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28.07.2014

Mood stabilizers for bipolar depression, herbal remedy for tinnitus - For Begninners

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The term mood stabilizer first originated with the use of lithium salts when it was discovered they could assist with alleviating mania.
Along with lithium, other mood stabilizers such as lamotrigine, carbamazepine, valproate and atypical antipsychotics such as olanzapine and aripiprazole have been approved for the prevention of mania, acute mania treatment and depression associated with bipolar disorder. The currently accepted and recognized use for mood stabilizers by the Food and Drug Administration is for the treatment of acute mania and acute bipolar depression, with the goal of stabilizing the existing manic or depressive episode in a timely fashion.
Lithium was the first maintenance medication approved for use in bipolar disorder, followed by lamotrigine.
It can prove to be quite difficult to treat mixed states of bipolar disorder because it is the manifestation of the combination of depressive and manic features. It is quite easy for one to experience an adverse reaction with lithium therapy if it is not used appropriately. Newer agents such as antipsychotics, other anticonvulsants (gabapentin, pregabalin, topiramate, tiagabine, oxcarbazepine, levetiracetam, zonisamide and ethosuxide), benzodiazepine, calcium channel blockers, and omega-3 fatty acids are also being used to treat mood disorders.
With the growth of the use of mood stabilizers, these agents are also being used for off-label indications. The long-term risks that can be associated with the use of mood stabilizers can be observed with more notable agents such lithium, which can cause hypothyroidism, goiter and reversible diabetes insipidus. A 20-year-old woman with a past medical history of bipolar I disorder is brought in by police after attempting to commit suicide by jumping from a bridge.
Although lithium is the prefered first line treatment for bipolar disorder, renal impairment increases the risk of lithium toxicity, and thus is a contraindication for lithium therapy.Lithium, which is a first line therapy for bipolar disorder, is notorious for having a narrow therapeutic window.
First, before treatment actually starts, you and your doctor must be sure that you don’t have thyroid changes causing your mood problem. For many people, a very important part of bipolar disorder treatment is getting help coming to terms with having the illness at all. Unfortunately, most psychotherapists (as of 2008) are not specifically trained in the bipolar-specific versions of these therapies.
The research behind these approaches has been summarized on a separate page on this website, Psychotherapies for Bipolar Disorder. Meanwhile, however, the good news is that we have at least ten different ways of treating depression in bipolar disorder, without using antidepressants. If you’ve just been diagnosed as bipolar, most doctors will add a mood stabilizer to your antidepressant. If you’re currently on a mood stabilizer and not doing well, then in my view you need to ask your doctor what risks she sees in tapering off the antidepressant. I advise patients that they have not had an adequate trial of mood stabilizers if they were simultaneously on an antidepressant at the time.
Bipolar I is a long-term illness that usually requires lifelong preventive strategies, at least after several manic or depressed phases have occurred.
I have seen mood stabilizers seem to make people more depressed than they were before they started, so that is worth watching for (we stopped the medication and things got better; then tried other approaches).
Since the introduction of lithium to the United States in 1969, other drugs have been approved and released into the market as mood stabilizers. If the episode is not effectively treated, it can lead to residual symptoms of mania or depression that can be associated with recurrences of the illness.
Second-generation antipsychotics are now becoming increasingly utilized as maintenance treatment for bipolar disorder as well. The use of the olanzapine-fluoxetine combination, olanzapine monotherapy, aripiprazole and quetiapine have also shown some efficacy, according to controlled studies, when it comes to reducing the depressive and manic episodes in individual with rapid-cycling bipolar disorder. But with the few studies that have examined the treatment response with mood stabilizer, carbamazepine has shown promise, as well as some second-generation antipsychotics. While the FDA does not promote the use of off-label indications, mood stabilizers are being used for other conditions such as the treatment of aggression, augmentation therapy in resistant schizophrenia and post-traumatic stress disorder to name a few.
Some individuals can also develop cogwheeling and mild signs of parkinsonism, and there can be the gradual development of slowed mentation and forgetfulness indicating a mental deficit. Like riding a slow-motion roller coaster, patients may spend weeks feeling like they're on top of the world before plunging into a relentless depression. It is intended for general informational purposes only and does not address individual circumstances. His family and friends said that for the last 2 weeks he had been increasingly grandiose, had been sleeping 3-4 hours per night, and had not gone to work.
Her family reports that for the past week she had been sleeping one hour a night, spending all day shopping for clothes, and exhibiting rapid and uninterruptible speech. Then skim through again and take some of the links in each section for more details on concepts of particular interest to you. One approach that is crucial for most patients with bipolar disorder is to maintain a regular daily schedule, especially regular patterns of sleep. Three major forms of bipolar-specific psychotherapy emphasize this process of acceptance and change.


Unless you live near one of the training centers for these methods, you may not be able to find a therapist who who has had specific training on using such an approach. But that’s really tough, especially since motivation goes missing during bipolar depression, and most of those approaches require either motivation or a really good system of habits. Many doctors shy away from talking about bipolar disorder as a possible diagnosis because the think the risks of the treatments are much greater than the risks of antidepressants, for example. While your mind may leap to considering the risks, you should step back first and consider the evidence for effectiveness, of any treatment you’re considering. Some experts think that antidepressants do not have a role at all in treating bipolar depression, except perhaps as a maneuver of last resort.
Overall, this is thought to occur between 20 and 40% of the time when a depressed patient with bipolar disorder is given an antidepressant.
This means that mood experts agree these are the best choices as a place to start if you’ve never taken a mood stabilizer before.
The reason for looking closely at fish oil is not the great results in research trials, although there are some; but rather the complete lack of any risk known at this point.
Recent research suggests that thyroid hormone, which is very inexpensive, may be both an antidepressant and a mood stabilizer, at least in women (2010); this has been under study for years, but with recent emerging evidence has climbed much higher on my list of options. I have seen this happen many, many times: so many, in fact, that I routinely rely on the mood stabilizers to help depressed people, and taper off their antidepressants, even while they are depressed.
Bipolar II is less well defined but intuition is generally correct: the longer people have had symptoms, the longer it makes sense to continue the medication before a trial of tapering it off.
Bipolar disorder in many cases seems to progress, as though each cycle was increasing the likelihood and the severity of yet more cycles. Mood stabilizers are also considered to be the cornerstone of maintenance therapy, but there is only some evidence to support their use.
The treatment of rapid-cycling bipolar disorder (four or more cycles per year) and mixed states is another use for mood stabilizers. The potential for misuse is not an option when it comes to valproate, because this can potentially turn out to be fatal.
She has gained a wealth of knowledge and training with the completion of residency training programs and being in practice for more than five years. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. He stresses, however, that "it isn't a problem" because he is still "full of energy" during the day at his banking job, which he "could do in [his] sleep anyway." He has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. Renal failure, hyponatremia, and dehydration all increase likelihood of lithium toxicities, and are thus contraindications for lithium therapy. For several hours, the patient is overcome by fits of laughter and refuses to answer questions.
Usually your doctor will also order other tests at this time, if you have not had a recent check of cell counts and blood chemicals, to make sure you don’t have other potential medical causes for your mood problems. All of them are variations on techniques which have been around for a long time: cognitive behavioral therapy, interpersonal therapy, and family therapy. Worse yet, the training manuals for these therapies, which are easily obtained, tend to focus on Bipolar I.
But if you read Prozac Backlash, which offers an extreme view of the possible risks of antidepressants, you’d probably think at least some of the mood stabilizers look better, by comparison. Such experts point either to the lack of evidence for sustained benefit, or the several lines of evidence that they can do harm. For details, first read basics about thyroid and bipolar disorder; then see my page on high-dose thyroid hormone. In many people, eventually a full depression episode occurs again, despite being on an antidepressant, even one that “worked” before! Left uncontrolled for a period of time, it can worsen so that previously effective treatments are no longer adequate. The patient's medical history is significant for diabetes, hypertension, hepatitis C, stage II chronic kidney disease, and congenital long QT syndrome. If you include the risk of antidepressants making bipolar disorder worse, then the risks of the mood stabilizers could be regarded as roughly in the same realm as the risks of antidepressants.
More details about the role of antidepressants in bipolar disorder treatment, including links to relevant articles that form the basis of my view, and a summary of an alternative point of view, can be found on the Antidepressant Controversies page. For some people, you can even say that the antidepressant is causing depression, by making the cycling continue, including cycling into depression. There are several studies in Bipolar I which seem to indicate that rapidly discontinuing lithium leads to rapid relapse, where tapering off does not present that risk. Depressive Phase SymptomsWithout treatment, a person with bipolar disorder may experience intense episodes of depression. The bipolar-specific versions simply incorporate some special features pertinent to people with bipolar disorder.


For lithium at least, stopping should take months, decreasing by 150mg increments all the way to zero; and this probably applies, by extension (for the moment, at least, until we have some data to go on), to other mood stabilizers. But listen to this statement from one of the most widely respected bipolar experts in the world, Dr. In other words, there is general agreement that antidepressants are not the first thing to turn to in the treatment of bipolar depression.
Risk factors for suicide are male sex, young age, early phase of illness, alcohol abuse, and previous suicide attempts.Osiro et al. This can result in inflated self-esteem, agitation, reduced need for sleep, being more talkative, being easily distracted, and a sense of racing thoughts.
Having three or more of these symptoms nearly every day for a week may indicate a manic episode. Bipolar IIPeople with bipolar I disorder have manic episodes or mixed episodes and often have one or more depressive episodes. People with bipolar II have major depressive episodes with less severe mania; they experience hypomania, a condition that is less intense than mania or lasting less than a week. It's more common in people who develop bipolar disorder at a young age, particularly during adolescence. Bipolar Disorder and Daily LifeBipolar disorder can disrupt your goals at work and at home.
The unpredictable mood swings can drive a wedge between patients and their co-workers or loved ones. Bipolar Disorder and Substance AbuseAbout 60% of people with bipolar disorder have trouble with drugs or alcohol. Patients may drink or abuse drugs to relieve the uncomfortable symptoms of their mood swings.
Bipolar Disorder and SuicidePeople with bipolar disorder are 10 to 20 times more likely to commit suicide than people without the illness.
Diagnosing Bipolar DisorderA crucial step in diagnosing bipolar disorder is to rule out other possible causes of extreme mood swings.
A psychiatrist usually makes the diagnosis based on a careful history and evaluation of the patient's mood and other symptoms. Medications for Bipolar DisorderMedications are key in helping people with bipolar disorder live stable, productive lives. Between acute states of mania or depression, patients typically stay on maintenance medication to avoid a relapse. Talk Therapy for Bipolar DisorderTalk therapy can help patients stay on medication and cope with their disorder's impact on work and family life. Cognitive behavioral therapy focuses on changing thoughts and behaviors that accompany mood swings. Interpersonal therapy aims to ease the strain bipolar disorder may place on personal relationships.
Lifestyle Tips for Bipolar DisorderEstablishing firm routines can help manage bipolar disorder. Patients should also learn to identify their personal early warning signs of mania and depression. Electroconvulsive Therapy (ECT)Electroconvulsive therapy can help some people with bipolar disorder.
Educating Friends and FamilyFriends and family may not understand bipolar disorder at first.
They may become frustrated with the depressive episodes and frightened by the manic states. Having a solid support system can help people with bipolar disorder feel less isolated and more motivated to manage their condition. When Someone Needs HelpMany people with bipolar disorder don't realize they have a problem or avoid getting help. If you're concerned about a friend or family member, here are a few tips for broaching the subject. Point out that millions of Americans have bipolar disorder, and that it is a treatable illness -- not a personality flaw.
There is a medical explanation for the extreme mood swings, and effective treatments are available.



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