Treating Bipolar Disorder

The article is professionally consulted by Master, Doctor Nguyen Minh Quyet - Psychological consultant, Department of General Internal Medicine - Vinmec Times City International General Hospital.

Bipolar disorder is mostly lifelong. People with a single manic or mixed bipolar disorder diagnosis. Psychotherapy plays an important role in the treatment of bipolar disorder.

1.1. When does bipolar disorder require hospitalization? When the patient has suicidal thoughts and behaviors during a depressive or mixed attack. When the patient acts dangerously towards others during a manic episode. When the patient has a severe affective disorder: No psychosis or psychosis. When the patient resists treatment, the hospital must be forced to seek treatment. When the patient has drug-resistant emotional disorder: at this time, it is necessary to go to the hospital to give an electric shock. When a patient experiences many side effects of the drug, hospitalization is required to correct those side effects. The patient has many serious physical diseases. 1.2. Principles of Bipolar Disorder Treatment Treatment for bipolar disorder should achieve the following goals:
Get rid of the patient's current emotional disturbance. Prevent recurrence. Rehabilitation of patients.

1.3. Attack treatment 1.3.1. Treatment of depressive episodes Use sedatives such as: Quetiapine (Seroquel) at a dose of 300mg/day, Olanzapine 10mg/day. After 3 weeks of treatment, if the patient's depressive symptoms do not reduce by more than 30% of the symptoms, it is necessary to combine with antidepressant drugs. For patients with bipolar disorder during a major depressive episode, it is sometimes necessary to combine antidepressants and sedatives to treat such as:
Depressive patients with psychosis. Patients with depression have suicidal ideation and behavior. Patients with depression are not exposed. Depressed patients refuse to eat. Patients in the depressive phase have many symptoms of autonomic dysfunction. Tricyclic antidepressants: Good indication in cases where depressed patients have many physical symptoms such as fatigue, insomnia, loss of appetite, headache, abdominal pain, joint pain,... Effects of the drug usually appear after 2 - 4 weeks, during this time do not change the drug. Some commonly used medications include Amitriptylin (Elavil), Clomipramine (Anafranil), and Tianeptin (Stablon).
Polycyclic antidepressants: This class of drugs has similar therapeutic effects to tricyclic antidepressants, but has fewer side effects and is better tolerated. Some commonly used drugs are Mirtazapine (Remeron, Tzap, Tazimed, Noxibel), Venlafaxin (Effexor, Velift).
Selective serotonin reuptake inhibitor (SSRI) antidepressants: This is a new class of antidepressants, selectively acting on the serotonin system, with almost no effect on other neurotransmitter systems. It is well tolerated and has very few side effects. This class of drugs includes Fluoxetin (Prozac, Oxedep, Oxeflu), Fluvoxamine (Luvox), Paroxetin (Pharmapar, Wicked, Xalexa), Sertraline (Zolofl, Serenata, Utralen, Zosertr), and Cytalopram (Citopam).
Electric shock:
Indications of electric shock method:
Depression with suicidal ideation. Depression refuses to eat. Tension depression. Depression with psychosis. Depression that has been treated with a full dose of an antidepressant for enough time and still has no effect (called drug-resistant depression). Cases of allergy to antidepressants. Contraindication of electric shock method: for depressed patients with combined damage such as cardiovascular disease, respiratory disease, brain damage due to trauma, encephalitis,...
Electric shock can be selected unipolar or bipolar, classical or electroshock with intravenous anaesthesia with Propofon. Normally, it is necessary to give electric shocks from 8 to 12 times and it can be done every day or every other day.
1.3.2. Treatment of manic and mixed episodes Treatment of manic and mixed episodes should note the following points:
It is necessary to use a combination of mood stabilizers and sedatives. Do not take antidepressants during this period. The use of psychotherapy should be limited. If applicable, it must be combined with mood stabilizers and sedatives. Benzodiazepines are also effective in the early stages of the disease, reducing insomnia and agitation. Drugs and treatments in this phase:
Mood stabilizers: Drugs have the same therapeutic effect as sedatives after 6-8 weeks. In addition, the drug also has the effect of preventing and preventing the recurrence of manic and mixed episodes. And the drug has fewer side effects than the sedative group. However, due to the slow effect, people often combine mood stabilizers and sedatives to treat patients. Some drugs in this group such as Lithium, Valproate, Carbamazepine, Oxacarbazepine, Lamotrigyl, Topiramate,... Sedatives: The drug works to stop manic episodes faster and better than mood stabilizers. The use of parenteral drugs helps to quickly control the psychomotor agitation of a manic episode. Sedatives fall into two groups: Classical tranquilizers: Haloperidol, Aminazin, Levomepromazine (Tisercin). New sedatives: Olanzapine, Amisulprid, Risperidol. Electroconvulsive: This is a very effective and safe treatment for manic and mixed episodes. Usually manic and mixed episodes are controlled after only 4-6 courses of bipolar electroconvulsive shock. Cases where electroconvulsive therapy is used are:
Patients with strong mania, drug resistance. The case of the patient commits suicide in a mixed attack. In case the patient refuses to eat during a mixed attack. In case the patient has tonicity. In case the patient is very agitated, it cannot be controlled immediately by sedation. In case the patient is allergic to the drug.

1.4. Consolidation treatment 1.4.1. Consolidation treatment after depressive episode Continue antidepressant use for at least 6 months at a dose equal to 1/2 - 1/3 of the initial treatment dose. Use in combination with mood stabilizers at a dose of 100 - 150mg/kg body weight. Then, gradually reduce the dose of antidepressant, but keep the same dose of mood stabilizer. In the event that the patient re-appears depressive symptoms, it is necessary to continue taking the antidepressant.
1.4.2. Consolidation therapy after a manic or mixed episode Use mood-modifying drugs at a dose of 1/2 - 1/3 of the loading dose.
Valproat at a dose of 100 - 150mg/kg body weight. Carbamazepine at a dose of 100 - 150 mg/kg body weight. Oxcarbazepine at a dose of 100 - 150 mg/kg body weight. 1.4.3. How long is the consolidation treatment? After consolidating therapy with mood stabilizers for many years, if the patient stops taking the drug, the disease will recur. Therefore, patients need lifelong consolidation therapy.

Psychotherapy plays an important role in the treatment of bipolar disorder. This method is almost always used in combination with other therapies including medication and the patient's lifestyle.
Psychotherapy is often used to improve the patient's understanding of their situation, thoughts, and behaviors, and their ability to maintain confidence and maintain relationships with others. with family and society.