Medications for Bipolar Disorder

http://www.webmd.com/bipolar-disorder/guide/medications-bipolar-disorder

If you have bipolar disorder, you will probably need medication. In reality, you may need bipolar medication for the rest of your life.

Bipolar disorder is a real medical illness. It’s not something you can cure with willpower. Taking bipolar disorder medication is just like taking medication for high blood pressure or heart disease.

Medication can be like a pair of glasses. Bipolar disorder distorts your view of things; medication may allow you to see clearly again.

Which bipolar medication is best?

Doctors use a number of different classes and brands of drugs to treat bipolar disorder.  Treatment for bipolar mania may include lithium, anticonvulsants, antipsychotics, and benzodiazepines.

Many people who have bipolar disorder keep taking these medications for years or decades after their last manic episode to stay healthy. This is called maintenance therapy for bipolar disorder.

During a period of bipolar depression, you might need other medications. Lithium and other mood stabilizers, antipsychotic drugs, and sometimes antidepressants are used to treat bipolar depression.

What is a mood-stabilizing medication?

A mood-stabilizing medication works on improving mood, social interactions, and behavior. Mood stabilizers are effective in the treatment and prevention of bipolar mood states that swing back and forth between the lows of depression and the highs of mania.

Which medications are used to stabilize moods?

According to the American Psychiatric Association (APA) 2002 guidelines for treating bipolar disorder, the first-line therapy for bipolar patients with severe mania or mixed episodes is an antipsychotic medication combined with either lithium or the anticonvulsant Depakote (valproate).

Lithium is one of the oldest and cheapest mood-stabilizing mediations for bipolar disorder. Lithium is administered as a salt available under the generic names of lithium carbonate and lithium citrate. Available in capsule, tablet, or liquid form, lithium may have the trade name of Eskalith, Lithobid, Lithane, Lithonate, Lithotabs, Cibalith-S, and others.

Findings show that lithium is effective in reducing symptoms and frequency of episodes with a response rate of 70% to 80% for the initial manic phase of bipolar disorder. In addition, studies show that lithium effectively reduces the risk of suicide at least sixfold.

If you take lithium, you need to have regular blood levels of the drug monitored by your physician, as the medication can be toxic to some people.

Are anticonvulsants used to stabilize the moods of bipolar disorder?

Anticonvulsants offer more treatment options for those with bipolar disorder.  Anticonvulsants may be combined with lithium or with other anticonvulsants for optimal effect.

Some commonly used anticonvulsants include Lamictal (lamotrigine), Depakote (valproic acid), Tegretol (carbamazepine), and Trileptal (oxcarbazepine). The anticonvulsants Neurotonin (gabapentin) and Topamax (topiramate) are being studied in clinical trials to see how they work with bipolar disorder.

What other medications help stabilize moods with bipolar disorder?

The antipsychotic medications are used alone or in combination with other mood stabilizers in patients with bipolar mania.  Acute mania may be treated with older antipsychotic medications such as Haldol (haloperidol) and Risperdal (risperidone). The newer atypical antipsychotics are also used for bipolar. These drugs include Abilify (aripiprazole), Geodon (ziprasidone), Saphris (asenapine), Seroquel  (quetiapine fumarate), and Zyprexa (olanzapine). Symbyax, an SSRI antidepressant (fluoxetine) combined with an antipsychotic (olanzapine), is also available to treat depression in bipolar disorder.

Sometimes benzodiazepines are prescribed to help patients with acute mania and also to relieve insomnia. These drugs belong to a group of medications called central nervous system (CNS) depressants, which act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and are sometimes prescribed as adjunctive therapy with bipolar disorder.

Commonly used benzodiazepines include Klonopin (clonazepam), Ativan (lorazepam), Xanax (alprazolam), and Valium (diazepam).  These drugs are all habit-forming/addictive medications.

Some of the newer sleep medications such as Lunesta (eszopicione) and Sonata (zaleplon) are purported  to be non-habit forming.

Which antidepressants are prescribed for bipolar disorder?

Antidepressants are commonly prescribed to treat depressive disorders, yet in bipolar disorder, a primary mood stabilizer is recommended. According to the 2002 APA guidelines, the first-line treatment for acute depression in bipolar patients is lithium or Lamictal (lamotrigine).

If an antidepressant is needed with bipolar disorder, it’s usually given in low doses to make sure it is tolerated. Antidepressants may cause some people with bipolar disorder to shift into a manic episode. Because of this risk, your health care provider will monitor you closely if you take an antidepressant.

How can I be sure the bipolar medication will work for me?

It’s impossible to predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different dosages. Getting the right medication or combination of medications for your bipolar disorder can take some time. You can’t expect to feel better overnight.

It can be frustrating, but don’t give up. Eventually, you and your health care provider should be able to find a prescription that works for you.

Medication Tips for Bipolar Disorder

If you have bipolar disorder, adopt good habits for taking your medication. Take it at the same time every day. It’s easiest if you do it along with some other activity, like brushing your teeth, eating breakfast, or getting into bed. Getting a weekly pillbox can make it easy to see if you’ve missed a dose.

Be sure to talk to your pharmacist or doctor about the best time of day to take your bipolar medications. Some are best taken in the morning or at bedtime and others with meals or after meals.

For those rare occasions when you miss a dose, know what you should do. Ask your health care provider. Don’t assume that doubling up is a good idea.

Side Effects of Bipolar Drugs

The medications available to treat bipolar disorder aren’t perfect. They can cause side effects that vary depending on which medications you use. These side effects can include:

• Nausea
• Tremors
• Hair loss
• Sexual problems
• Weight gain
• Liver failure
• Renal failure
• Diarrhea
• Abdominal pain

Some medications can affect your liver function or white blood cell or platelet counts (which can lead to increased susceptibility to infection or bleeding), so you may need regular tests to make sure that you’re staying healthy.

Many side effects will fade after a few weeks of treatment. If you’re still having unpleasant problems after that, see your health care provider. Don’t assume you’re just stuck with unwanted symptoms. Changing your dosage, adding another medicine to control the side effects, or trying a different medication altogether may help.

Sticking to Your Treatment for Bipolar Disorder

Medications for bipolar disorder are powerful drugs, and you must take them exactly as your doctor recommends. Don’t ever stop taking a drug without your doctor’s approval. It can be dangerous.

When you’re feeling good, you might want to stop taking your medication. But that’s a bad idea — unless your doctor agrees. Getting treatment only during mood swings may not be enough. In most people, maintenance treatment between mood episodes substantially reduces the severity and frequency of mania and depression. If you’re feeling good now, that’s likely because your medication is working. So why stop?

Along with medication, ongoing psychotherapy, or “talk” therapy, is an important part of treatment for bipolar disorder. During therapy, you can discuss feelings, thoughts, and behaviors that cause you problems. Talk therapy can help you understand and ultimately master any problems that hurt your ability to function well in life. It also helps you stay on your medication — and helps you deal with effects of bipolar disorder on your social and work life. It can help you maintain a positive self-image.

Types of psychotherapy used to treat bipolar disorder include:

Behavioral therapy. This focuses on behaviors that decrease stress.

Cognitive therapy. This type of approach involves learning to identify and modify the patterns of thinking that accompany mood shifts.

Interpersonal therapy. This involves relationships and aims to reduce strains that the illness may place upon them.

Social rhythm therapy. This helps you develop and maintain daily routines