How can caregivers find support?

Like other serious illnesses, bipolar disorder can be difficult for spouses, family members, friends, and other caregivers. 

Relatives and friends often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania, extreme withdrawal during depression, or poor work or school performance. 

 These behaviors can have lasting consequences.

Caregivers usually take care of the medical needs of their loved ones. 

But caregivers have to deal with how this affects their own health as well. 

Caregivers' stress may lead to missed work or lost free time, strained relationships with people who may not understand the situation, and physical and mental exhaustion.

It can be very hard to cope with a loved one's bipolar symptoms. 

One study shows that if a caregiver is under a lot of stress, his or her loved one has more trouble following the treatment plan, which increases the chance for a major bipolar episode.

If you are a caregiver of someone with bipolar disorder, it is important that you also make time to take care of yourself.

What are the side effects of mood stabilizers?

Lithium can cause side effects such as:

• Restlessness
• Dry mouth
• Bloating or indigestion
• Acne
• Unusual discomfort to cold temperatures
• Joint or muscle pain
• Brittle nails or hair.

When taking lithium, your doctor should check the levels of lithium in your blood regularly, and will monitor your kidney and thyroid function as well. 

Lithium treatment may cause low thyroid levels in some people.

Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.

Because too much or too little thyroid hormone can lead to mood and energy changes, it is important that your doctor check your thyroid levels carefully. 

You may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

Common side effects of other mood stabilizing medications include:

• Drowsiness
• Dizziness
• Headache
• Diarrhea
• Constipation
• Heartburn
• Mood swings
• Stuffed or runny nose, or other cold-like symptoms.

These medications may also be linked with rare but serious side effects. 

Talk with your doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking.

If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.

How is bipolar disorder treated?

Bipolar disorder cannot be cured, but it can be treated effectively over the long-term. Proper treatment helps many people with bipolar disorder—even those with the most severe forms of the illness—gain better control of their mood swings and related symptoms.But because it is a lifelong illness, long-term, continuous treatment is needed to control symptoms.

However, even with proper treatment, mood changes can occur. In the NIMH-funded Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study—the largest treatment study ever conducted for bipolar disorder—almost half of those who recovered still had lingering symptoms. Having another mental disorder in addition to bipolar disorder increased one's chances for a relapse.

Treatment is more effective if you work closely with a doctor and talk openly about your concerns and choices. An effective maintenance treatment plan usually includes a combination of medication and psychotherapy.

Medications

Different types of medications can help control symptoms of bipolar disorder. Not everyone responds to medications in the same way. You may need to try several different medications before finding ones that work best for you.

Keeping a daily life chart that makes note of your daily mood symptoms, treatments, sleep patterns, and life events can help you and your doctor track and treat your illness most effectively. If your symptoms change or if side effects become intolerable, your doctor may switch or add medications.

The types of medications generally used to treat bipolar disorder include mood stabilizers, atypical antipsychotics, and antidepressants. For the most up-to-date information on medication use and their side effects, contact the U.S. Food and Drug Administration (FDA).

Mood stabilizers are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Lithium (also known as Eskalith or Lithobid) is an effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes.

Anticonvulsants are also used as mood stabilizers. They were originally developed to treat seizures, but they also help control moods. Anticonvulsants used as mood stabilizers include:

• Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania. It is a popular alternative to lithium. However, young women taking valproic acid face special precautions. See the sidebar, "Should young women take valproic acid?"
• Lamotrigine (Lamictal), FDA-approved for maintenance treatment of bipolar disorder. It is often effective in treating depressive symptoms.
• Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal).

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be monitored closely for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. If you take any of these medications, do not make any changes to your dosage without talking to your doctor.

Disclaimer:  The information is from the research study on Bi-polar and taken from International Bipolar Disorder support groups.