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Treatments for bipolar disorder

Visit us (http://www.khanacademy.org/science/healthcare-and-medicine) for health and medicine content or (http://www.khanacademy.org/test-prep/mcat) for MCAT related content. These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen in any Khan Academy video. Created by Brooke Miller.

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Video transcript

- [Voiceover] Bipolar Disorder is treated with medication and with specific psychological interventions. In terms of the medication the most common treatment is also the oldest one and that's treatment . with Lithium Salts. And, this has actually been the primary treatment for Bipolar Disorder for the last 50 years. And, that's because it's still the most effective treatment that we have. It's still the most effective at managing manic episodes. But, as it turns out researchers still aren't 100% certain why it's so effective. They're not certain about how it works on neuronal level. One theory is that Lithium enhances serotonin release by increasing production of the components that make up serotonin or maybe that it increases serotonin release in other ways. But, there are also theories that focus on other neurotransmitters. So, there are some theories that say Lithium enhances the reuptake of Norepinephrine and in doing so it would decrease the effect of Norepinephrine over time. There are other theories that state that Lithium actually exerts it's effects on areas of the neuron other than the synapse. So, one theory is that it influences the sodium channels along the axon, the ones that help move the action potential down the neuron. And, who knows, maybe in a year or two research will lead us to a newer, more accurate hypothesis and then I will have to remake this video. But, for the time being know that whatever the mechanism is it is a very effective mood stabilizer. It has other things going for it as well, it's also relatively fast acting, so it starts to work in as little one to two weeks. And, it also avoids some of the worst side effects that we might see in other Bipolar medications. Specifically, it doesn't bring about a depressive episode or cause general sedation. And, you can see why this might be a concern for Bipolar medications that in bringing people down from mania they could inadvertently push them too far down or too far in the other direction. But, with that said Lithium does have other side effects. The first one I want to talk about isn't so much a side effect as it is a problem with mood stabilizers more generally, and that's that individuals sometimes treat Lithium the same way that they might treat medications for a headache. So, if you have a headache you might take something to make it go away and once you feel better you don't take any more of the drug. But, Lithium and also other mood stabilizers they don't work this way, individuals need to keep taking them for the medication to be effective. They can't just stop taking them once they feel better. In terms of side effects of taking Lithium specifically a big one is the effect that Lithium can have on memory. It can cause memory loss and can also cause problems with creating new memories. Another side effect is that Lithium can sometimes blunt normal mood changes and this can lead to a huge decrease in quality of life. So, imagine not being able to feel happy at your own birthday party, or not feeling sad when a partner loses a job. These kinds of mood changes are a part of everyday life and it's very apparent to people when they're missing. Some individuals might also be hesitant to give up their manic episodes because they see them as something positive, even though they can be incredibly destructive they can also increase a person's productivity and their creativity. So, individuals might be resistent to taking medication to stop something that they don't believe is a problem. But, maybe the biggest side effect of Lithium has to do with toxicity. Lithium can effect kidney and thyroid functioning, and this can become even worse when a person is dehydrated which is something that Lithium itself causes. So, individuals who take it have to be very careful about staying hydrated at all times, even more so than the rest of us. And, because of this toxicity problem people taking Lithium need to be carefully monitered by doctors. The last side effect I want to talk about isn't really a side effect at all, it is actually more of a limitation. And, that's that Lithium doesn't treat depressive episodes. So, it helps with mania, but it doesn't help with the depression part of Bipolar Disorder. And, because of this individuals taking Lithium generally have to take an antidepressant as well. And, this can lead to two problems. One is that some antidepressants like SSRIs which are the most common treatment for depression they can actually trigger manic episodes for some individuals with Bipolar Disorder. And so, this can limit treatment options. And, the second point is that in addition to the side effects from Lithium the patient will also have to deal with any side effects for this additional antidepressant. I wanna point out that there are some other medications that people are using to treat Bipolar Disorder. There has been success with treatments that involve anticonvulsants and antipsychotics, and also some benzodiazepines. But, at least in the short term, like I said before, Lithium is still the preferred treatment. So, now I wanna move on to talk about psychological treatments. And, you might remember from your psychology class or from other videos in this series that there are some psychological interventions that are very effective for treating Major Depressive Disorder, sometimes as effective as medication. But, the same is not true of Bipolar Disorder. Psychotherapy in all forms from Psychodynamic Therapies to more modern forms of pychotherapy, they are not effective in treating Bipolar Disorder. Talking about Bipolar Disorder and trying to find the cause isn't very helpful for this disorder. One type of therapy that is very effective in treating depression is CBT, or Congnitive Behavioral Therapy. And, this type of therapy addresses problematic thoughts and behaviors. So, it's a very action oriented therapy. But, even though it is effective in treating depressive symptoms of Bipolar Disorder it is not effective in treating manic episodes. But, even if these psychological interventions don't help treat the symptoms of Bipolar Disorder directly, they can still be a very important part of the treatment of Bipolar Disorder more broadly. For example, CBT can provide support for an individual after a manic phase has ended. So, it can help them to fix the social and financial situations that might have been brought about from the manic episode. But, it turns out that the most effective type of therapy for Bipolar Disorder is actually family therapy. There's a lot of research that shows that stressful situations can trigger manic episodes for individuals with Bipolar Disorder. And, we know that this is especially true for social stressors. And, because living with someone with Bipolar Disorder might be stressful for the family that family might sometimes inadvertently be triggering for the individual with that disorder. And so, it turns out that one of the best ways to manage Bipolar Disorder, both short term and long term, is by providing the family with the tools necessary to help them provide support and to help them provide a stable home environment.