapine.
Note: electroconvulsive therapy has a good therapeutic effect on both manic episodes and depressive episodes, especially on depressive episodes accompanied by serious suicidal ideas and very excited manic episodes, the efficacy is very good, the effect is fast, and the condition can be controlled quickly.
Problems of combined medication.
The clinical manifestations of bipolar affective disorder are complex and diverse, often monotherapy is not effective, schizophrenia is generally recommended for single medication, bipolar affective disorder is different from him, combined medication may be more effective, and combined medication is generally recommended. Emotion stabilizer + emotion stabilizer: lithium carbonate + sodium valproate is more commonly used.
Emotion stabilizer + atypical antipsychotics: emotion stabilizer + olanzapine, quetiapine, etc.
Patients with refractory bipolar disorder: a combination of three drugs may be required, e.g., 2 emotion stabilizers + atypical antipsychotics, or 1 emotion stabilizer + 2 atypical antipsychotics.
We wish all patients a speedy recovery and a smile on every patient’s and family’s face.
As for which medication is appropriate for each patient, it is necessary to consider the patient’s condition, previous medication experience and the effect after taking the medication, the patient’s tolerance of the medication, side effects, and also the patient’s financial situation, and then make a decision after comprehensive consideration, and then follow up with the patient to adjust the treatment plan at any time, so that the patient can gradually move toward recovery and let smiles bloom on the face of each family member.