- With Mayo Clinic psychiatrist
Daniel K. Hall-Flavin, M.D.
read biographyclose windowBiography of
Daniel K. Hall-Flavin, M.D.
Daniel K. Hall-Flavin, M.D.
Dr. Daniel Hall-Flavin, board certified in general psychiatry and addiction psychiatry, is a St. Louis native looking to the Internet as a way to help people improve their health and be more active participants in their own health care by learning from Mayo Clinic's experts.
Dr. Hall-Flavin served on the faculties of Cornell University Medical College, New York Medical College and The George Washington University Medical School before joining the Mayo Clinic staff in 1996. He has special interests in adult psychiatry, addiction psychiatry, pharmacogenetics and personalized medicine. He served as medical director of the National Council on Alcoholism and Drug Dependence from 1986 to 1999, and is currently involved in translational medicine research involving the introduction of pharmacogenetic technology into the daily practice of community psychiatry.
"With the advent of pharmacogenetics and related fields and the advances in translational medicine, informed collaborative relationships between knowledgeable, capable health professionals and informed, proactive individuals and their families are more vital than ever," he said.
"I'm optimistic that our Internet health education activities will contribute to ever-improving health outcomes for all who participate and apply what is learned."
Tests and diagnosis (1)
- Bipolar disorder in children: Is it possible?
Complications (1)
- Bipolar disorder and alcoholism: Are they related?
Treatments and drugs (2)
- Bipolar treatment: Are bipolar I and bipolar II treated differently?
- Bipolar medications and weight gain
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Question
Bipolar treatment: Are bipolar I and bipolar II treated differently?
Is treatment for bipolar I different from treatment for bipolar II?
Answer
from Daniel K. Hall-Flavin, M.D.
Bipolar treatment generally involves taking medications and going to mental health counseling (psychotherapy) — whether you have bipolar I or bipolar II. Both bipolar I and bipolar II disorders have several subtypes.
The types and doses of medications prescribed are based on your particular symptoms. Medications may include:
- Mood stabilizers. Whether you have bipolar I or II, you'll typically need mood-stabilizing medication to control manic episodes. With bipolar I, unmanaged manic episodes can lead to irrational thinking, inappropriate decisions, and dangerous or out-of-control behavior. A less severe type of mania (hypomania) occurs with bipolar II, but it can still cause problems. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
- Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic medication such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. For either type of bipolar disorder, a mood stabilizer or antipsychotic alone may be enough to control depression. If not, your doctor may add an antidepressant. Because an antidepressant can sometimes trigger a manic episode, it's usually prescribed along with a mood stabilizer or antipsychotic. Examples of antidepressants used for bipolar disorder include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and bupropion (Wellbutrin).
In addition to medication for bipolar disorder, other treatment approaches include:
- Mental health counseling (psychotherapy). As a key part of treatment, your doctor may recommend individual, group or family counseling.
- Substance abuse treatment. According to a national survey, about half of people with bipolar disease also abuse alcohol, significantly increasing the risk of life-threatening complications. If you have a problem with alcohol or other drugs, tell your doctor so this can be part of your treatment plan.
- Hospital treatment. This can include an inpatient hospital stay or participation in an outpatient treatment program. Because bipolar I is generally more severe than bipolar II, the need for urgent outpatient treatment or hospitalization is more common with bipolar I.
- Lifestyle changes. Successful management of your bipolar disorder includes living a healthier lifestyle, such as getting more sleep, eating healthier and getting more physical activity. If you need help in these areas, ask your doctor for advice.
You may need to try different medications or combinations of medications to determine what works best. So it's important to regularly meet with your doctor to see how well your treatment is working. If necessary, your doctor may make periodic adjustments to your medication to keep symptoms and side effects under control.
Next questionBipolar medications and weight gain
- Stovall J. Bipolar disorder in adults: Pharmacotherapy for acute depression. http://www.uptodate.com/home/index.html. Accessed Jan. 31, 2012.
- Muzina DJ. Bipolar spectrum disorder: Differential diagnosis and treatment. Primary Care Clinics in Office Practice. 2007;34:521.
- Frye MA. Bipolar disorder — A focus on depression. New England Journal of Medicine. 2011;364:51.
- Swartz HA, et al. Pharmacotherapy for the treatment of acute bipolar II depression: Current evidence. Journal of Clinical Psychiatry. 2011;72:356.
- Frye MA, et al. Bipolar disorder and comorbid alcoholism: Prevalence rate and treatment considerations. Bipolar Disorders. 2006;8:677.
- Oquendo MA, et al. Increased risk for suicidal behavior in comorbid bipolar disorder and alcohol use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry. 2010;71:902.
- Post RM. Bipolar disorder in adults: Maintenance treatment. http://www.uptodate.com/home/index.html. Accessed Jan. 31, 2012.
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