work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness. For more information on psychotherapy, visit the NIMH Web site at http://www.nimh.nih.gov/health/topics/treatment/index.shtml. Other treatments 1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments. Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.43 Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a fi rst-line treatment. 18 • National Institute of Mental Health ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.44 2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications. People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects. Herbal Supplements In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John’s wort (Hypericum perforatum ), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.45 St. John’s wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.46 Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder.47 Study results have been mixed.48 It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications. • • • Bipolar Disorder • 19 What can people with bipolar disorder expect from treatment? Bipolar disorder has no cure, but can be effectively treated over the long-term. It is best controlled when treatment is continuous, rather than on and off. In the STEP-BD study, a little more than half of the people treated for bipolar disorder recovered over one year’s time. For this study, recovery meant having two or fewer symptoms of the disorder for at least eight weeks. However, even with proper treatment, mood changes can occur. In the STEP-BD study, almost half of those who recovered still had lingering symptoms. These people experienced a relapse or recurrence that was usually a return to a depressive state.49 If a person had a mental illness in addition to bipolar disorder, he or she was more likely to experience a relapse.49 Scientists are unsure, however, how these other illnesses or lingering symptoms increase the chance of relapse. For some people, combining psychotherapy with medication may help to prevent or delay relapse.42 Treatment may be more effective when people work closely with a doctor and talk openly about their concerns and choices. Keeping track of mood changes and symptoms with a daily life chart can help a doctor assess a person’s response to treatments. Sometimes the doctor needs to change a treatment plan to make sure symptoms are controlled most effectively. A psychiatrist should guide any changes in type or dose of medication. How can I help a friend or relative who has bipolar disorder? If you know someone who has bipolar disorder, it affects you too. The fi rst and most important thing you can do is help him or her get the right diagnosis and treatment. You may need to make the appointment and go with him or her to see the doctor. Encourage your loved one to stay in treatment. To help a friend or relative, you can: Offer emotional support, understanding, patience, and encouragement Learn about bipolar disorder so you can understand what your friend or relative is experiencing Talk to your friend or relative and listen carefully • • • • • • • 20 • National Institute of Mental Health Listen to feelings your friend or relative expresses—be understanding about situations that may trigger bipolar symptoms Invite your friend or relative out for positive