Mending Moods in People with Manic Depressive Illness

Treating bipolar disorder is a challenge. Not only do doctors have to treat the mania and depression, but sufferers also need long-term medication to prevent relapses. "It's arguably one of the most difficult diseases to treat," says Husseini Manji, M.D., former director of the Mood and Anxiety Disorders Program for the National Institute of Mental Health. "Sometimes, drugs may work for a while, then stop."

Treatment is always highly individualized and typically requires mood stabilizers like lithium, or anticonvulsants such as valproate (Depakote), lamotrigine (Lamictal) and carbamazepine (Tegretol).

Patients may also be given antipsychotic medications such as risperidone (Risperdal), quetiapine (Seroquel), and ziprasidone (Geodon). Sufferers who have trouble sleeping may require a sedative such as clonazepam (Klonopin) or lorazepam (Ativan). Less than half of patients have success with lithium alone, and most people need a combination of drugs to achieve relief and prevent recurrence.

Many drugs have bothersome side effects such as weight gain, nausea, tremors, hair loss and loss of libido, which is why there's often a lengthy trial and error period before finding the right drug or combination of drugs. In December 2014, the FDA warned that ziprasidone may be associated with a rare, but serious skin reaction that may affect other areas of the body. This reaction, which is called drug reaction with eosinophilia and systemic symptoms (DRESS), causes high levels of certain white blood cells (eosinophils) and can be fatal. Symptoms include rash that spreads, fever, swollen lymph nodes, and organ inflammation.

Taking medications is only part of the equation. Many people with bipolar disorder—along with loved ones—need psychotherapy, too. "Bipolar disorder can be catastrophic for relationships and marriages, and interpersonal psychotherapy and marital therapy can help," Dr. Manji says. Therapy can help family members better understand the illness and the patient understand the hardships on the family. Also, certain kinds of psychotherapy, along with medication, might help reduce the risk of relapse and improve medication adherence, adds Manji.

Dr. Mondimore also recommends patients control stress with regular exercise, relaxation techniques, and good sleep hygiene. Eating foods rich in omega-3 fatty acids such as tuna, salmon and mackerel, may help, too. Preliminary studies suggest these fats may help stabilize moods.

But according to Dr. Manji, patients should avoid simple carbs, like bagels and soda, which can cause fluctuations in blood sugar and worsen depression, and stimulants like caffeine and alcohol, which can destabilize moods.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 26 May 2010

Last Modified: 18 Dec 2014