Friday, October 10, 2008

Manic Depression Treatment Modalities

Recovery, as defined by SAMSHA (the Substance Abuse and Mental Health Services Administration/Center for Mental Health Services) (http://www.samhsa.gov/) is:

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.


There are a broad range of treatments for Manic Depression. The best page I've seen is this one at the Depression and Bi Polar Support Alliance: http://dabsa.convio.net/site/PageServer?pagename=about_depression_treatmentmain . There are a TON, almost literally, of links on that page to cover every aspect of treatment.
The NIMH treatment page can be found here: http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml

I'd like to touch briefly on the treatments with which I have the most familiarity. Let me preface my remarks about medication by stating Psychotropic medicines should be prescribed by a Psychiatrist. While regular M.D.s CAN prescribe medicines to treat Manic Depression; Psychiatrists have more experience treating Manic Depression and are more knowledgeable about the latest medicines, drug interactions and and side effects.

Medications know as ”mood stabilizers” are on the front line in the battle against Manic Depression and its cycling feature. There are also anti-convulsant drugs that have mood stabilization as a side effect. For a list of medications please go to the NIMH's treatment page:
[http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml]

A caution about using anti-depressants to treat the Depression aspect of M/D. Studies, according to the NIMH have shown:

"that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. "

The anecdotal evidence supports the assertion that people on antidepressants are more likely to have a more severe Depression when the manic period ends. I like to call This side effect “Rebound Depression.”


Psychotherapy/Talk therapy

Therapy can help prevent prevent inappropriate and negative behaviors. It can help the patient [and their family if involved in Family Therapy sessions] recognize the signs of the early stages of each cycle. Once this recognition is established, steps can be taken by the patient, family, therapist and psychiatrist working together to prevent a full blown episode of That aspect of the disorder.
The DBSA has a list of the benefits of therapy:

Understand your illness
Overcome fears or insecurities
Cope with stress
Make sense of past traumatic experiences
Separate your true personality from the mood swings caused by your illness
Identify triggers that may worsen your symptoms
Improve relationships with family and friends
Establish a stable, dependable routine
Develop a plan for coping with crises
Understand why things bother you and what you can do about them
End destructive habits such as drinking, using drugs, overspending or risky sex
Address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability or unpleasant feelings


Therapy can also help you come to terms with the fact you will need medicine for the rest of your life. You CANNOT stop taking it because you feel better. That doesn't mean you're cured. If you go off of medication ALL your symptoms will return. You may be able to stop talk therapy once you've met your goals for therapy, but you will always need medication. The first medicine [or combination of medicines] you try, may not be the one for you. You may have to try several different medications before you find the one[s] that work for you. You may need to tweak the dosages over time, as well.
Despite the effort involved in finding the medicine[s], it's worth it when you fine the correct one[s] for you. The depressions are so much less intense and the mania is just enough to give you energy and creativity without causing the negative aspects of a full blown manic episode.


Another important aspect of treatment is a Thyroid Function test. According to NIMH, many Manic Depressives have abnormal thyroid functioning. Too much or too little of the hormone secreted by the thyroid can play hell with the patient's mood and cycling between moods. If necessary, get the medication and take it.
In some rare cases when medication and therapy are ineffective, ECT [electric convulsive therapy] may be utilized. The NIMH says:

In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.


Even though Manic Depression is what's called a “long term illness” it can be treated. It IS possible to find recovery. The DBSA website :
http://dabsa.convio.net/site/PageServer?pagename=home
contains many links with suggestions that can help a newly diagnosed patient, a patient who has been diagnosed at sometime in the past, and family and friends cope in effective ways with this complex disorder.
If you are a Patient, take comfort in knowing there ARE many resources and solutions available to you. If you are a family member or friend looking to help, there are many strategies and methods you can utilize in supporting the patient. Both websites I've used for my references contain more links to help. Use them, and the sites they refer to as starting points on your personal journey to recovery. It IS possible.

4 comments:

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Thank you.

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