High rates of comorbidity contribute to the cost of treatment of patients with psychiatric disorders, as comorbidity hinders diagnosis and complicates treatment. Psychiatric and general medical comorbidity are especially common in patients with bipolar disorder. The Epidemiologic Catchment Area ECA study was a collaborative research effort conducted by the National Institute of Mental Health, which assessed the prevalence of psychiatric disorders in the combined community and institutional populations.
The lifetime prevalence of any affective disorder was reported at 8. The ECA study further assessed the comorbidity of bipolar disorder with any substance abuse ie, drug and alcohol , panic disorder, and obsessive-compulsive disorder OCD. The ECA identified individuals with bipolar disorder. Strikingly high rates of comorbidity in patients with bipolar disorder were reported in the National Comorbidity Survey NCS study, a general population survey of disorders, conducted 1 decade after the ECA study.
The lifetime prevalence rates of bipolar disorder in the NCS study were lower than commonly reported, with the rate for manic episodes reported at 1. All cases reported at least 1 other disorder, and The episode of bipolar disorder either mania or depression for Bipolar disorder comorbidity with other mental disorders has also been evaluated in a number of clinic-based studies. Lifetime and current axis I comorbidity were associated with earlier onset of affective symptoms and syndromal bipolar disorder.
Forty-one patients admitted for a first psychiatric hospitalization were assessed for the presence of psychiatric and general medical comorbidities in a study conducted by Strakowski and colleagues. Women had a 2. Numerous studies have documented high rates of comorbid substance abuse in bipolar patients. Substance abuse is prevalent in the United States, with lifetime rates of alcohol and drug abuse reported at Among individuals with bipolar disorder in the ECA study, Symptoms of anxiety often occur in patients with bipolar disorder.
Therefore, the high rates of comorbidity of anxiety disorders in patients with bipolar disorder are not surprising. As with substance abuse, comorbid anxiety hinders treatment response in patients with bipolar disorder. It has been reported that bipolar patients with anxiety have significantly poorer response to treatment, specifically to lithium therapy, than patients without anxiety.
In the Zurich cohort study, individuals with hypomania and those with recurrent brief hypomania had higher lifetime prevalence rates of binge eating Childhood bipolar disorder is often comorbid with ADHD and conduct disorder. Features of bipolar disorder often overlap with those of ADHD, leading to misdiagnosis and consequent treatment with psychostimulants, which may induce mania or rapid cycling in bipolar patients.
Although literature on the comorbidity of TS with bipolar disorder is limited, at least 1 study suggests co-occurrence of TS with bipolar disorder. A major study funded by the National Institute of Mental Health showed that adding an antidepressant to a mood stabilizer was no more effective in treating bipolar depression than using a mood stabilizer alone.
Another NIMH study found that antidepressants work no better than placebo. Antidepressants can trigger mania in people with bipolar disorder. If antidepressants are used at all, they should be combined with a mood stabilizer such as lithium or valproic acid. Taking an antidepressant without a mood stabilizer is likely to trigger a manic episode.
Antidepressants can increase mood cycling. Many experts believe that over time, antidepressant use in people with bipolar disorder has a mood destabilizing effect, increasing the frequency of manic and depressive episodes. The new focus in bipolar depression treatment is on optimizing the dose of mood stabilizers. If you can stop your mood cycling, you might stop having depressive episodes entirely. If you are able to stop the mood cycling, but symptoms of depression remain, the following medications may help:.
DO NOT stop taking your antidepressant suddenly, as this can be dangerous. Talk to your doctor about slowly tapering off the antidepressant. The tapering process should be done very slowly, usually over the course of several months, in order to reduce adverse withdrawal effects. If you lose touch with reality during a manic or depressive episode, an antipsychotic drug may be prescribed. They have also been found to help with regular manic episodes.
Antipsychotic medications may be helpful if you have tried mood stabilizers without success. Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid. Sexual and erectile dysfunction is a common side effect of antipsychotic medications, one that often deters bipolar disorder patients from continuing medication. However, a study in Vellore, India concluded that the medication Sildenafil citrate Viagra is safe and effective in the treatment of antipsychotic-induced erectile dysfunction in men.
Other medications your doctor may recommend include benzodiazepines, calcium channel blockers, and thyroid medications. Mood stabilizers can take up to several weeks to reach their full effect. Benzodiazepines are fast-acting sedatives that work within 30 minutes to an hour. Because of their high addictive potential, however, benzodiazepines should only be used until your mood stabilizer or antidepressant begins to work.
Those with a history of substance abuse should be particularly cautious. Traditionally used to treat heart problems and high blood pressure, they also have a mood stabilizing effect. They have fewer side effects than traditional mood stabilizers, but they are also less effective. People with bipolar disorder often have abnormal levels of thyroid hormone, especially rapid cyclers.
Lithium treatment can also cause low thyroid levels. In these cases, thyroid medication may be added to the drug treatment regimen. While research is still ongoing, thyroid medication also shows promise as a treatment for bipolar depression with minimal side effects. Bipolar medication is most effective when used in combination with other bipolar disorder treatments , including:. People who take medication for bipolar disorder tend to recover much faster and control their moods much better if they also get therapy.
Getting regular exercise can reduce bipolar disorder symptoms and help stabilize mood swings. Exercise is also a safe and effective way to release the pent-up energy associated with the manic episodes of bipolar disorder.
Stable sleep schedule. Studies have found that insufficient sleep can precipitate manic episodes in bipolar patients. To keep symptoms and mood episodes to a minimum maintain a stable sleep schedule. It is also important to regulate darkness and light exposure as these throw off sleep-wake cycles and upset the sensitive biological clock in people with bipolar disorder.
Healthy diet. Omega-3 fatty acids may lessen the symptoms of bipolar disorder. Avoid caffeine, alcohol, and drugs as they can adversely interact with bipolar medications.
Social support network. Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group can give you the opportunity to share your experiences and learn from others.
Support from loved ones also makes a huge difference, so reach out to your family and friends. They care about you and want to help. Authors: Melinda Smith, M. Reviewed by Damon Ramsey, MD.
DSM Library. American Psychiatric Association, Gitlin, Michael J. Gitlin, Michael, and Mark A. Goodwin, Charles Bowden, Rasmus W. Cascade, Elisa F. Kalali, and Nassir Ghaemi. Vardi, Kalya, Jessica L. Warner, and Noah S. Pacchiarotti, Isabella, David J.
Bond, Ross J. This does not mean that the new drug is not "cost-effective" because increased "benefits" associated with the drug in terms of the improved quality of life may be worth the increased costs. However the findings do indicate that "cost-offsets" must be measured and not taken for granted. Incorporating such drug-offset evidence into policy and business decisions can facilitate appropriate clinical practices and improve efficiency of resource allocation.
The methods used in this study to test for cost-offsets can be applied to other clinical areas and drug classes. Abstract Background: Promoters of new medications often argue that using newer drug can reduce use of non-drug medical services and therefore reduce total healthcare spending.
Publication types Research Support, N.
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