Most people with manic-depressive illness can be helped with treatment. Almost all people (even those with the most severe forms) can obtain stabilisation of thier mood swings. Because manic-depressive illness is usually long-term illness, and symptoms often relapse, long-term preventive treatment is highly recommended.
A variety of medications are used to treat manic-depressive illness, but even with optimal treatment, many people with manic-depressive illness do not achieve full remission of symptoms.
Lithium has long been used as a first-line treatment for manic-depressive illness. Lithium is usually very effective in controlling mania and preventing reappearance of both manic and depressive episodes.
Carbamazepine and valproate (mood-stabilising anticonvulsants) are drugs which were originally developed for use in epilepsy, but which have also been found useful in bipolar illness, especially for patients who do not respond to other treatment. Anticonvulsant drugs have been used as alternatives to lithium in many cases., but often these drugs are combined with lithium for greatest effect.
It may be that these drugs work because they prevent the brain becoming sensitised to stress. This process has been suggested to be important in bipolar disorder, so that eventually the brain shows episodes of abnormal activity even in the absence of an external trigger. It is thought that lithium acts to block the early stages of this process and that carbamazepine and valproate act later.
During a depressive episode, people with manic-depressive illness commonly require treatment with antidepressant medication. For depressive symptoms, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate. Usually, lithium or anticonvulsant mood stabilisers are given together with an antidepressant to protect against a switch into mania or rapid cycling, which can be brought about in some people with manic-depressive illness by the use of antidepressant drugs.
In some cases, the newer, atypical antipsychotic drugs such as clozapine, risperidone or olanzapine may help relieve severe or treatment-resistant symptoms of manic-depressive illness and prevent relapse of mania. Further research is necessary, however, to establish the safety and efficacy of the atypical antipsychotics as long-term treatments for manic-depressive illness.
The high potency benzodiazepines clonazepam and lorazepam may be useful when added to other drugs. They may help to reduce sleep problems.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications.
Psychotherapy, in combination with medication, often can provide additional benefit. As an addition to drug treatment, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
Studies show acupuncture may affect part of the nervous system that regulates the stress response, and aid patients with bipolar disorder. Acupuncture can be used both as a treatment for bipolar disorder as well as a means to help manage side effects of the medications used to treat bipolar disorder.