Bipolar Disorder

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Most people with even the most severe forms of bipolar disorder can achieve substantial mood stabilization. Bipolar disorder is a recurrent illness, and in most cases, requires long-term preventive treatment. Combining medication with psychotherapy is the best way to treat this disorder.

Medications for bipolar disorder are generally prescribed by psychiatrists, medical doctors with expertise in diagnosing and treating mental disorders. While primary care physicians certainly can prescribe these medications, it is recommended that people with bipolar disorder seek a psychiatrist for treatment.

Typical medications prescribed for bipolar disorder include lithium, anti-convulsants, and atypical anti-psychotics.

Other types of therapy include psychotherapy and electroconvulsive therapy.

Lithium

Lithium (brand names Eskalith, Lithobid, and Lithonate) remains a standard treatment for bipolar I disorder. It is the most commonly used drug for short-term, long-term, and prophylactic treatment of bipolar I. Both manic and depressive episodes respond to lithium. Overall, 70 to 80 percent of patients respond to this form of treatment. Because lithium may take one to three weeks to start working, it is often initially combined with faster-acting medications such as anti-psychotics and benzodiazepines.

The types of adverse effects associated with lithium treatment may include renal (thirst, frequent urination), nervous system (memory loss, tremor), metabolic (weight gain), gastrointestinal (diarrhea), dermatologic (acne, psoriasis), and thyroid (goiter).

The use of lithium requires close monitoring of thyroid and kidney function. Also, anything that can lower the level of sodium in the body could increase levels of lithium, potentially to toxic levels. Sweating, fever, vomiting, and diarrhea may cause this. Notify your physician immediately if you experience these symptoms. Also, tell your physician if you are following a low-sodium diet.

Anti-convulsant medications

Valproate (brand names Depakote, Depakote ER, and Depakene) is another very commonly used medication in bipolar I, but also in treating mixed-state, rapid-cycling, and psychotic manias. Response may occur as early as seven days into treatment.

The types of adverse effects associated with valproate may include the nervous system (tremors, sedation), metabolic (weight gain), gastrointestinal (upset), and endocrinologic (hair loss).

The use of valproate requires close monitoring, and baseline levels of liver function, complete blood count, and a pregnancy test are recommended. Once treatment is initiated, these tests should be taken regularly in addition to monitoring the valproic acid level.

Carbamazepine (brand name Tegretol) is a medication used in bipolar I as well as mixed-state, rapid cycling, and psychotic manias. You may see improvement within 714 days of initiating treatment.

The types of adverse effects associated with carbamazepine may include the nervous system (ataxia/unsteadiness, sedation), gastrointestinal (nausea), and dermatologic (rash).

The use of carbamazepine also requires close monitoring, and baseline levels of liver function, complete blood count, electrolytes, a pregnancy test and an EKG are recommended. Once treatment is initiated, your doctor will need to follow these tests in addition to monitoring carbamazepine level.

Carbamazepine is unique in that it is an "auto-inducer." This means it increases its own metabolism as well as that of other drugs that may be administered with it. Therefore, monitoring the effects of the other medications and rechecking the levels within the first several weeks of treatment is suggested.

Lamotrigine (brand name Lamictal) is another medication prescribed for maintenance treatment of bipolar I disorder. This drug is not known to be effective for short-term treatment of mood episodes.

Gabapentin (brand names Neurontin and Gabarone) and topiramate (brand name Topamax) have also shown promise in treating bipolar disorder.

Atypical antipsychotic medications

  • Aripiprazole (brand name Abilify)
  • Olanzepine (brand name Zyprexa)
  • Quetiapine (brand name Seroquel)
  • Risperidone (brand name Risperdal)
  • Ziprasidone (brand name Geodon)
  • All of these medications have received FDA approval to treat bipolar I disorder. All are used in the acute as well as maintenance phase of bipolar disorder, delaying the onset of another occurrence. Zyprexa, Seroquel, and Lamictal can also be used to treat bipolar depression. These medications may begin to work as soon as two to four days after initiating therapy.

    Before the use of this group of medications, your doctor will record certain baseline information on your health, including liver function, glucose, cholesterol, and weight. These should be rechecked periodically to make sure the medications are not having any adverse effects. Your doctor may have you try different doses of these medications to find the best level for you.

    Psychotherapy

    While medication may be the primary treatment for bipolar disorder, there are a variety of talk therapies that may be useful additions. These include: cognitive-behavioral, psychoeducation, family therapy, and interpersonal therapy. These therapies provide education about the illness, skills for better communication with others, and ways for family members to learn how to cope with their loved one's bipolar disorder.

    Electroconvulsive therapy

    Electroconvulsive therapy (ect) may be used to treat severe bipolar episodes when medications do not seem to be working, or perhaps not working quickly enough. It may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. Although long-lasting memory problems were a concern in the past, modern ect techniques have significantly reduced this worry.

    Last reviewed on 9/20/2010

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