Bipolar Disorder
S. Nassir Ghaemi, MD
What should families do if they think someone is
manic and are fearful?
First of all, very few bipolar patients are dangerous. Only half of patients
with mania have psychotic symptoms at some point in their lifetime. Without
treatment, manic episodes are very brief and usually only last a few weeks
to a few months maximum. With medication, manic episodes only last a few weeks.
Usually these manic symptoms are not dangerous or scary.
If the patient is dangerous, usually it means the patient is not well and
is not taking medication, or the medication isn't working. So, family members
need to get the patient into medical treatment. This may sometimes mean calling
the police or trying to get guardianship for involuntary treatment. It is
very hard, if not impossible, to convince someone that they have bipolar disorder
if they lack insight completely. Being supportive, nonjudgmental, but also
being willing to intervene when necessary - this is the difficult balance
families have to keep. There is no easy answer, but I think the bottom line
is a balance between keeping some kind of alliance or at least communication
with the patient and at the same time making judgments about what is in the
patient's best interest even if the patient disagrees.
Which type of medication is used to treat bipolar
disorder?
The correct diagnosis of bipolar disorder is extremely important because there
is such a difference between bipolar treatment and treatment for unipolar
or major depression.
For unipolar (major) depression, antidepressants are prescribed. In unipolar
depression, 50% of people respond after a month on the first antidepressant.
If they need to try more than one antidepressant, by the third trial, 80%
of people respond. They usually completely respond, recover, and are back
to normal.
For bipolar disorder, mood stabilizers are the cornerstone of treatment.
Mood stabilizers work for both the depressive and manic symptoms. In bipolar
depression, antidepressants also work in the depressive stage. But, once bipolar
patients are well, antidepressants have not been proven to prevent future
depression. Antidepressants may or may not be used in bipolar treatment. There
is a disagreement among psychiatrists whether antidepressants should be used
in bipolar disorder and it is a focus of my research. We generally use it
for the acute depression that is unresponsive to mood stabilizers alone or
during suicidal periods.
The risk of antidepressants in bipolar patients is that it can induce mania.
This is a common occurrence. Also, there is some risk that antidepressants
could worsen the course of bipolar treatment. Bipolar patients on antidepressants
may have more episodes of depression or mania and rapid cycling episodes.
The antidepressants may act as mood destabilizers, counteracting the benefits
of the mood stabilizers. In my opinion, and I think most of the scientific
literature supports this view, it is important to not use the antidepressant
chronically in everyone in long-term treatment. The important point is to
make sure bipolar patients receive an effective mood stabilizer, since some
clinicians prescribe not enough or no mood stabilizers. Antidepressants should
be used, but cautiously.
© 2001 Families for Depression Awareness
