What is the course of a bipolar disorder?
A person with a bipolar disorder has an average of seven to eight manic-depressive phases in his or her life. This is significantly more frequent compared to normal depression, which has about three to four relapses. A mania usually lasts for about two to three months, while the depressive phase can last up to six months.
It becomes particularly problematic for those affected when the phase changes. A type 1 bipolar disorder is present if there is at least one pronounced manic phase and one further emotionally disturbed episode. It can also be present if at least two episodes of mixed moods are present.
In type 2 bipolar disorder, the depressive episode predominates. In addition, there is a weakened mania with slight elevation of the mood and somewhat increased drive. One speaks of rapid cycling when there are at least four phases of mania, light mania or depression within a year.
Rapid cycling occurs particularly in bipolar disorders type 2. Those affected experience an average of seven to eight episodes of their bipolar disorder. The depression lasts for about five to six months. The manic phase usually lasts two to three months.
Non-drug treatment of the bipolar disorder
The treatment of a bipolar disorder must be carried out by a psychiatrist. It consists of a non-drug and a drug component. The non-drug therapy includes
- Psychoeducation: In psychoeducation, the person affected should above all be informed about their illness and acquire knowledge about it.
Studies have shown that people who have dealt with their illness in the context of psychoeducation and are familiar with it have fewer relapses than those who have received only drug treatment. – cognitive behavioural therapy: Cognitive behavioural therapy is still important. Here the affected person should learn that he/she can control certain problems by his/her own thoughts and feelings and can therefore change them.
- Mood control therapies: The affected person should learn through various exercises to stabilize his or her mood. – Family therapy and couple therapy: Ideally, the relatives should also be included in the treatment of bipolar disorders. Here, the most important thing is to learn how to deal with the disease.
Drug treatment of bipolar disorders
Mania and depression in the context of a bipolar disorder are treated differently in principle. The therapy of the bipolar disorder tends to target mania, because mania can become more dangerous than depression due to its increased activity. In addition, antidepressants for bipolar disorders have not been shown to be effective in studies to date.
In the drug therapy of a bipolar disorder, a distinction is made between acute therapy, maintenance therapy and phase prophylaxis. In the case of a bipolar disorder, the treatment of mania is more important than the treatment of depression. For more information, we therefore recommend: Therapy of maniaAcute therapy is usually carried out with the second generation of antipsychotics, including risperidone, olanzapine and others.
The first generation of antipsychotics can also be used for a short period of time, but these have more frequent side effects such as movement disorders. The antipsychotics are effective against both mania and depression. Maintenance therapy is continued for about one year after acute therapy.
The main aim here is to protect the affected person from relapse. Every bipolar disorder must be treated with a mood stabilizer to protect against new manic and depressive phases. The most popular substance for phase prophylaxis is lithium.
However, depending on the type of bipolar disorder, antipsychotics may also be preferred (e.g. for bipolar disorder type 2). If the mood stabilizer responds, it should generally be taken for life. Lithium is the first choice for mood stabilization in bipolar disorders, especially if the manic phases predominate.
It is excellent against manias and has a proven effect in reducing suicidal tendencies. Not everyone affected responds well to lithium, patients with type 1 bipolar disorders benefit more from it. All patients should first try out treatment with lithium.
If there is a response, lithium should be taken for life. Lithium can lead to kidney failure and hypothyroidism. Second generation antipsychotics (atypical antipsychotics) are preferred over first generation in the treatment of bipolar disorders.
This is because atypical antipsychotics cause less movement disorders. However, they cause more disturbances in the metabolic process. This includes above all weight gain, which many patients complain about. Nevertheless, the atypical antipsychotics have fewer side effects than the typical ones.
