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Bipolar disorder is a complex disease that requires medications that often are accompanied by close monitoring of blood levels. A successful medication regimen typically involves trial and error, and demands a close relationship with your medical doctor.
For acute mania, the following medications are commonly prescribed: lithium, Depakote (divalproex), Tegretol and Equatro (carbamazepine), Trileptal (oxcarbazepine), and antipsychotic medications such as Zyprexa (olanzapine) or Seroquel (quetiapine).
For depression, the following drugs are the most frequently prescribed: lithium, Lamictal (lamotrigine), Seroquel (quetiapine), or Symbyax (a combination of olanzapine and fluoxetine). On occasion antidepressants such as Prozac (fluoxetine) may be added on. At times antidepressants can aggravate bipolar disorder and therefore should never be prescribed alone; sometimes they can be used in combination with antimanic agents such as lithium or divalproex.
To maintain stable moods and prevent relapse, lithium or Lithobid (a slow-acting version of lithium), lamotrigne, and divalproex are the drugs most commonly prescribed.
The three most important types of medication used to control the symptoms of bipolar disorder are mood stabilizers, antidepressants, and antipsychotics. Your doctor may also prescribe other medications to help with insomnia, anxiety, or restlessness. While we do not understand how some of these medications work, we do know that all of them affect chemicals in the brain called neurotransmitters, which are involved in the functioning of nerve cells.
Due to the complexity of bipolar disorder, there are a variety of medications that are used in treatment. These medications treat a particular set of symptoms. Side effects may cause a patient to discontinue the medication, others may go away with time or be tolerable or treatable, and some side effects are dangerous.
The nature of Bipolar Disorder, with its cyclical mood swings, requires more than one medication. Four main types of medications are used to treat various symptoms of Bipolar Disorder:
- Mood stabilisers
- Anticonvulsant medications
- Antipsychotic medications
Mood stabilizers, anticonvulsant medications and antipsychotic medications are used to stabilize and maintain mood. The depressive phase is one of the most difficult aspects of the disorder to treat. Antidepressants can be prescribed, but only in combination with antimanic medications to prevent switching to mania or hypomania, mixed episodes, and rapid cycling that the use of antidepressants alone can cause.
Bipolar disorder (BD): Bipolar I and Bipolar II are related conditions, but there also are some significant differences. Both cause severe depressive episodes. BD I also presents with manic episodes: marked hyperactivity, agitation, rapid speech, decreased need for sleep and either euphoria or dysphoric mania. Dysphoric mania includes the symptoms noted above, but rather than euphoria, the mood changes include intense irritability and/or depressionand increased risk for suicide. BD II has severe depressions but no mania; rather it has brief periods of hypomania (increased self-confidence, up-beat mood, and decreased need for sleep).
Life style management is equally important for BD I and II: including getting good quality sleep and sleeping 7-9 hours every night, avoiding excessive caffeine and alcohol use (e.g. only one cup of coffee per day, and very little if any alcohol), waking up at the same time each day, avoiding sleep deprivation, never using illicit drugs such as methamphetamine and cocaine. I must strongly emphasize that these strategies may seem simple, but are high yield interventions.
Psychiatric medication treatment is absolutely necessary to treat BD and to prevent reoccurrences. Standard treatments for BD I and II include mood stabilizers (lithium, Depakote, Tegretol, Trileptal and often antipsychotic drugs, such as Zyprexa, Seroquel, and Abilify). All of these drugs treat mania and can help to prevent recurrences of mania. Lithium can be effective in preventing depressive episodes. Bipolar depression (seen in BD I and II) is treated with the following: Seroquel, Lamictal, Symbyax, and lithium (for lithium to be effective it generally requires reaching a lithium blood level of 0.8 or higher). The most important difference in treating BD I and II is the use of antidepressants (ADs). All experts agree that with BD I ADs carry significant risks (risks of provoking mania and in general, causing the disorder to become more severe over time) and should rarely if ever be used. ADs are also not first line treatments for BD II. However in people who have not responded to the drugs mentioned above, ADs may be used, but only along with a mood stabilizer. Antidepressants used alone have 2 negative consequences: most commonly, they just don’t work. Secondly, the use of ADs may, over time, increase the frequency of mood episodes. It is important to note that these are not my personal recommendations; they come from established “best practices” treatment guidelines. The use of ADs alone to treat BD is, unfortunately, a common mistake.
Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.