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How do we treat bipolar disorder? Specifically, how do we treat mania or depression associated with bipolar disorder? The treatment of these two clinical states is not the same.

The treatment of mania is dependent upon its severity and acuity. For mild to moderate mania, mood stabilizers such as lithium and valproic acid (Valproate) are still the standard of treatment and may be sufficient to contain the symptoms. Lithium starts to work after 10 to 14 days while valproic acid, about 7 to 10 days.

Also, recent studies have shown the effectiveness of atypical antipsychotics such as risperidone, olanzapine, and quetiapine even when used alone to treat the acute phase of bipolar disorder.

These drugs are relatively safe but they don t come without side effects. Nausea, vomiting, tremors, and dizziness during the initial phase of treatment are commonly experienced. The more serious side effects such as renal and thyroid problem from lithium, liver dysfunction and pancreatitis from valproic acid, and increased risk of diabetes and high cholesterol from atypical antipsychotics are uncommon. However, regular blood tests are required to monitor any abnormalities.

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For moderate to severe cases, atypical antipsychotics such as risperidone and quetiapine should be added to the mood stabilizers during the acute phase. Once the illness has stabilized and the symptoms have subsided, then the atypical neuroleptics can be gradually tapered off. But the mood stabilizers should continue. Regardless of severity, patients usually do well on a combination of mood stabilizer and atypical antipsychotic during the acute phase.

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What is the treatment for bipolar depression? In general, the mood stabilizers dosage should be optimized or if the patient is not on any medication yet, a mood stabilizer such as lithium should be started. Physicians should make sure that the medication maintains a therapeutic level. If not, the dosage should be adjusted. Moreover, possible precipitants such as stresses at home should be addressed.

If these measures don t help and the depression is so severe, an antidepressant with the least risk to induce mania such as bupropion should be added to the mood stabilizer. When the depression is resolved, then the antidepressant can be gradually tapered off because its prolonged use even in the presence of mood stabilizer can still induce mania.

When should the medication be discontinued? Bipolar patients have to continue taking the medication for several months even after they become normal. High relapse rate is common if medications are prematurely stopped. Also, for patients with multiple or difficult-to-treat episodes, they may need to take the medication for years or even for life to prevent recurrence.

Patients and their physicians should thoroughly discuss the risk and benefits of any treatment intervention. Knowledge about the drug s indication, side effects, and prognosis with or without treatment is a must.

Furthermore, it is crucial that bipolar patients should also receive individual psychotherapy to help them deal with the many personal and psychosocial issues they face on a daily basis. As you know, medication alone won t suffice to address financial problems, marital conflict, work issues, and prior abuse.

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In summary, the combination of medication and psychotherapy is the best treatment for bipolar disorder.

About the Author

Copyright 2004. Dr. Michael G. Rayel author (First Aid to Mental Illness Finalist, Reader s Preference Choice Award 2002) psychiatrist, and inventor of Oikos Game: A Personal Development and Emotional Skills Game. For more information, please visit www.oikosgame.com.

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Easy Costumes Kids Can Make

 by: Wendy Legendre

Kids love making things with their own hands, including costumes. The two costumes that follow, a flower and a bumblebee, are so easy to make and just perfect for children to help create.

To make a bumblebee you will need …

• 1 Yellow Garbage Bag
• Black Electrical Tape
• A Hair Band
• 2 Pipe Cleaners

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• 2 Small Foam Balls (available at craft and dollar stores)

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To make the body, lay the yellow garbage bag flat on a table and have your child hold it down, while you cut and place four stripes of electrical tape across, front and back. Your child can then press the tape down snuggly. (Each stripe needs 3 widths of the tape.) Finally, cut holes out for the arms and the head. Note: If you make a mistake, clear packing tape or scotch tape works wonders.

To make the antennae twist 2 pipe cleaners to the hair band and then, push a foam ball onto the other end of each pipe cleaner (the wire inside the pipe cleaners makes this easy). Note: Before adding the pipe cleaners, wrap them around a pencil to give them that curly look and add strength.

To make a flower you will need …

• 1 Green Garbage Bag
• Several Sheets of Colored Paper
• Scotch Tape

To make the body, Cut head and arm holes out of the green garbage bag.

To make the head of the flower, cut a 2-inch wide strip of paper and wrapped it around your child’s head from the top of her head to her chin, being sure to create a comfortable fit. Tape it and remove it. Next, cut out several petals about 5-6 inches high by 3-4 inches wide. Let your child pick the colors she wants for her petals. Cut the petals by eye, or create a pattern first (wide and rounded at the top and tapering at the bottom.) Next, attached the petals all along the inside edge of the band you just made and finally, fold the petals outward. Note: The number of petals will depend on your child’s preference.

If the flower headpiece wants to slip off, add a second strip of 2-inch wide paper to the first one from approximately ear to ear, around the back of the head.

Upon completion, your child will not only look adorable, but will be thrilled with knowing she helped make her own costume.

Please remember, plastic bags are not a toy and should be used with caution, under adult supervision.

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