Where to Now

  • General Treatments
  • Alternative Treatmemts
  • Medications
  • Links

General Treatments

              There are a number of pharmacological and psychotherapeutic techniques used for Bipolar Disorder. Or some Individuals may decide to try self-help and pursue a personal recovery journey.

              Medications would include lithium (not the drug of first choice for Mixed States Bipolar). The anticonvulsants, also known as Mood Stabilisers are the first line treatment for Bipolar Mixed States. For example Sodium Valproate (first choice for mixed states if mania is the problem) then the second choice for Bipolar Mixed states Lamotrigine, if depression is the main problem, followed by carbamazepine and then Lithium. These drugs are often used in conjunction with antipsychotic medications, such as Quetiapine (Seroquel), Olanzapine (Zyprexa) and Chlorpromazine.

              Topiramate is also an anticonvulsant is often used as mood stabiliser. There are various other medications which are used in conjuction with the mood stabilisers.

              Antidepressants are rarely used alone (in fact they should NOT be used without a mood stabiliser). They can induce mania or rapid cycling. There is also a possibility that they can induce depression, within seven days if the person suffers from Bipolar Mixed States.

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              Hospitalization may occur, especially with manic episodes. This can be voluntary or (if mental health legislation allows it) involuntary (called civil or involuntary commitment. In Australia is it called "Sectioned". Long-term inpatient stays are now less common due to deinstitutionalization, and better medication.

              Although long stays can still occur. Following (or in lieu of) a hospital admission, support services that are available can include drop-in centers, visits from members of a community mental health team (in Australia The Acute Care Team), or Assertive Community Treatment team, supported employment (CES - or CRS Australia ) and patient-led support groups. Unfortunately there do not appear to be any or many in Australia. We have no idea why this is.

               Psychotherapy is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing symptoms before full-blown recurrence. Practicing the factors that lead to maintenance of remission.

              Cognitive behavioural therapy family-focused therapy, and psychoeducation have the most evidence for efficacy in regard to relapse prevention. While interpersonal and social rhythm therapy and cognitive behavioural therapy appear the most effective in regard to residual depressive symptoms.

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              Most studies have been based only on Bipolar I, however, and treatment during the acute phase can be particularly challenging. Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a therapeutic alliance in support of recovery.5

              Ultimately one's prognosis depends on many factors, several of which may, in fact, be under the individual's control, these may include: the right medicines; the right dose of each; taking their medication; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist.

              A supportive family or significant other; adequate health insurance; secure finances and housing, and a balanced lifestyle including a regulated stress level, regular exercise and regular sleep and wake times.

              There are obviously other factors that lead to a good prognosis as well, such as being very aware of small changes in one's energy, mood, sleep and eating behaviors, as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes.5

              Some say that a psychartist is necesary to check on the patient's progress and to prescribe medications. Although some can use a family doctor successfully. Medication and Psychotherapy can be expensive. This points to a great disadvantage to those who do not have financial means or family support to seek this treatment.

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Herbal Options - Claims about Alternative Treatments - Various Alternative Treatments

Alternative Treatments

              Before you leave your psychiatrist for the nearest health food store or alternative healthcare provider, there are two things you should know. First, it is very unwise to rely solely on alternative measures to treat Bipolar Disorders, with the possible exception of mild Cyclothymia or mild Seasonal Affective Disorder. When we say mild we mean mild.

              The risks of going without medical treatment include death by suicide or accident, and the terrible personal consequences of self-injurious behavior, manic spending sprees, hypersexuality, social difficultes, the lose employment. lose of friends and lose of famiy support.

              Parents must be especially careful to ensure proper medical care for bipolar children and adolescents, as minds and bodies cannot develop properly when a child is in the throes of depression, mania, or psychosis. (Some believe that it is only in late adolescents can be diagnosed).

              Second, there is much misinformation, (some of it deliberate) abroad about alternative healthcare.

Herbal Options

              Botanical formulas can differ wildly in their potency, both from manufacturer to manufacturer, and from vial to vial. There is also a potentially dangerous lack of scientific and regulatory oversight in this field, and sometimes a blatantly anti-science attitude. Some alternative practitioners are well-trained and highly competent, while others are charlatans.

              Accordingly, you must be wary of the claims you read in advertisements, in magazine and newspaper articles, TV or on the Internet. Check the credentials of alternative practitioners practioner before you heed their advice, especially if it involves expensive tests or remedies. Seek the advice of your medical practioner before you embark on any of these alternative treatments. Be doubley doubtful if an alternative practitioner encourages you or your child to forego prescription medications.

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Claims about Alternative Treatments

              None of the herbal remedies or other alternative treatments available today is known to cure bipolar disorders; in fact, if you see or hear such claims, you should be highly suspicious right away.

              However despite the ease with which adults demand the latest prescription pill for everything from premature balding to weight loss, many people are very much against giving psychiatric medications to children (please see Bipolar Mixed States - Diagnosis - Children at the end of the page). It is advised that the parent consult their medical practioner, weigh up the pros and cons of giving psychiatric medications to their child or children. We personally believe if a child is diagonsed with Bipolar (an/or ADHD for that matter) that the parents seek a second opinion.

              Well-meaning friends and relatives may approach you with information about natural cures for childhood behavior problems or mental illness, and get angry if you say you're not interested. Often these people either don't know your child's actual diagnosis, or have no idea what a serious illness it is, or anything about Bipolar Disorder.

              Just as you have a right to consider alternative medical treatments, you also have a right to stick with your doctor's regimen — especially if it's working.

              Finally, a few people with bipolar disorders never find full relief from any medication, especially those who are rapid cyclers. Don't give up on finding a better medication or combination of medications, but if you or your child has seemingly tried it all for an adequate amount of time without benefit, you may find at least partial relief with a different approach. Occasionally a patient will have very valid health reasons for giving up pharmaceutical treatments that are actually working.

              As almost all of the medications used to treat bipolar disorders are believed to cause birth defects. A female wishing to become pregnant should consult her doctor before comming pregnant; it is important that they do so. Pregnant girls and women who are bipolar can find themselves faced with a very difficult decision. Alternative treatments rarely produce dramatic changes.

              When medications work, they usually assist your body's own self-righting mechanisms, promoting better sleep, fewer and less severe mood swings, improved general health, and a better frame of mind.

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Various Alternative Treatments

Omega-3 Fatty Acids & Bipolar Disorder.

              Pfeiffer Treatment Center The PTC express their concern that many nutritional treatments offered are highly generalized and can produce unpleasant effects. Their research has found that a subgroup of bipolar disorder patients are deficient in arachidonic acid, an omega-6 fatty acid. They have developed three primary biochemical classifications of bipolar disorder as follows (written by and printed with permission of co-founder and chief-scientist of the PTC).

              The True Hope Institute is an organization dedicated to helping the mentally ill through nutritional supplementation. They place a major focus on bipolar disorder. True Hope has designed a nutritional supplement called Empowerplus, containing a range of vitamins, minerals, amino acids and other components.

Hypoglycemia and bipolar disorder

              Hypoglycemia is characterized by abnormally low blood sugar. Hypoglycemia can reduce the glucose supply to the brain, contributing to mood swings and depression.

              Sensitivities and bipolar disorder, food and chemical sensitivities may contribute to bipolar disorder. Some people find hidden food sensitivities are a major contributing factor. Common sensitivities include:


             •  Gluten (a protein found in wheat, oates and barley)

             •  Aspartame (an artificial sweetener)

             •  Chocolate

             •  Caffeine

             •  Casein (a protein found in dairy products)

              Please think very well before giving up medication which has been prescribed by a medical professional. And always consult with this professional about any alternative treatment you might be considering. Some alternative treatments can conflict with prescribed medications.

              To be honest as we read some of the claims re alternative treatments above (excluding Emega 3), we said to ourselves: "They have to be joking". This comment is not being made by medical professional and may not be reliable. However please check with your doctor. Before trying any alternative treatment.

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              Firstly the medications which are used to treat Bipolar Disorder are complex and carry with them a variety of side effects. A small amount of relevant information which relates to the following drugs has been presented here. And is not comprehensive by any means.

              We do recommend that you consult with your prescribing doctor as to what benefits he/she expects the drugs to have, any side effects, if the drug effects need to be monitored, and how long it will be until you reach therapeutic dose. We are sure there are other questions you might have.

              There are some drugs which require blood tests to see if the therapudic dose has been reached or not exceeded. There are also some drugs which carry side effects which require the patient to undergo regualr blood tests. It is wise to be aware of this and see that your prescribing doctor arranges for the relevant blood tests.

              If you are considering to become pregnant it is very important that you inform your doctors.

As this page is a very big one the following links have been set up to take you to the following subject matter. Antidepressants, Mood Stabilizers, Lithium, Epilim, Lamictal, Nerontin, Topamax.

Antidepressant monotherapy is not useful in Mixed State treatment and may worsen the prognosis. If antidepressants are considered, they should be used VERY cautiously after mood stabilization.

Anticonvulsants are called mood stabilizers when they are used for Bipolar medication treatment.

              Epilim (Valproic acid for Sodium Vaproate), Tegretol (Carbamozepine) and Lamictal (Lamotrigine) are the corner stones of Bipolar Mixed States treatment. Usually a person with Bipolar Mixed States is started off with Epilim. Should Epilim not be helpful or cause adverse side effects then Lamictal may be tried before Tegretol. Some doctors may like to try Tegretol before they trry Lamictal. Lamictal can potentily cause serious side effects on rare occasions.

              Lithium, although found in clinical trials to be more effective than a placebo, is less helpful than anticonvulsant mood stabilizers for Mixed States.

              All atypical antipsychotics have been shown to be useful as adjunctive treatments or monotherapy in Bipolar Mixed States. Please see further on information about atypical antipsychotics.

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Polypharmacy (more than one medication) is often necessary to achieve full stability for someone who has Bipolar Mixed States disorder. 4

Mood stabilizers (lithium and some anticonvulsants) and antidepressants are the traditional medications used in the treatment of bipolar disorder and major depression respectively.

Antidepressants may induce Bipolar Mixed States and Rapid Cycling. An anticonvulsant (mood stabilizer) and/or lithium can reduce (but does not eliminate) this risk.

              Among the anticonvulsants, Epilim and Lamictal have antidepressant effects. With some saying that Lamictal is the more effective and others saying it is Epilim which is more effective.

              It has been found that Epilim and then Lamictal are the drugs of first choice for Bipolar Mixed States.

              Lamictal and Lithium (not an anticonvulsant) are the only drugs FDA-approved for the maintenance treatment of bipolar disorder.

              These are the only "true" mood stabilizers in that they possess antidepressant as well as antimanic properties. Of the two, Lamictal is the more effective treatment for Bipolar Depression and Lithium is more effective for Mania. (Calabrese, Vieta & Shelton, 2003).

              The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabilizer is also taken.

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              However, most mood stabilizers are of limited effectiveness in depressive episodes. Rapid cycling can be induced or made worse by antidepressants, unless there is adjunctive treatment with a mood stabilizer. One large-scale study found that depression in bipolar disorder responds no better to an antidepressant with mood stabilizer than it does to a mood stabilizer alone. Recent research indicates that triacetyluridine may help improve symptoms of bipolar disorder.7

              Mixed states requires medication. Psychotherapy is best reserved for a more stable period. There are doubts as to Lithium's efficacy in mixed states. The anticonvulsant Divalproex (other names Epilim and Depakote) is frequently used and particularly when psychotic features are present (MMDT).

              The atypical antipsychotics such as Clozapine (Clozaril), Quetiapine (Seroquel) and Olanzapine (Zyprexa)) are also effective. However clozapine, quetiapine and lithium are not US FDA-approved for bipolar mixed states. Aripiprazole (Abilify) and ziprasidone (Geodon) are atypical antipsychotics recently receiving FDA approval for bipolar mixed states.

              Electroconvulsive therapy may benefit severe cases of mixed states.

Mood Stabilizers


              Lithium has been found to be helpful in all phases of Bipolar Disorder treatment. Lithium has found to be effective in treating both acute Mania and acute Depression. As well as being as prevention of both Mania and Depression. However there is a tendency for it to work better in patients who have fewer mood episodes.

              Lithium can also enhance the effects of another drug.

              It is estimated that thirty three percent of those on Lithium only remain episode free for two or three years. And some fifty five percent of patients can develop a resistance to Lithium after three years.

              Lithium is not effective straight away; it can take a few days before its effects are noticed.

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Bipolar Mixed States and Lithium

              Mixed states require medication (psychotherapy is best reserved for a more stable period). There are doubts as to lithium's efficacy in mixed states. 8

              Because of Lithium’s toxicity with risks to the kidneys, thyroid regular blood tests are necessary to measure the level of Lithium in the blood, as well as kidney function and the function of the thyroid. It is recommended that when taking Lithium that the patient drink plenty of water. Please see the symptoms of toxicity below.

Toxicity you may have toxicity if you start to experience:

             •  Severe shaking

             •  Blurred vision

             •  Drowsiness

             •  Weakness

             •  Twitching

             •  Diarrhea

             •  Vomiting

             •  Slurred speech • Impaired concentration 7

              Lithium poses a different set of risks for pregnant women and their growing baby. With the risk of fetal heard defects and especially Ebstein’s anomaly (a heart defect where the tricuspid valve in abnormally formed and there is often a hoe in the wall between the atria, ie the heart’s two upper chambers. Thus if a female on Lithium wishes to become pregnant she should defiantly consult her physician.

              As a result of clinical trails using dogs, it has been suggested that Lithium may grow new cells in the hippocampus.

For some further information about Lithium will be found at: Lithium

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Epilim (Sodium Valproate)

              Because of the problems with Lithium in treating Mixed States the usual treatment of choice is Epilim. It is also effective for people who have co-occurring substance abuse.

              Epilim can be given high doses quickly with it reaching therapeutic dose long before Lamictal. Lamictal needs to be titrated up the full dose and this can take six or eight weeks. Which is another reason to choose Epilim if the patient is in a manic or severe depressed state. However some clinical trials have found that Epilim was no better than the placebo.

              Because Epilim interacts such that it enhances one or more effects or side effects it can be used with Lithium, Tegretol and atypical antipsychotics.

              As Epilim can be toxic regular blood tests are required. It can cause damage to the liver, neural tube defects in fetuses and pancreatitis (rarely.)

              Epilim has been known to cause weight gain.

              As Epilim has complex associations it is recommended and if you are seriously considering Epilim that you go to the url below for a fact sheet. Epilim

              Tegretol (carbamazapine). In studies Tegretol has been shown to be effective against mania and to prevent mania and depression, either alone or in conjunction with Lithium.

              There is a risk of agranulocytosis (failure of the bone marrow to make enough with blood cells _neutrophis) however this risk is remote.

              Tegretol can affect the cytochrome enzyme and can affect the metabolism of other drugs. Thus those taking either of the following drugs may need to consider raising the dose of Depakote, Lamictal, Topamax, antipsychotics, benzodiazepines such as Xanax, and tricyclic antidepressants. But only of course with your prescribing doctors approval.

              However the drug’s labeling warns of the dual admistration of Tegretol and Lithium may increase the risk of neurotoxic side effects. And there is a risk of congenital anomalies.

              To find more information about Tegretol please go to for fact sheet: Tegretol

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Lamictal (lamotrigine)

              Various studies have found that Lamictal is effective for Bipolar Depression without causing the risk of switching into Mania. Lamictal reduces the need to take antidepressants. It has also been found to be helpful for Bipolar Mixed States.

              Lamictal has been found in another study, to still be effective at a dose of 200mgs daily after seven weeks of treatment.

Lamictal has been approved for the long term maintenance for Bipolar I.

              Lamictal has also been considered safe of Rapid-Cycling and Mania prevention. But has not been regarded as particularly effective for acute Mania.

              Owing to a risk of a serious rash it has been recommended that when a patient is started on Lamictal that the patient is started off on a low dose, with the dose being slowly increased for six to eight weeks till the patient is taking a therapeutic dose of 200mgs. However while the usual therapeutic 200mgs some patients are given more if necessary.

              If the patient is also on other medications such as Epilim or Tegretol then the rate of which the patient is titrated up to the required dose is altered to take into account the effects of the Epilim or Tegretol and Lamictal when taken together.

              Lamictal is probably the safest of the anti epileptics to take during pregnancy. However if you are trying to get pregnant any drug you are considering to take should be discussed with your doctor or doctors.

              To find more information about Lamictal please go to for fact sheet: Lamictal

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              Nerontin was found in clinical trials not to be particularly effective when treating Bipolar Disorder. However, some who have taken it have claimed that it worked for them.

Topamax (topiramate)

              Is a new mood stabilizer which is being noticed because of its appetite diminishing and weight reducing properties.

              Nor does Topamax particularly react with other mood stabilizers. However it is not known for its anti mania properties.

              It has been found helpful if used as an add-on for those who are not responsive to Lithium, Epilim or Tegretol.

              Topamax is helpful in treating behaviors that go with Bipolar and Bipolar medications. These include impulsivity, bulimia, binge eating, substance abuse, PTSD (post traumatic stress disorder) and Obesity.

              Topamax is known by some who take it as “dopamax” as it dulls cognition

 To find more information about Topamax please go to for fact sheet: Topmax

              Antipsychotics are often prescribed for those with bipolar disorder (manic depression) to help control mania or alleviate psychotic features that can be present during extreme mood swings. Below are links to resources and information regarding medications in this class of drugs.

Trilafon (1) Mellaril (2) Abilify (9) Haldol (2) Clopixol (1) Prolixin (2) Clozaril (4) Risperdal (1) Etrafon (2) Thorazine (2) Fluanxol (2) Zyprexa (10) Loxitane (1) Stelazine (1) Geodon (2) Orap (1) Invega (2) Seroquel (3)

Antipsychotic Medications - Black Box Warning

Antipsychotic medications approved for use by the US Food and Drug Administration are required to carry a warning in a black box regarding an increased chance of death if these medications are used to treat elderly people who have dementia.

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3.The Hypomania Handbook By Christopher M. Doran 4. Psychoses of Uncertain AetiologyBy Lorna Wing 5.http://en.wikipedia.org/wiki/Bipolar_disorder#Mixed_affective_episode
6. http://en.wikipedia.org/wiki/Mixed_state_(psychiatry)
7. http://en.wikipedia.org/wiki/Mixed_state_(psychiatry)
8. http://www.health.vic.gov.au/mentalhealth/druginfo/lithium.pdf


The following are Emergency contact details for mainly for the state of NSW in Australia. They are open for contact 24 hours a day.

      • Ambulance/Fire/Police - 000

      • Lifeline - 13 11 14

      • Men's Line Australia - 1300 78 99 78

      • Salvo Crisis Line (suicide prevention) - 02 9331 2000

      • Salvo Care Line - (02) 9331 6000

      • Salvo Youth Line - 02 9360 3000

      • Child Abuse Prevention Services - 02 9716 8000 or 1800 688 009

      • Family Crisis Service (after hours only) - 02 9622 0522 or 02 9622 0313

      • Kids Help Line - counselling and support provided for young people (to 24         years old) who are feeling depressed, sad, or lonely - or just need         someone to talk to - 1800 55 1800

In an emergency you can also visit your local hospital's emergency department4.


4. http://www.blackdoginstitute.org.au/public/gettinghelp/emergencyhelp.cfm