Can I be manic, depressed, and Christian
Psychiatry, Psychosomatics & Psychotherapy
If the disease is recognized early and consistently treated, the episodes of the disease can be delayed or even avoided entirely. Modern treatment methods can effectively combat the symptoms of the disease and significantly improve the course, but it is not possible to eliminate the causes. This in turn means: bipolar disorders are chronic diseases that require lifelong treatment. Only if this is clear to those affected and their relatives, the therapy can be carried out permanently and effectively and the quality of life can be decisively improved.
The treatment of bipolar illness is subject to different goals depending on the phase of the illness the person concerned is in.
A distinction is made between:
- Acute therapy
With the growing level of knowledge about the treatment of bipolar disorders and the associated recognition of the complexity of the disease, it has become increasingly clear how important it is to design acute treatment taking into account any drug therapy (mood stabilizer) that may be necessary. Acute therapy begins as soon as an acute phase of illness occurs. The acute therapy is continued until the acute symptoms have improved significantly. Different drugs and non-drug treatments are used depending on the severity and type of symptoms.
- Maintenance therapy
It follows on from acute therapy and is intended to stabilize the patient's condition to such an extent that there is no direct relapse. The aim is to maintain this stable state for at least six to 12 months. A combination of psychotherapy and drug treatment is used for this.
- Relapse prophylaxis
It begins as soon as the mood of the person concerned has normalized and is intended to prevent another acute episode of illness in the long term. How long relapse prophylaxis is carried out depends on the number of phases. If there are three or more phases within 5 years, continuous treatment with medication to prevent recurrence is indicated.
In the case of bipolar diseases, each person affected shows their own spectrum of symptoms, which can vary in severity. It is therefore important to always put the medication together individually. Three main groups of drugs are used today, the mood stabilizers, antidepressants, and atypical antipsychotics. These drugs, which act on the central nervous system and affect psychological functions, only develop their full effect after a few weeks. Therefore the symptoms do not improve immediately. Therefore, the medication must continue to be taken punctually in accordance with the doctor's recommendation, even if it has not yet taken effect.
The mood stabilizers are usually used in all three treatment phases (acute therapy, maintenance therapy, relapse prophylaxis). They compensate for excessive mood swings in both a manic and a depressive illness episode. They can develop this effect both acutely and in the long term. The prevailing mood is stabilized without triggering an opposite episode. These properties make mood stabilizers an important treatment option in the therapy of bipolar disorders, which are also used in phases of relative stability to prevent relapse. It is particularly important to take it at this time in order to prevent repeated episodes of illness.
They include lithium salts and so-called anticonvulsants (especially valproate, but also lamotrigine and carbamazepine). The choice of active ingredient depends primarily on the type of bipolar disease, tolerability and possible concomitant diseases. Lithium salts prevent the recurrence of manic and depressive episodes in up to 80%, at least they significantly weaken the symptoms. In the case of lithium salts, it is important to take them regularly and precisely so that they work properly and do not cause serious side effects. Lithium reduces the likelihood of suicide by 80%, even if there is no improvement in symptoms, while other drugs have an anti-suicidal effect only indirectly (i.e. by improving the depressive symptoms). The risk of overdosing is lower with the anticonvulsants. In general, regular medical check-ups should be carried out while taking mood stabilizers.
Medicines for the treatment of acute depressive and manic phases
In the acute phase of depression, quetiapine and the combination with antidepressants have proven to be effective. In acute manic phases, the mood stabilizer must often be combined with an atypical antipsychotic (e.g. risperidone, olanzapine, aripiprazole) in order to achieve a sufficient anti-manic effect. Sedatives (e.g. diazepam, lorazepam, alprazolam) can be used temporarily for restlessness, aggressive impulses and anxiety states.
Psychotherapeutic methods are used successfully in the treatment of bipolar diseases. In the case of bipolar disorders, they are generally to be regarded as a supplement and not as an alternative to drug therapy (psychopharmacotherapy). With the help of psychotherapy, those affected learn to deal with their illness, to cope better with everyday life and stressful events, to improve their interpersonal relationships and to prevent relapses. He becomes more self-confident and therefore more reliable when it comes to taking medication, for example. Among the various forms of therapy that can be used successfully for bipolar diseases, the psychiatrist must find the most suitable one for his patient. Cognitive behavioral therapy, family therapies, and social rhythm therapy are particularly effective in bipolar disease. Psychoeducation and the involvement of relatives should be part of every treatment.
Electroconvulsive Therapy (ECT)
With ECT, a weak electrical impulse triggers a seizure in the brain. The seizure usually lasts about 20 to 40 seconds and then resolves. The therapy is carried out under general anesthesia, so those affected do not notice the attack. This attack normalizes the mood of the person affected, the exact mechanism is currently unclear.
In the short term, ECT is a very effective method for treating severe depressive and manic episodes of illness (success rate: 80%). It is used when drug and psychotherapeutic treatment does not work or it is not possible to administer medication. However, ECT can only be performed on patients who are in good physical condition. After electroconvulsive therapy, if possible, those affected must take appropriate medication to prevent relapse.
Waking therapy / sleep deprivation
Awake therapy is successfully used in the acute treatment of a severe depressive episode, especially in the case of strong daily fluctuations. Around 50 to 60% of those affected show a significant improvement in symptoms - but often only for a short time. Therefore, drug therapy with mood stabilizers and antidepressants should be carried out at the same time as sleep deprivation.
When it comes to sleep deprivation, a distinction is made between total sleep deprivation (from the morning of the 1st day to the evening of the 2nd day, 40 hours) and partial sleep deprivation (from 1.00 a.m. to the next evening). Both forms have an antidepressant effect, the latter is less stressful for those affected. Sleep deprivation can be repeated once or twice a week, depending on the severity of the symptoms and effectiveness.
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