Monday, June 22, 2020

Depression-manic fight, three principles in mind

Kobayashi, a girl who has just entered the university campus, feels depressed and painful because of a failed professional exam, often crying alone, encountering pessimistic and negative things, not interested in learning, losing hope for the future, all day long The dormitory does not go out, does not go to class, does not communicate with classmates, has difficulty falling asleep at night, does not think about tea and rice, and gradually loses weight. On the advice of the counselor, Kobayashi came to the hospital for treatment, and the doctor suggested taking antidepressant medication. Kobayashi took the medicine on time, his mood gradually improved, and soon resumed his daily study life.

Time is running, and Kobayashi has been taking medicine for more than 4 months. During a follow-up visit, Kobayashi told his doctor: "I have recently felt inexplicably excited. I only sleep for 3-4 hours at night. I am still energetic during the day. I love to talk and laugh, write all day, and I think I will actively participate. The various club activities in the school are busy all day long, but never feel tired." The doctor said meaningfully after hearing this: "Kobayashi, your current emotional state is a manifestation of mania. Throughout your course of illness, you suffer What is bipolar disorder, we need to adjust the treatment plan in time."

Bipolar disorder (BD) is a chronic disease with periodic attacks, which is characterized by recurrent episodes of mania, depression, or mixed attacks. Most patients present with a first episode of depression, and some patients are on antidepressant treatment. Hypomania or mania will appear later. Once bipolar disorder is diagnosed, patients must receive corresponding medical treatment as soon as possible. At present, the United States, Canada, the United Kingdom and my country's guidelines for the prevention and treatment of bipolar disorder all regard drug therapy as the first-line therapy for bipolar disorder.

The treatment of bipolar disorder needs to follow the following principles.

The first is the principle of treatment for the entire course of disease. Because bipolar disorder recurs almost cyclically throughout life, its frequency of attacks is much higher than that of depression. Therefore, in addition to relieving the symptoms in the acute phase, the goal of treatment should also adhere to the full course of treatment to block recurrent attacks. Only by taking medication as long as possible, can the patient better control the onset of the illness and maintain a good mental state. Many patients have a lot of resistance to taking medicine. In fact, bipolar disorder, like hypertension and diabetes, requires maintenance treatment of drugs, otherwise the disease will easily fluctuate.

The second is the principle of joint participation of doctors and patients. Social and psychological factors in daily life (stress, fatigue, etc.), poor medication compliance, insufficient drug dosage, or short medication duration are all causes of bipolar disorder recurrence, so patients, doctors, and family members are also needed in the treatment process With joint participation, the family urges the patient to take medication and regularly return to the clinic for early detection of signs of relapse.

Finally, the principle of comprehensive treatment. On the basis of drug treatment, patients can assist psychological treatment, physical therapy, etc. to promote the patient's full recovery. After systematic treatment, patients can work normally during the remission period, which is basically the same as normal people.

At present, the main drugs commonly used to treat bipolar disorder are divided into three categories.

The first category is mood stabilizers, which are the basic drugs for the treatment of bipolar disorder. Whether it is a manic episode, a depression episode or a mixed episode, you must take a mood stabilizer. Such drugs have a therapeutic and preventive effect on mania and a certain therapeutic and preventive effect on depression. At present, commonly used mood stabilizers in clinic include lithium carbonate, valproate, lamotrigine, and topiramate. Patients taking mood stabilizers must regularly monitor the drug concentration. One drug concentration is within the appropriate range to achieve the desired therapeutic effect. The other is to ensure the safety of the patient's medication, especially lithium carbonate, the therapeutic concentration and poisoning concentration of the drug Closer.

The second category is atypical antipsychotic drugs. Clinically commonly used are olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, paliperidone, amisulpride and so on. Such drugs mainly have a good therapeutic effect on manic episodes, among which olanzapine and quetiapine also have a good effect on bipolar disorder depression episodes.

The third category is antidepressant drugs. For patients with bipolar disorder, it is generally considered that in the case of mild depression, antidepressant drugs are not required to avoid mania. For severe depression, bupropion, fluoxetine, citalopram, sertraline, paroxetine and other antidepressant drugs that are not easy to induce mania are generally selected. Whether to use antidepressant drugs must follow the doctor's advice and guidance.

The clinical manifestations of bipolar disorder are complex and diverse, and they often use drugs together. Patients need to visit the hospital regularly to inform their doctors of their medical conditions and medication changes. The doctors will take into account each person's age, constitution, disease characteristics, severity, and remission period. The length and effectiveness of medications are used to formulate and adjust individualized treatment plans, which is more conducive to the overall recovery of patients, reduces the frequency of relapses, prolongs the remission period, and improves the quality of life.

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