Bipolar Disorder

The Problem

Bipolar disorder requires medication for most (mood stabilizers prevent episodes, reduce suicide risk—appropriate treatment) BUT: Medications manage symptoms, don't cure, Side effects significant: Lithium: tremor, weight gain, acne, thyroid dysfunction, kidney damage long-term, narrow therapeutic window (toxicity risk), frequent monitoring, Valproate: weight gain, hair loss, liver toxicity, teratogenic (birth defects—strict contraception required), Lamotrigine: rash (rarely severe—Stevens-Johnson syndrome), Atypical antipsychotics: MAJOR weight gain, metabolic syndrome (diabetes, high cholesterol, hypertension), sedation, movement disorders (tardive dyskinesia risk), increased mortality in elderly, Treatment resistance (30-50% don't respond adequately to first-line treatments), Medication non-adherence (50%+ stop meds—side effects, feeling better, denial of illness, lack of insight during mania), Suicide risk (bipolar has highest suicide rate of mood disorders—15-20% lifetime risk), conventional approach often: Medication only (without psychotherapy—both needed for best outcomes), Doesn't emphasize circadian rhythm regulation (light therapy, consistent sleep schedule—PROVEN to prevent episodes, should be first-line lifestyle intervention), Doesn't optimize nutrients (omega-3, NAC, folate, inositol—evidence for bipolar depression, augment medications), Doesn't address inflammation, mitochondrial dysfunction, gut health (underlying biology—supportive interventions could help), Polypharmacy common (mood stabilizer + antipsychotic + antidepressant + benzodiazepine—side effects compound), Many patients could improve with: Medication (necessary for most) + Psychotherapy + Circadian rhythm optimization (light therapy, sleep hygiene) + Omega-3 and NAC supplementation + Anti-inflammatory diet + Stress management + Routine, Better outcomes with comprehensive approach vs. medication alone (medication prevents episodes but psychotherapy, lifestyle, and biomedical support improve quality of life, function, reduce relapses).