Overcoming Bipolar Disorder: The Clinical Side of Treatment

TREATMENTS FOR A BIO -PSYCHOSOCIAL CONDITION

Understanding and treating bipolar disorder requires tuning in to biological, psychological, and social aspects—it is a bio-psychosocial condition.
Typically, bipolar disorder is treated with one or more medications plus some type of counseling or psychotherapy. The counseling may be very structured—even guided by a step-by-step manual—or educational and with a more informal kind of support. This will briefly outline some of the types of medications and therapies that are available.

COLLABORATIVE CARE AND JOINT DECISION MAKING

Please note this most important aspect—there is no single “best” treatment for everyone with bipolar disorder; treating the condition is a joint exploration between you and your care provider.

A FIELD GUIDE TO CARE PROVIDERS

We’ve tended to use the term “care provider”; another general term is “clinician.” These are professionals who work with individuals with bipolar disorder or other related health conditions. But who, exactly, are these providers? What is their training and what do they do? The following table is by no means exhaustive but will give you an idea of the types of clinicians most often involved with treating bipolar disorder or related conditions.

Provider type (educational degree) and Description
* Psychiatrists (MD, DO)
Psychiatrists are medical doctors, like surgeons or internists. They can prescribe medications or conduct psychotherapy.

* Psychologists (PhD, PsyD, MA)
Psychologists receive masters or doctoral degrees in graduate school. They are not trained to prescribe medications, but do conduct psychotherapy and may do other types of specialized treatments such as hypnosis.

* Advanced practice nurses (MSN, RNPC, NP, RNCS, RNC)
Advanced practice nurses go by several names, such as “clinical specialist” or, for medical fields, “nurse-practitioner.” They have advanced nursing training, often work in primary care, can prescribe some medications, and may conduct psychotherapy.

* Other mental health clinicians (LSW, MSW, LICSW, LMHC)
Clinical social workers and other mental health clinicians offer counseling or help with life problems relating to the illness. They have various backgrounds and usually specialize in a specific area.

* Primary care physician (MD, DO)
Primary care physicians are medical doctors, as are psychiatrists. They both take care of a wide variety of medical problems and also prescribe medications for a wide variety of mental conditions. More straightforward mental conditions can be treated in primary care, but more complex situations require assessment by a psychiatrist—just as more complex heart conditions require consultation by a specialist, a cardiologist.

OPTIONS, OPTIONS, OPTIONS
Despite the decades of research and clinical experience, no one single treatment has turned out to be the cure-all. Is this bad news? We think not: this means that there are a number of options that are potentially equally good.

In the real world of treatment, providers are guided to a series of possible treatment options, usually summarized in clinical practice guidelines, which are based on research data and clinical experience.
These may be large books or one-page diagrams, depending on the type of guideline and the particular condition.

The provider usually comes up with several options that should be equally effective. Sometimes the provider will present only one option that he or she believes will work best for you, having thought through the relative advantages and disadvantages of several treatments.

Key note: It’s always appropriate to ask, “Well, what are my options?” After all, you’re the one taking the medication or going through the therapy. If you went to a car dealer and the salesman chose a model for you based on what he thought you said that you wanted, wouldn’t you ask the same thing before signing the contract? For example, you don’t need to know how a turbocharger for the engine works, but you should at least know what happens if you have it and what happens if you don’t. Since there are options, decision making becomes a partnership.

CONSIDERING INNOVATIVE TREATMENTS

One of the treatment options you may discuss with your provider is medication. Maybe you have already had this discussion or are already taking medication. In this module, we’ll mention different types of medicines most often prescribed for bipolar disorder. We’ll discuss strategies to help you to be confident and knowledgeable when you make treatment decisions with your provider about such medications or other alternatives you may hear about.

The media is constantly full of information about new treatments, medications, nutritional supplements, and alternative therapies for a variety of problems. Whether you’re listening to an advertisement or discussing traditional medications with your prescriber, it is important to make informed decisions, be able to evaluate what you hear, and weigh the personal costs and benefits.

It can be easy to believe advertisements, especially when they promise breakthrough results. The weight-loss industry is a multibillion-dollar industry based on the promise of easy miracle cures. Herbal and “natural” treatments for many conditions are well publicized. A huge proportion of the U.S. population uses one or more so-called natural remedies. Please note that just because something is called “natural” or “herbal” doesn’t mean it is safe or better than traditional medicine. In fact, as of this writing, there are no restrictions from the U.S. Food and Drug Administration (FDA) that ensure quality control with regard to these products. That means we cannot rely on the label to tell us that what is advertised is actually in the product or present in the amount described. It’s left up to the manufacturer to police how closely the contents match the label. Many of these over-the-counter products have side effects and can have interactions with other medicines that can be dangerous, so it’s important to check with your care provider before taking any of these types of remedies—even if they are “natural.”

PLAYING AN ACTIVE ROLE IN TREATMENT

Outcome improves when a person with bipolar disorder plays an active role in his or her own treatment
(Bauer, McBride, et al. 2006a, 2006b; Simon et al. 2006). You provide valuable information. You express your priorities and limitations when it comes to making decisions about treatment options. You provide feedback on what’s working and what’s not. The care provider is the professional expert, and you are the values expert.

Consider this scenario: You have two options. Some medications that treat bipolar disorder may carry the risk of causing tremors, but wouldn’t have any effect on your weight; another equally effective medication may have a risk of causing weight gain but not tremors. Which treatment is right for you?
The care provider can’t make that decision alone—he or she can provide information to help you with your decision and may even have some strong recommendation based on your history; the reasoning behind the recommendation may be based on new research about the effectiveness of medications in treating people with bipolar disorder, or it may be based on your personal history of how similar medications affected you in the past. Ultimately, though, the choice is yours.

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Excerpt from OVERCOMING BIPOLAR DISORDER: A Comprehensive Workbook for Managing Your Symptoms & Achieving Your Life Goals (New Harbinger Publications)