Most people with manic depressive illness can be helped with treatment. Almost all people with bipolar disorder--even those with the most severe forms--can obtain substantial stabilization of their mood swings. One medication, lithium, is usually very effective in controlling mania and preventing the recurrence of both manic and depressive episodes.
Most recently, the mood stabilizing anticonvulsants carbamazepine and valproate have also been found useful, especially in more refractory bipolar episodes. Often these medications are combined with lithium for maximum effect.
Some scientists have theorized that the anticonvulsant medications work because they have an effect on kindling, a process in which the brain becomes increasingly sensitive to stress and eventually begins to show episodes of abnormal activity even in the absence of a stressor. It is thought that lithium acts to block the early stages of this kindling process and that carbamazepine and valproate act later.
Children and adolescents with bipolar disorder are generally treated with lithium, but carbamazepine and valproate are also used.
Valproate has recently been approved by the US Food and Drug Administration for treatment of acute mania. The high potency benzodiazepines clonazepam and lorazepam may be helpful adjuncts for insomnia. Thyroid augmentation may also be of value.
For depression, several types of antidepressants can be useful when combined with lithium, carbamazepine, or valproate. Electroconvulsive therapy (ECT) is often helpful in the treatment of severe depression and/or mixed mania that does not respond to medications. As an adjunct to medications, psychotherapy is often helpful in providing support, education, and guidance to the patient and his or her family.
Constructing a life chart of mood symptoms, medications, and life events may help the health care professional to treat the illness optimally. Because manic-depressive illness is recurrent, long-term preventive (prophylactic) treatment is highly recommended and almost always indicated.
