Bipolar Disorder - Medications

Medications

Medications, when taken regularly as prescribed, can help control bipolar mood swings. Although your family doctor can prescribe medications to treat bipolar disorder, you will probably be referred to a psychiatrist, who is trained specifically to treat mental disorders.

Mood stabilizers, such as lithium, are usually prescribed first to treat mania and to prevent the return of both manic and depressive episodes. You may need to take a mood stabilizer for several years, or even for the rest of your life, to manage the illness. Your doctor may prescribe additional medications-typically antipsychotics-to better control your symptoms.

Your doctor will vary the amounts and combinations of your medications according to your symptoms, which type of bipolar disorder you have (bipolar I or II, rapid-cycling, or bipolar with mixed symptoms), and how you respond to the medications.

Medication Choices

Several medications are used to treat bipolar disorder. It may take time and several attempts at using different medications to find the treatment that works best for you. The most common medications used to treat bipolar disorder are:

• Mood stabilizers, such as lithium carbonate (Eskalith, Lithane, and Lithobid, for example). Experts believe lithium may affect certain brain chemicals (neurotransmitters) that cause mood changes, but how the medication works is not completely understood. A mood stabilizer and an antipsychotic are recommended as the first medications for acute manic episodes. Anticonvulsants, such as valproate sodium (Depakene Syrup), divalproex (Depakote), and carbamazepine (Tegretol and Equetro) are also considered mood stabilizers. Valproate and divalproex are used to treat manic episodes. The anticonvulsant lamotrigine (Lamictal) was approved for the long-term maintenance treatment of bipolar I disorder and may be helpful for depression. Anticonvulsants can be helpful in hard-to-treat bipolar episodes.
• Antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), quetiapine (Seroquel), and aripiprazole (Abilify). Antipsychotics improve manic episodes. Olanzapine may be used in combination with mood stabilizers and anticonvulsants.
• Benzodiazepines, such as diazepam (Valium). These may be used instead of antipsychotics or as an additional medication during a manic phase.

What To Think About

Antidepressants, such as fluoxetine (Prozac, for example), are used very carefully to treat depression because they can trigger a manic episode. Experts now recommend that antidepressants only be used for short periods of time during severe episodes of depression and that they be combined with mood stabilizers.⁹

If you are prescribed lithium carbonate, valproate, or carbamazepine, you will need regular blood tests to monitor the amount of medicine in your blood. Too much lithium in your bloodstream may lead to serious high lithium carbonate side effects. Your doctor may want you to have blood tests while on medication to check whether the medication is affecting your liver, kidneys, and thyroid gland or to measure the amount of blood cells in your body.

During your doctor's appointment, ask about:

• The side effects of each medication.
• How often you will need to take the medications.
• How the medications may interact with other medications you are taking.
• Whether it's important that you take the medications at the same time every day.

The U.S. Food and Drug Administration (FDA) advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania. It is most important to watch for these behaviors in children, who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses. The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.