Medications

Medicines, when taken regularly as prescribed, can help control bipolar mood swings. Although your family doctor can prescribe medicines to treat bipolar disorder, you will probably be referred to a psychiatrist, who is trained specifically to treat mental disorders.

Mood stabilizers, such as lithium, are usually prescribed first to treat mania and to prevent the return of both manic and depressive episodes. You may need to take a mood stabilizer for several years, or even for the rest of your life, to manage the illness. Your doctor may prescribe additional medicines, typically antipsychotics, to better control your symptoms.

Your doctor will vary the amounts and combinations of your medicines according to your symptoms, which type of bipolar disorder you have (bipolar I or II, rapid-cycling, or bipolar with mixed symptoms), and how you respond to the medicines.

Medication Choices

Several medicines are used to treat bipolar disorder. It may take time and several attempts at using different medicines to find the treatment that works best for you. The most common medicines used to treat bipolar disorder are:

• Mood stabilizers, such as lithium carbonate (for example, Eskalith and Lithobid). Experts believe lithium may affect certain brain chemicals (neurotransmitters) that cause mood changes. But how the medicine works is not completely understood. A mood stabilizer and an antipsychotic are recommended as the first medicines for acute manic episodes. Anticonvulsants, such as valproate (Depakene Syrup), divalproex (Depakote), and carbamazepine (Tegretol and Equetro), are also considered mood stabilizers. Valproate and divalproex are used to treat manic episodes. The anticonvulsant lamotrigine (Lamictal) was approved for the long-term maintenance treatment of bipolar I disorder and may be helpful for depression. Anticonvulsants can be helpful in hard-to-treat bipolar episodes.
• Antipsychotics, such as olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), quetiapine (Seroquel), and aripiprazole (Abilify). Antipsychotics improve manic episodes. Olanzapine may be used in combination with mood stabilizers and anticonvulsants.
• Benzodiazepines, such as diazepam (Valium). These may be used instead of antipsychotics or as an additional medicine during a manic phase.

What To Think About

Antidepressants, such as fluoxetine (for example, Prozac), are used very carefully to treat depression, because they can trigger a manic episode. Experts now recommend that antidepressants only be used for short periods of time during severe episodes of depression and that they be combined with mood stabilizers.¹⁰

If you are prescribed lithium carbonate, valproate, or carbamazepine, you will need regular blood tests to monitor the amount of medicine in your blood. Too much lithium in your bloodstream may lead to serious high lithium carbonate side effects. Your doctor may want you to have blood tests while you are on medicine, to check whether the medicine is affecting your liver, kidneys, and thyroid gland or to measure the number of blood cells in your body.

During your doctor's appointment, ask about:

• The side effects of each medicine.
• How often you will need to take the medicines.
• How the medicines may interact with other medicines you are taking.
• Whether it's important that you take the medicines at the same time every day.

Taking medicines during pregnancy for bipolar disorder may increase the risk of birth defects. If you are pregnant, or thinking of becoming pregnant, talk to your doctor. Medicines may need to be continued if your bipolar disorder is severe. Your doctor can help weigh the risks of treatment against the risk of harm to your pregnancy.

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• An advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• A warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.