Bipolar Disorder (Manic-Depressive Illness): Therapy

Other treatment options (mania)

The following measures are recommended:

• Keep mood diaries
• Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
  • Self-management as part of coping with the disease; in this context also references to self-help contact points.
  • Individual interventions
    • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.
    • Training of everyday and social skills
    • Artistic therapies
    • Occupational therapy – work or occupational therapy.
    • Movement and sports therapies
    • Health promotion interventions
  • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.
• Psychotherapy
• Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy) – for severe treatment-resistant manic episodes.
• Repetitive transcranial magnetic stimulation (rTMS) – currently still experimental.
• Supportive: occupational, art, music, dance therapy.

Other therapy options (depression)

The following measures are recommended:

• Keep mood diaries
• Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
  • Self-management as part of coping with the disease; in this context also references to self-help contact points.
  • Individual interventions
    • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.
    • Training of everyday and social skills
    • Artistic therapies
    • Occupational therapy – work or occupational therapy.
    • Movement and sports therapies
    • Health promotion interventions
  • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.
• Psychotherapy – psychoeducation, cognitive behavioral therapy (CBT), family-focused therapy (FFT), interpersonal/social rhythm therapy.
• Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy) – for severe treatment-resistant depressive episodes.
• Repetitive transcranial magnetic stimulation (rTMS) – currently still experimental.
• Light and awake therapy can be used adjunctively in phase-specific therapy for bipolar depression.
  • In a small placebo-controlled study, remission rates were threefold higher with light therapy (six weeks of 7,000-lux daylight therapy (color temperature 4,000 Kelvin)) than in a control group with red light.

Other therapeutic options (phase prophylaxis)

The following measures are recommended:

• Keep mood diaries
• Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
  • Self-management as part of coping with the disease; in this context also references to self-help contact points.
  • Individual interventions
    • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.
    • Training of everyday and social skills
    • Artistic therapies
    • Occupational therapy – work or occupational therapy.
    • Movement and sports therapies
    • Health promotion interventions
  • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as recovery processes (recovery processes).
• Psychotherapy – psychoeducation (group psychoeducation), cognitive behavioral therapy (KVT), family-focused therapy (FFT), interpersonal / social rhythm therapy, cognitive-behavioral psychotherapy (for the prophylaxis of depressive episodes).
• Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy).
• Supportive: occupational, art, music, dance therapy; relaxation techniques such as progressive muscle relaxation (PMR).

Other therapy options (rapid cycling)

The following measures are recommended:

• Keep mood diaries
• Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
  • Self-management as part of coping with the disease; in this context also references to self-help contact points.
  • Individual interventions
    • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.
    • Training of everyday and social skills
    • Artistic therapies
    • Occupational therapy – work or occupational therapy.
    • Movement and sports therapies
    • Health promotion interventions
  • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.
• Psychotherapy
• Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy).

Other measures that have a positive effect:

• Preservation / creation of a job
• Strengthening of own skills
• Community-based and need-oriented outpatient services expand

Other treatment options (suicidality)

The following measures are recommended:

• Psychotherapy
• Electroconvulsive therapy (ECT; synonym: electroconvulsive therapy) – for severe treatment-resistant depressive episodes.

Nutritional medicine in bipolar disorder (manic-depressive illness)

• Nutritional counseling based on nutritional analysis
• Nutritional recommendations according to a mixed diet taking into account the disease at hand. This means, among other things:
  • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
  • High-fiber diet (whole grains, vegetables).
• Observance of the following special dietary recommendations:
  • Diet rich in:
    • Vitamins (folic acid, vitamin D).
    • Minerals (magnesium)
    • Trace elements (zinc)
    • Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – at least once or twice a week fresh sea fish, i.e. fatty marine fish such as salmon, herring, mackerel).
    • Secondary plant substances (eg isoflavones (phytoestrogens)).
• Selection of appropriate food based on the nutritional analysis
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Endurance training (cardio training).
• Motor activity – higher physical activity led to better mood and higher energy levels
• Creation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
• Detailed information on sports medicine you will receive from us.

Psychotherapy

• Psychosocial procedures/measures according to S3 guideline: psychosocial therapies for severe mental illness.
  • Self-management as part of coping with the illness; in this context also references to self-help contact points.
  • Individual interventions
    • Psychoeducation – systematic didactic-psychotherapeutic interventions designed to inform patients and their families about the disease and its treatment, to promote understanding of the disease and self-responsible management of the disease, and to help them cope with the disease.
    • Training of everyday and social skills
    • Artistic therapies
    • Occupational therapy – work or occupational therapy.
    • Movement and sports therapies
    • Health promotion interventions
  • Ambulatory psychiatric care (APP) as an aid in times of crisis to establish self and disease history and to promote individual as well as recovery processes.

Training

• Instructions for patients taking lithium:
  • Avoid loss of fluency (e.g., fever, severe diarrhea, or vomiting) and saline deficiency; if loss of fluency occurs, discontinue lithium and monitor serum levels immediately
  • Drink enough, esp. in heat or physical exertion.
  • Contraindications ((interactions) for lithium note, ie no intake of ACE inhibitors, calcium antagonists, diuretics, NSAIDs (eg, diclofenac, ibuprofen) without consulting the lithium-prescribing doctor.
• Education about side effects and signs of intoxication (stop taking lithium and immediately check serum levels).
• Contraception counseling (counseling about contraception).