- With Mayo Clinic psychiatrist
Daniel K. Hall-Flavin, M.D.
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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 medications and weight gain
- Bipolar treatment: Are bipolar I and bipolar II treated differently?
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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. However, there are some differences.
The types and doses of medications you're prescribed for bipolar treatment are based on your particular symptoms. These medications include:
- Mood stabilizers. Examples of mood stabilizers include lithium (Lithobid, others), valproic acid (Depakene), divalproex sodium (Depakote) and lamotrigine (Lamictal). With bipolar I, controlling mania with one of these medications is essential. 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. Hypomania isn't as disruptive as full-blown mania — but it can still be a problem, so mood-stabilizing medication is generally part of bipolar II treatment as well.
- Antidepressants. For either type of bipolar disorder, a mood stabilizer alone may be enough to control depression. But if it isn't, adding an antidepressant may also be necessary. Examples of antidepressants used for bipolar disorder include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and bupropion (Wellbutrin). With bipolar I, an antidepressant can sometimes trigger a manic episode. For this reason, antidepressants are always prescribed in combination with a mood stabilizer. Treating depression is usually the predominant concern with bipolar II disorder.
- 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) or quetiapine (Seroquel) may help.
Other approaches used to treat bipolar disorder include:
- Mental health counseling (psychotherapy). Counseling is generally considered an important part of treatment for both kinds of bipolar disorder. It's most often done one-on-one, but some types of bipolar disorder counseling are done in groups or include family members.
- Lifestyle changes. This is an important part of managing either type of bipolar disorder. Examples include getting plenty of sleep, getting regular exercise, and overcoming drug or alcohol abuse.
- 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.
The best treatment for either type of bipolar disorder varies from person to person. You may need to try different medications or combinations of medications to determine what works best. You'll need to meet with your doctor on a regular basis to see how well your treatment is working, and make periodic adjustments to your medication to keep symptoms and side effects under control.
Next questionBipolar disorder in children: Is it possible?
- Stovall J. Bipolar disorder: Treatment. http://www.uptodate.com/home/index.html. Accessed Nov. 13, 2009.
- Muzina DJ. Bipolar spectrum disorder: Differential diagnosis and treatment. Primary Care Clinics in Office Practice. 2007;34:521.
- Practice guideline for the treatment of patients with bipolar disorder. 2nd ed. American Psychiatric Association. Arlington, Va.: http://www.psychiatryonline.com/content.aspx?aID=50099. Accessed Nov 13, 2009.
- Frye MA (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 12, 2010.
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