Medication is just the start . . .
Although Bipolar disorder can’t yet be cured, treatment can do a lot to reduce and even eliminate symptoms.
Combining medication with a healthy lifestyle and support from community services and health professionals can help to keep you well.
Being prescribed one or more drugs with different actions at different times can help you balance your moods.
It’s important to take medication as directed, otherwise your symptoms won’t be controlled as effectively. If you have any side-effects from your medication, tell your doctor – they may be able to reduce or change the dosage, or suggest other ways to manage the problem.
Do I really have to take medication?
Taking medication is one of the most positive things you can do to ﬁght the effects of mental illness – reducing symptoms and the risk of relapse, and improving quality of life. Many symptoms of Bipolar disorder are caused largely by changes in brain chemistry – medication can help restore the usual chemical balance.
Medications for Bipolar disorder
These types of medication are prescribed for Bipolar disorder:
- Mood stabilisers – may be given to treat and reduce the risk of further manic episodes and depression.
- Antidepressants – may be given for a short period if someone feels depressed even though they’re taking mood stabilisers. When you take antidepressants, it’s important to keep taking mood stabilisers – otherwise there’s a risk of developing mania or hypomania.
- Antipsychotic drugs – these can work in a way similar to mood stabilizers, treating both mania and depression, and helping reduce the risk of further episodes. They also prevent or minimize psychotic symptoms such as hallucinations and delusions.
What about side-effects?
It’s important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same unwanted side-effects.
Lithium carbonate is a mood stabiliser that many people find helpful, but can sometimes accumulate in the body and cause unwanted (and potentially harmful) effects.
To prevent this, a blood test is repeated regularly during treatment to monitor the lithium concentration and to confirm that the dose is at the right level. People taking lithium long term should also have thyroid, kidney and central nervous system monitoring to ensure there are no problems.
The signs of lithium toxicity are nausea, vomiting and diarrhoea, usually preceded by increasing tiredness, difficulties in concentrating, unsteadiness and increased thirst. If it appears that someone has a toxic reaction, the treating doctor should be contacted immediately. In most cases of toxicity, the lithium will be eliminated from the body within about two days after stopping the treatment.
Other possible side-effects of lithium (when taken at recommended levels) are a ﬁne tremor, muscular weakness and cognitive difficulties such as memory problems.
Antipsychotic medication, prescribed for some people with Bipolar disorder, can also have side-effects. As with other medications, these vary from person to person. They may include drowsiness, weight gain, dry mouth, problems with sexual function, absence of periods, and a fall in blood pressure when standing which can cause dizziness.
Always tell your doctor about any of these unwanted effects, so that you can discuss ways to avoid or manage and minimise them.
Getting the most from medication
Here are some tips on how to get the most from your medication:
- Don’t be afraid to ask questions about your medication – understanding what a drug does, and why you need it, makes it easier to keep taking it. Ask how the treatment will help you, how it will affect you and about its advantages and disadvantages.
- Make it simpler – using dosage dispensers available from pharmacies or calendars can help you keep on track and make it easy to remember to take medication.
- Let family and close friends know about your medication – people close to you can provide good support when you’re taking medication long term – it’s good for them to understand how the medication helps and what any side-effects might be.
- Always tell your doctor if your medication is causing problems.
- Look after your physical health – including a healthy diet, regular exercise and checkups. If you take an antipsychotic medication, these may cause weight gain as a side-effect, and this is associated with a number of physical health problems. See How to help yourself for more details on what you and your doctor can do to manage it.
How ‘talking therapies’ can help
Talking to your doctor or another mental health professional can be very worthwhile – besides providing support, it can help you learn ways to cope with problems.
There are different types of ‘talking therapy’, including Cognitive behaviour therapy (CBT) and Interpersonal therapy (IPT).
For further information on the different types of therapies available, see Psychological treatments in the Medication and other Treatments guide.
Can ECT (electroconvulsive therapy) help?
ECT is an established, safe treatment that can be helpful for severe depression, mania and psychosis in cases where medication doesn’t help.
It works by using electrical stimulation to release brain chemicals that help restore normal functioning to the brain.
The treatment is usually only given with the consent of the person involved. An exception is when a psychiatrist believes a person is unable to give informed consent and gives the consent for them (but this should only happen after discussing the issue with the person’s primary carer). In some parts of Australia ECT can’t be given unless two doctors agree that it’s the best approach.
The treatment, done in hospital under general anaesthetic, involves passing an electrical current through the brain.
There are not thought to be any long-term adverse effects, apart from memory problems, which are mostly mild and improve with time. These sometimes persist for weeks or (less commonly) months. A headache after treatment is usually gone after a few hours. Studies show that ECT does not cause any ongoing damage to the brain.
Treatment in hospital
In-patient hospital treatment for mental illness is usually only necessary during periods when someone is very ill.
The chances are that their stay will be as short as possible and in the psychiatric unit of a general hospital, rather than a hospital dealing only with psychiatric illness.
Having treatment without your consent
If a psychiatrist or other health processional recommends someone needs treatment and the person doesn’t agree, they may sometimes be treated without their consent. In some parts of the country, this is known as ‘sectioning’ or ‘scheduling’.
The law covering this varies from one State or Territory to another, but the intention is to make sure people have treatment for the sake of their own health or safety, or that of others.
There may be legal limits on how long someone can be treated without their consent, and they may ask to be discharged by a doctor or a body such as a Mental Health Review Board. These facts should be explained to anyone having treatment without their consent.
Getting together with other people who have the same diagnosis as you can really help. As well as overcoming isolation, it’s a good way to share useful information and strategies to help you cope.
To ﬁnd a support group in your area: call the SANE Helpline on 1800 18 SANE (7263) or on SANE Helpline Online.
There may be other useful support services in your area too. These include recreational programs, personal helpers and services that provide support to ﬁnd accommodation or jobs, for instance. Ask your case manager for details.
Will alternative therapies help?
Some people ﬁnd alternative therapies such as acupuncture or herbal medicine helpful. If you decide to try an alternative therapy as well as your prescribed treatment, make sure that there will be no harmful side-effects. Some alternative therapies are not recommended for people with a mental illness (herbal remedies can interact with other drugs, for example) so it is important to discuss using them beforehand with your doctor.
Be wary of anyone who suggests they can cure your condition (when something sounds too good to be true, it usually is).
For more information, see Medication and other treatments.