How to manage bipolar depression in a 29-year-old male?

Question

Hello doctor,

My brother is 29 years old and has been diagnosed with bipolar disorder with depressive episodes. He sometimes experiences prolonged low mood, loss of interest in activities, and difficulty concentrating, followed by periods of increased energy and restlessness.

He is currently taking medication prescribed by a psychiatrist, but we are concerned about long-term management and maintaining emotional stability.

What are the most effective ways to manage bipolar depression?
How can patients reduce the risk of mood episode recurrence?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

In bipolar disorder (a mental health condition where you have extreme mood changes), strategies are helpful in maintaining a euthymic state, decreasing the relapse rate, and reducing the symptom severity in breakthrough episodes.

IPSRT (interpersonal and social rhythm therapy) is basically a structured psychotherapy for bipolar disorder. It includes:

Keep daily routines regular.
Maintain the sleep-wake cycle (two body processes control sleeping and waking periods).
Maintain social connections.
Psychoeducation about the nature of illness and the role of medications.
Avoid sleep deprivation.
Engage in light exercise.
Avoid substance use and too much caffeine.
Recognize the early symptoms of relapse and consult with psychiatrists as soon as possible.
Avoid triggers like arguments, fights, workloads, financial crisis situations, etc.

As he has already experienced more than two episodes, pharmacotherapy is advised lifelong. Regular medication reduces the risk of breakthrough episodes, reduces the severity of symptoms, and increases the interepisodic period.
Ask your psychiatrist to prescribe those medications that are equally effective in mania and depressive episodes and best for maintenance, such as Lamotrigine.
Also, ask for medications with minimal metabolic side effects, as some psychotropics are associated with metabolic syndrome and some with EPSE (extrapyramidal side effects).
The average duration of a depressive episode is usually longer than a manic episode and can remain for years if not effectively treated. Also, the risk of self-harm is high during depressive episodes.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.