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Hi! I'm glad to hear from you again.
Boy, this time you've asked me a very difficult question. The reason it's difficult is because it is really very subjective. This is because BD1 and BD2 have very different life repercussions. And these necessitate a different focus for each.
Now, both most commonly require medications and psychotherapy. However, BD2 in my experience lends itself more easily in some patients to either no medication or lower dosage or fewer medications. Psychotherapy is a key in BD2 to stabilizing the mood swings. This is because in BD2, while they are not nearly as extreme as in BD1, the mood swings are much more frequent. The cycling tends to be quicker is the terminology we use.
BD1, wherein there is a full manic episode that leads to a very depressed state is much more dependent on medications for treatment long term. (I know we discussed ECT as well, but medications are the first line treatment.) So the first difficulty with treating BD1 is finding the right medication and/or medications. Doctors do their best to choose based on the symptoms the patient has and the doctors' past experience with particular medications. If the medications work well right away, then stability can be gained in a matter of time without further effort. Therapy will assist but the meds will do the main job.
The second difficulty with BD1 is patient compliance. Sometimes, part of the disorder is a resistance to taking medications. This can cause the medications not to work. So this is a major difficulty.
So, you see, each of these two disorders has its challenges. With BD1 it is finding the right meds and getting the patient to take them every day over the long term. With BD2 it's getting the patient to recognize the cycling (sometimes daily or more than once a day) and to learn skills to control the cycling so that stability can be reached. Medications can help in this but the person needs to learn how to identify his moods and to manage them.
Okay, I wish you the very best!
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