Someone with bipolar disorder may need to be hospitalized immediately if it seems that they may be a danger to themselves or others, or if they are psychotic. A person who is experiencing a particularly severe episode of manic-depressive illness should be brought to the hospital immediately to prevent suicide or possible violence to another person. An acute episode is treated with medications and a low-stimulation environment. Depending on the individual's symptoms and history, longer-term hospitalization may be required.
Even in the absence of a crisis, you should seek immediate help at the first sign of a manic episode, as episodes can progress rapidly, with potentially serious consequences.
Family and friends must be aware that someone with bipolar disorder may attempt suicide. Bipolar disorder carries a high risk of suicide. Individuals at particularly high risk are those who express a desire to commit suicide, and who have devised a plan to carry it out. People who are impulsive and have irrational thoughts are also in danger, and may need to be hospitalized to protect themselves.
- Expression of suicidal intent
- Evidence of plans to carry out suicide: e.g., a stash of pills, a weapon
- Extreme agitation
- Extreme weight loss
- Hallucinations or delusions (imaginary thoughts or beliefs, such as hearing voices or believing one has god-like powers)
- Characteristics that can lead to dangerous decisions (e.g., hypersexuality)
Avoid using drugs and alcohol excessively. People with bipolar disorder are at a high risk for drug and alcohol abuse, as they may attempt to use those substances in an attempt to self-medicate. Such efforts complicate treatment efforts, and are usually destructive to their lives.
Learn as much as you can about bipolar disorder. Learning about the disease and recognizing one's own warning signs is very important for managing the problem and knowing when to seek professional care. Sometimes joining a support group or organization for mental disorders can be helpful.
National Institute of Mental HealthInformation Resources and Inquiries Branch6001 Executive BoulevardRoom 8184, MSC 9663Bethesda, MD 20892-9663Phone: 301-443-4513FAX: 301-443-4279http://firstname.lastname@example.org
National Depressive and Manic Depressive Association730 Franklin Street, Suite 501Chicago, IL 60610Phone: 312-642-0049; 1-800-826-3632FAX: 312-642-7243http://www.ndmda.org
National Alliance for the Mentally IllColonial Place Three2107 Wilson Blvd., Suite 300Arlington, VA 22201-3042Phone: 703-524-7600; 1-800-950-NAMI (6264)FAX: 703-524-9094http://www.nami.org
National Foundation for Depressive Illness, Inc.P.O. Box 2257New York, NY 10116Phone: 212-268-4260; 1-800-239-1265FAX: 212-268-4434http://www.depression.org
National Mental Health Association1021 Prince StreetAlexandria, VA 22314-2971Phone: 703-684-7722; 1-800-969-NMHA (6642)FAX: 703-684-5968http://www.nmha.org
Reduce stress in your life, and try to develop regular sleep patterns. Psychosocial stress may be associated with the onset of manic and depressive episodes. Work with your doctor to identify specific stressors, and to develop skills for coping with them. It may be necessary, for example, to take time off rather than "toughing it out" if mood symptoms hinder your ability to work.
Sleep disturbances may signal the early phase of a manic or depressive episode. Recognizing these disturbances and making an effort to maintain regular sleep patterns is thought to be important in preventing symptoms from escalating into a full-blown episode.
Limit your intake limit of common stimulants. Alcohol, caffeine, and some over-the-counter medications, even in small amounts, may interfere with sleep patterns or mood, and possibly trigger a relapse.
Learn to recognize the early warning signs of relapse. Warning signs of relapse vary from patient to patient, and may include thoughts of death (or sudden optimism), or slight changes in sleep patterns (a common indicator), mood, energy, self-esteem, sexual interest, concentration, willingness to take on new projects, and dress or grooming.
Seek out the support of family members and friends.
Call your doctor if you feel strong changes in your usual mood, including suicidal or violent feelings.
Your doctor is the best source of information on the drug treatment choices available to you.
Psychotherapy can be a helpful adjunct to drug treatment. Counseling can help individuals gain further insight into the nature of their problem, and can help them better cope with the disorder. It can also help people recognize early symptoms so that they can seek prompt medical assistance.
Electroconvulsive shock treatment (ECT) can be used for severe depression that does not respond to medications. ECT may be used for people with severe depression and mania who are unresponsive to medication. The procedure involves passing an electric current through electrodes placed on the head to induce a seizure. It is typically given in a series of five to eight treatments, with one treatment given on alternate days. Muscle soreness may result because of the seizure-induced muscle contractions. Temporary memory loss may occur, but is usually not permanent. Because the treatment is done under a general anesthesia, it involves similar risks as other minor medical procedures involving anesthesia, including a very small risk of death.
Despite generalized fears of ECT, most psychiatrists consider it to be a safe and effective treatment that works more rapidly than medications or counseling. It is most commonly used for individuals who are at extreme risk for suicide, for people who have lost a dangerous amount of weight, or for those who are extremely agitated.
Avoid St. John's wort if you are taking medication for bipolar disorder, and discuss any use of complementary/alternative medications (herbs, teas, etc.) with your physician. St. John's wort (Hypericum perforatum), an herbal remedy used for various anxiety and depressive conditions, can potentially interact with drugs prescribed for bipolar disorder. Talk to your doctor before taking any alternative medications.
Some patients use omega-3 fatty acid supplements (fish oil or flaxseed oil) as a complementary treatment for bipolar disorder. The results of a recent study suggest that omega-3 fatty acids may temper the symptoms of bipolar disorder.
A variety of commercially available fish oil and flaxseed oil supplements contain omega-3 fatty acids. Flaxseed oil should not be cooked because doing so destroys the omega-3 fatty acids contained therein.
Manic-depressive episodes recur periodically throughout life. If untreated, cycles of mania and depression tend to recur more frequently, and become more severe over time. Suicide rates tend to be high with this disorder, making proper diagnosis and effective treatment particularly important. Although all symptoms may not be completely eliminated, medications can usually stabilize moods so that a person can lead a normal life.
Patients should follow up with their doctors at regular intervals, and when symptoms recur. After an initial episode, individuals should work closely with their physicians to achieve a maintenance regimen so that episodes do not recur. Medications may need to be periodically adjusted. Patients who are maintained on lithium must have their blood tested routinely to ensure a proper dosage.
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