Manic depression, which is now more commonly split into the diagnoses of bipolar disorder I and II, is a condition in which people experience destabilizations in mood. This can result in mania (bipolar I), where mood is elevated significantly, thoughts come too quickly, and people may make irrational choices or have some features of psychosis, hypomania (bipolar II), where a lower level of mood elevation occurs, and depression, where mood is low, suicidality may be high, and a sense of hopelessness pervades. These pronounced swings in mood can sometimes cease, but they usually come back, particularly without treatment. The goal of treatment for manic depression is to create an even mood that avoids both highs and lows, and though certain treatments may be more common than others, any person with this disorder and any psychiatrist treating it is quick to point out that treatment is highly individualized over the course of a disease and is subject to change.
There are a few basic elements involved in treatment for manic depression. The first of these is mood stabilization through a variety of drugs called mood stabilizers. A number of these fall into the class of drugs know principally as anti-convulsants. The most common mood stabilizers are lithium, valproic acid (Depakote®), carbamazepine (Tegretol®), and lamotrigine (Lamictal®).
For a long time lithium was most commonly used, and it remains effective for many people. Lamotrigine has grown in popularity, though it is one of the newest mood stabilizers used for bipolar disorder. The other two medications are prescribed often, and specific dosage of any one of these depends on the person. Not all mood stabilizers work equally well for each person, so more than one drug may need to be tried initially, and sometimes people use two mood stabilizers concurrently.
Mood stabilizer treatment for manic depression doesn’t always provide full symptom relief. Other medicines might be prescribed in conjunction with mood stabilizers. Some of the most commonly used belong to a class of medications called atypical antipsychotics. These include Geodon®, Abilify®, Seroquel®, and Zyprexa®. Particularly if the condition is bipolar I and the person experiences some features of psychosis during mania, an atypical antipsychotic might be recommended, but these are very often also used in bipolar II or bipolar I without psychosis.
Additional treatment for manic depression might include antidepressants, but there is argument about their benefit and concern about their use. Many antidepressants can result in mania or hypomania and they need to be used with particular vigilance. Other medications that can prove of use include sleep medicines or tranquilizers like benzodiazepines. Getting the right combination can take significant time, and patients are urged to continue to report any adverse symptoms or unresolved issues as they work with doctors to get this disease under control.
It’s also important to recollect that treatment for manic depression isn’t just drug therapy. Most people benefit from psychotherapy as well. Psychotherapy and drug treatment combined may be most effective in treating this disease and are the general recommendation when a person receives diagnosis of this illness.
