Although<unk>  is a prevalent condition associated with morbidity and mortality, there has been an absence of robust clinical trials and systematic reviews that investigate the efficacy of pharmacologic treatments for the hypomanic and depressive phases of<unk> . Thus, the current treatment guidelines for the symptoms of<unk>  are derived and extrapolated from the treatment guidelines in BP-I, along with limited randomized controlled trials published in the literature. The treatment of<unk>  consists of the following: treatment of hypomania, treatment of major depression, and maintenance therapy for the prevention of relapse of hypomania or depression. As<unk>  is a chronic condition, the goal of treatment is to achieve remission of symptoms and prevention of self-harm in patients. Treatment modalities of<unk>  include medication-based pharmacotherapy, along with various forms of psychotherapy. Medications Lamotrigine (Lamictal) is an anticonvulsant that can be used as a mood stabilizer to treat<unk> . The most common pharmacologic agents utilized in the treatment of<unk>  includes mood stabilizers, antipsychotics, and antidepressants. Mood stabilizers Mood stabilizers used in the treatment of hypomanic and depressive episodes of<unk>  include lithium, and the anticonvulsant medications valproate, carbamazepine, lamotrigine, and topiramate. There is strong evidence that lithium is effective in treating both the depressive and hypomanic symptoms in<unk> , along with the reduction of hypomanic switch in patients treated with antidepressants. Furthermore, lithium is the only mood stabilizer to demonstrate a decrease in suicide and self-harm in patients with mood disorders. Due to lithium's narrow therapeutic index, lithium levels must be monitored regularly for prevention of lithium toxicity. There is also evidence that the anticonvulsants valproate, lamotrigine, carbamazepine, and topiramate are effective in the reduction of symptoms of hypomanic and depressive episodes of bipolar disorder. Potential mechanisms contributing to these effects include a decrease in brain excitation due to blockage of low-voltage sodium-gated channels, decrease in glutamate and excitatory amino acids, and potentiation of levels of GABA. There is evidence that lamotrigine decreases the risk of relapse in rapid-cycling<unk> . It is more effective in<unk>  than BP-I, suggesting that lamotrigine is more effective for the treatment of depressive rather than manic episodes. Doses ranging from 100 to 200 mg have been reported to have the most efficacy, while experimental doses of 400 mg have rendered little response. A large, multicenter trial comparing carbamazepine and lithium over two and a half years found that carbamazepine was superior in terms of preventing future episodes of<unk> , although lithium was superior in individuals with BP-I. There is also some evidence for the use of valproate and topiramate, although the results for the use of gabapentin have been disappointing. Antipsychotics Quetiapine (Seroquel) is an antipsychotic that is used to treat acute<unk>  depression Antipsychotics are utilized as a second line option for hypomanic episodes, typically indicated patients who do not respond to mood stabilizers. However, quetiapine is the only antipsychotic that has demonstrated efficacy in multiple meta-analyses of Randomized controlled trials for treating acute<unk>  depression, and is a first-line option for patients with<unk>  depression. Other antipsychotics that are used to treat<unk>  include lurasidone, olanzapine, cariprazine, aripiprazole, asenapine, paliperidone, risperidone, ziprasidone, haloperidol, and chlorpromazine. As a class, the first generation antipsychotics are associated with movement disorders, along with anticholinergic side effects compared with second generation antipsychotics. Antidepressants There is evidence to support the use of SSRI and SNRI antidepressants in<unk> , but the use of these treatments are controversial. Potential risks of antidepressant pharmacotherapy in patients with bipolar disorder include increased mood cycling, development of rapid cycling, dysphoria, and switch to hypomania. In addition, the evidence for their efficacy in bipolar depression is mixed. Thus, in most cases, antidepressant monotherapy in patients with<unk>  is not recommended. However, antidepressants may provide benefit some patients when used in addition to mood stabilizers and antipsychotics, as these drugs reduce the risk of manic/hypomanic switching. However, the risk still exists, and should be used with caution. Non-pharmaceutical therapies Although medication therapy is the standard of care for treatment of both BP-I and<unk> , additional non-pharmaceutical therapies can also help those with the illness. Benefits include prevention of relapse and improved maintenance medication adherence. These include psychotherapy (e.g. cognitive behavioral therapy, psychodynamic therapy, psychoanalysis,interpersonal therapy, behavioral therapy, cognitive therapy, and family-focused therapy), social rhythm therapy, art therapy, music therapy, psychoeducation, mindfulness, and light therapy. Meta-analyses in the literature has shown that that psychotherapy plus pharmacotherapy was associated with a lower relapse rate compared with patients treated with pharmacotherapy alone. However, relapse can still occur, despite continued medication and therapy. People with bipolar disorder may develop dissociation to match each mood they experience. For some, this is done intentionally, as a means by which to escape trauma or pain from a depressive period, or simply to better organize one's life by setting boundaries for one's perceptions and behaviors.
Bipolar II disorder
Bipolar I disorder
Bipolar disorder
Bipolar disorder not otherwise specified
Major depressive disorder
Major depressive episode
Cyclothymia
Dysthymia