Bipolar Disorder

For many years, psychotherapy for bipolar disorder was not considered an effective treatment because of the nature of the disorder. It was thought that manic episodes were very disruptive in therapy sessions, particularly in group therapy, and depressive moods caused primitive transferences, provocation of conflict (particularly in a group setting), primitive regression, intense denial, vulnerability to frustration, and problematic interpersonal styles.

For this reason, treatment for bipolar disorder has relied heavily on the use of medications. A number of drug types have been tried, including tricyclics, selective serotonin reuptake inhibitors, and lithium. The tricyclic antidepressants cause many unwanted side effects, which include nausea, headaches, dizziness, and drowsiness. They can also interact with other medications the patient is taking with serious consequences. Selective serotonin reuptake inhibitors also cause many unwanted side effects, including sexual dysfunction, and can interact with other medications.

Lithium has proven very effective in treating bipolar disorder through mood-stabilization, and is often used in combination with either tricyclics or selective serotonin reuptake inhibitors. There are differing opinions on its effectiveness, however. Some researchers find that bipolar patients become nonresponsive to lithium if the discontinue the medication for a period of time, while other doubt its efficacy at all. Patient nona

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cations the patient is taking. One side effect is nausea, and a study by Bergeron and Blier (1994) showed that a low dose of cisapride (five mg b.i.d.) produced rapid relief of nausea from SSRIs in eight patients. The effect is thought to be due to cisapride's serotonin-sub.3 antagonistic properties. SSRIs may result in a reduction in sexual function. A study by Rothschild (1995) found that giving the patient a few days off from taking the SSRIs sertraline and paroxetine (from the Thursday morning dose until their Sunday noon dose) resulted in significant improvement in sexual function. It had no effect on patients taking fluoxetine. There were no statistically significant increases in mean Hamilton depression scores in the patients after discontinuation of the SSRIs. This study suggests that a brief holiday from taking sertraline or paroxetine may significantly improve sexual functioning in patients without a significant return of depressive symptoms. SSRIs have been shown to interact with other medications being taken by the patient. Fluoxetine can increase serum levels of clozapine and norclozapine. A study reported in the American Journal of Psychiatry in 1996 looked at the effects of fluoxetine, paroxetine and se

Category: Psychology - B