Treating Bipolar Disorder with Medication What are the Options? What are the Treatment Options for Bipolar Disorder?
Medications are always an issue that you should discuss with your psychiatrist. The information that is provided here is meant to be informational only. Your psychiatrist can answer your specific questions and is trained in this field. However, sometimes you don’t get all your questions answered in the office, or another one pops into your mind when you get home.
A drug is said to be a mood stabilizer if it provides relief from acute episodes of mania or depression, or prevent them from occurring and it does not worsen depression or mania or lead to increased cycling. There are four classes of medications being used for stabilization of bipolar disorder:
Lithium is by far the oldest known mood stabilizer known and used in the United States. It was discovered in the 1950’s and has been used as a mood stabilizer since the 1970’s. Blood level must be monitored to adjust the level of the compound for toxicity, which is the number one problem with this drug. So why take Lithium? Because, to date, it is still considered the front line treatment for Bipolar Disorder. Lithium is most effective for individuals with “pure” or euphoric mania, where there is little depression mixed in with elevated mood. Lithium has a clear track record of reducing the risk of suicide.
Valproate (Depakote) has been used for many years as an anticonvulsant, treating seizures. There has been a lot of research in the use of Depakote with Bipolar Disorder, and some physicians feel that it is just as effective as lithium with fewer side effects. Depakote can be given in large initial doses and works quickly and well with rapid cycling manic symptoms. Potential side effects are weight gain, tremor, dizziness, sedation, headache, nausea, indigestion, bruising, and hair loss. Valproate may cause a mild liver inflammation and may affect the production of a type of blood cell called platelets. Although it is quite rare for there to be any serious complications from these potential effects, it is important to monitor liver function tests and platelet counts periodically.
Lamotrigine (Lamictal) Serious rash is its only major side effect, and it occurs more frequently in children than in adults.
Carbamazepine (Tegretol) Potential side effects include: aplastic anemia, hepatic toxicity, impaired learning and memory, emotional affects such as irritability and agitation, insomnia, changes in vision, fatigue, nausea, water retention, weight gain, dermatitis, and pancreatitis.
Oxcarbazepine (Trileptal) Potential side effects include: dizziness, nausea, headache, diarrhea, vomiting, upper respiratory tract infection, constipation, dyspepsia, ataxia, nervousness. The major advantage of Gabapentin (Neurontin) is its relative safety and lack of interactions with other drugs. Its major drawback is that it doesn’t work. A study was sponsored by Parke-Davis in preparation, and gabapentin was found to be no better than placebo when used as a mood stabilizer. In use with other medications, gabapentin seems to be useful in managing anxiety and violent behavior. Side effects of gabapentin can include fatigue and tiredness, sedation, and lightheadedness.
Topiramate (Topamax) is yet another anticonvulsant with mood stabilizing effects for some patients. It seems to help with anxiety and a number of eating disorders. Topamax is used clinically for migraine headaches. The most common adverse events were sweating, fuzzy vision, difficulty sleeping, tremor, cognitive slowing or memory problems, and numbness and tingling in the hands and feet.
Antidepressants treat the symptoms of depression. In bipolar disorder, an antidepressant will be paired with a mood stabilizing medication (e.g. lithium, Depakote, Lamictal). Without the mood stabilizer, an antidepressant can actually cause a manic state for a person with bipolar disorder. There are many antidepressants on the market. Not every antidepressant is the same, and they have different properties. They all also have different potential side effects.
Antipsychotic medications are sometimes used when there is severe depression, mania, hallucinations, or delusions, which sometimes occurs with bipolar disorder.
There are two other ways that antipsychotics are used in bipolar treatment, even if no none of the above are present. They have sedating properties and may be used for insomnia or anxiety. Researchers have found that the newer atypical antipsychotic medications behave as mood stabilizers and may help control depressive or manic symptoms. In this way the newer atypical antipsychotic medications may actually be prescribed in place of mood stabilizers. Characteristic side effects of the atypical antipsychotics include tiredness and weight gain.
Ask any specific questions you have from your psychiatrist.
Cheryl L. McKinzie, M.S., M.A, LPCI [http://www.McKinzieCounseling.com]