should be monitored regularly by a doctor while taking these medications. In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug. • • • • • Bipolar Disorder • 15 3. Antidepressants The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include: Headache, which usually goes away within a few days. Nausea (feeling sick to your stomach), which usually goes away within a few days. Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed. Agitation (feeling jittery). Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex. Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately. For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet at http://www.nimh.nih.gov/ health/publications/medications/complete-publication.shtml. Should women who are pregnant or may become pregnant take medication for bipolar disorder? Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant.39 But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.40 Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder.40, 41 However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk.41 Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments. 16 • National Institute of Mental Health Psychotherapy In addition to medication, psychotherapy, or “talk” therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include: 1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors. 2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving. 3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. 4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers. A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor’s instructions for any psychotherapy will provide the greatest benefi t. For more information, see the Substance Abuse and Mental Health Services Administration Web page on choosing a mental health therapist at http://mentalhealth.samhsa.gov/publications/allpubs/KEN98-0055/default.asp. Bipolar Disorder • 17 Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder (information at http://www.nimh.nih.gov/health/trials/ practical/step-bd/index.shtml). In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.42 They were also more likely to get well faster and stay well longer. NIMH is supporting more research on which combinations of psychotherapy and medication