Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe and can result in damaged relationships, poor job performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.
To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.
Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found. Most of these drugs have side effects; some will go away over time. Always tell your doctor if symptoms become more severe.
Here are the most common medications prescribed as a treatment for bipolar disorder:
Mood stabilizing medications
These are usually the first choice to treat bipolar disorder.
Lithium
(sometimes known as Eskalith or Lithobid) has been in use for fifty years. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
Side effects include restlessness, dry mouth, drowsiness, weakness, nausea, fatigue, hand tremor, a lack of coordination, increased thirst and urination, dulled emotions, difficulty thinking and remembering, blunted sexual drive and weight gain. Lithium levels in the blood should be checked regularly to make sure the kidneys and the thyroid are working normally.
Anticonvulsant medications
These are usually used to treat seizures, but they also help control moods. These drugs may be an alternative for patients who do not tolerate or respond to lithium. They may be used in combination with lithium, atypical antipsychotics, or other drugs.
Valproic acid or divalproex sodium (Depakote) FDA approved for treating mania, it is generally as effective as lithium for treating bipolar disorder and may be more effective for multiple manic episodes, mixed episodes, and rapid cycling.
Lamotrigine (Lamictal) FDA approved for maintenance treatment of bipolar disorder; helpful in controlling depressive symptoms.
Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal), Carbamazepine (Epitol, Tegretol, Equetro), are sometimes prescribed for bipolar disorder.
Side effects may include drowsiness, dizziness, headache, diarrhea, constipation, nausea heartburn, cold-like symptoms, changes in weight. Lamotrigine can cause a rare but serious skin rash that needs to be treated in a hospital. Valproic acid may cause damage to the liver or pancreas, so people taking it should see their doctors regularly.
Warning: Anticonvulsant medications may increase the risk of suicidal thoughts and behaviors. People taking these medications should be closely monitored for new or worsening symptoms of depression or suicidal thoughts or behavior.
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 Atypical antipsychotic medications
Atypical antipsychotics are standard drugs for schizophrenia, but are effective for bipolar disorder when used alone or in combination with the mood stabilizers that treat mania.
Aripiprazole (Abilify) is approved for treatment of a manic or mixed episode; also used for maintenance treatment after a severe or sudden episode.
Clozapine (Clozaril) is often used for people who do not respond to lithium or anticonvulsants.
Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania, mixed states or psychosis.
Quetiapine (Seroquel) relieves the symptoms of severe manic episodes and bipolar depression.
Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics prescribed for controlling manic or mixed episodes.
Symbyax is a drug that combines olanzapine and the antidepressant fluoxetine.
Side effects: drowsiness, dizziness, headache, blurred vision, rapid heartbeat, sun sensitivity, rashes, cold-like symptoms, memory and cognitive problems, menstrual problems and major weight gain. Risk of weight gain is highest with clozapine and olanzapine, lowest with aripiprazole and ziprasidone. In rare cases, long-term use of atypical antipsychotic drugs may cause a movement disorder called tardive dyskinesia (TD). Talk to your doctor about more severe side effects, including risk of diabetes.
Antidepressants
Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder, usually in combination with a mood stabilizer. Taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms. A recent federally-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.
Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) may be prescribed to treat symptoms of bipolar depression. Bupropion appears to pose a lower risk for triggering mania than do other antidepressants.
Side effects: Some antidepressants are more likely to have side effects than others and some side effects go away over time. Side effects can include dry mouth, headache, nausea sleep problems, agitation and sexual dysfunction.
Talk to your doctor
Changes to your treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. Your psychiatrist should guide any changes in type or dose of medication.
- Be sure to tell your psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking to prevent adverse reactions.
- To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.
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Sources
The National Institute of Mental Health (NIMH), part of the National Institutes of Health (NIH), U.S. Department of Health and Human Services
University of Maryland Medical Center (UMMC)
Page updated November 1, 2009 |
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