Bipolar disorders are characterized by irregular acute episodes of depression,

mania, hypomania and mixed states (various admixtures of elevated and depressed mood).
Bipolar disorder is the sixth leading cause of disability worldwide (Cassano, et. al., 2000)
with a lifetime prevalence of 1–4% (Kessler, et. al., 2005). The lifetime risk of death by
suicide is as high as 19% (Woods, 2000). The impact of bipolar disorder on patients’ lives is
similar to multiple sclerosis, and greater than end-stage renal disease or rheumatoid
arthritis (Robb, et.al., 1997).

Mood stabilizers can help control and ‘even out’ mood swings. Mood stabilizers are
often added to a typical medication regimen because they can help control or even out
mood swings. A mood-stabilizing medication works on improving social interactions,
mood, and behavior and is recommended for both treatment and prevention of bipolar
mood states that swing from the lows of depression to the highs of hypomania or mania.
Monotherapy, in people with bipolar disorder is not encouraged. It’s true that
antidepressants are effective treatment for people with major depressive (unipolar)
disorder, but they are not always as effective for bipolar depression, and generally should
not be given alone because there’s a risk that the drug might ignite a manic episode.

People of different races have different views regarding mental illnesses. For
example, the stigma of mental illness among Asians delay access to appropriate care. In the
Philippines where I came from, there are many patients who remain untreated, therefore
end up in suicide because of the fear and shame to seek for professional help. There are
many people who use herbal medications, because alternative healing methods are widely
practiced and available through herbalists, psychic healers, spiritual mediums and others.
Patients often consult alternative healers first and may continue seeing them, even while in
mental health treatment.

The clinician needs to ask the patient about the use of herbal medications, because
alternative healing methods are widely practiced and available through Oriental medicine
doctors, acupuncturists, herbalists, bone setters, psychic healers, and spiritual mediums.
Patients often consult alternative healers first and may continue seeing them, even while in
mental health treatment, so it is important to ask specifically about these practices.
Eisenberg and colleagues found that 42% of all patients surveyed in the United States used
some form of complementary or alternative medical treatment.

It is important to be aware of particular issues for Asian, Hispanic, and African-American

patients, such as health beliefs, illness models, and diagnostic biases, to diagnose and treat
them properly. Also, different ethnic groups metabolize drugs differently, and that extrinsic
factors such as diet and smoking can affect the blood levels of psychotropic medications
which include mood stabilizers; the best practice is to start with lower doses and increase
cautiously, watching for side effects.
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Eisenberg DM, Davis RB, Ettner SL. Trends in alternative medicine use in the United States,
1990-1997: results of a follow-up national survey. JAMA. 1998;280:1569-1575.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence
and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey
Replication. Arch Gen Psychiatry 2005;62:593-602.

Lim, R, Lu, F. Clinical Aspects of Culture in the Practice of Psychiatry: Assessment and
Treatment of Culturally Diverse Patients. Medscape. Retrieved from
https://www.medscape.org/viewarticle/507208.

Robb JC, Cooke RG, Devins GM, Young LT, Joffe RT. Quality of life and lifestyle disruption in
euthymic bipolar disorder. J Psychiatr Res 1997;31:509-17.

Woods SW. The economic burden of bipolar disease. J Clin Psychiatry 2000;61 Suppl 13:38-
41.