Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
A variety of medications are available by prescription. These medications are usually referred to as mood stabilizers.
Many people start by taking lithium, which has
been used for many years to treat bipolar disorder. Yet as many as half of all
people with bipolar disorder do not respond to this medication.
Other possibilities for medical treatment are carbamazepine (Tegretol), valproic acid (Depakote), lamotrigine (Lamictal), and Quetiapine
(Seroquel). Some of these are medicines that were originally developed to
treat seizures, and so other antiseizure medicines are sometimes used to treat
bipolar disorder as well.
Certain medications, such as olanzapine (Zyprexa) and risperidone (Risperdal), used to treat psychosis are
sometimes used to treat bipolar disorder; both of these medications have been
shown to be effective for such symptoms.
All these medications have side effects, and each
person with bipolar disorder needs close monitoring for the side effects while
taking the medication.
Antidepressant medication should be taken with a mood-stabilizer medication during depressive episodes. Taking the antidepressant medication alone can trigger mania. There is now a ready-made combination medicine approved for use in bipolar depression, Symbyax, which has the antipsychotic drug, olanzapine, along with the antidepressant, fluoxetine (Prozac),
both in one capsule.
The choice of medications is customized for each person.
Be sure to tell your health-care provider about any
other medical conditions you have.
Tell your health-care provider about all medications you take, including over-the-counter
drugs and herbal preparations. These may interact with the medications used for bipolar disorder. For example, the herbal preparation known as St. John's wort may
reduce the effectiveness of some medications. Also, since it is itself an
antidepressant, it may trigger a manic episode in a person with BD who is not
on another mood stabilizer.
Women also should discuss any plans for pregnancy and breastfeeding with their health-care provider, because a change in medication may be necessary.
Lithium: The exact way lithium works in controlling the mood swings of bipolar disorder is unknown.
Lithium may take as long as two weeks to take full
effect.
It may have an "anti-suicide effect."
Levels of the drug must be closely monitored with
blood tests.
Drink plenty of fluids and do not restrict intake of salt while taking lithium because dehydration can
cause the level of the drug in the blood to be dangerously high.
If you have kidney or heart problems, you may be
started on another medication instead.
Valproic acid
(Depakote): This drug works for bipolar disorder by controlling abnormal
electrical activity in the brain that may cause mood swings.
This medication can be used alone or in combination
with another medication.
Blood levels should be monitored.
Liver function is tested occasionally.
Do not drink alcohol with this drug; the combination
may cause excessive sleepiness.
Its most common side effects are drowsiness, nausea, diarrhea, tremor, and weakness.
Lamotrigine (Lamictal): This medication appears to be most useful for the depressed phase of bipolar disorder.
This drug usually is used in combination with another
medication.
Do not take this drug if you have kidney, lung, or
heart problems.
Possible side effects, though rare, include severe rash, lip and tongue
swelling, balance problems, and vision changes.
Olanzapine (Zyprexa): This medication is approved for
treatment of both acute mania and maintenance once the symptoms are under
control.
This medication may be used in combination with an
antidepressant for treatment of depression in bipolar disorder.
One must be cautious of hyperglycemia in patients on any of the "atypical antipsychotics," of which Zyprexa is one. Patients who are
known to have diabetes need to watch for poorer control of their blood sugar. Weight
gain is possible, with or without problems with blood sugar.
There may be increased levels of blood lipids (fats) and weight gain, especially in children and adolescents who are prescribed this medication.
There is a possibility of so-called extrapyramidal side effects (EPS) at higher doses of this medicine. Oversedation or at least
decreased alertness may occur.
This medicine may be safer in pregnant women who
have bipolar disorder than some of the other medications mentioned above.
Risperidone (Risperdal):
This is another of the atypical antipsychotic medications, and it has been
approved by the U.S. Food and Drug Administration (FDA) for use in acute mania.
At higher doses, this medicine may cause
restlessness, tremor, or other EPS symptoms.
Other side effects are similar to those of
olanzapine.
Quetiapine (Seroquel): This is another of the atypical
antipsychotic medications which has been FDA-approved to treat both the depressive
episodes and acute manic episodes in bipolar disorder.
This medication may be used alone or in combination with other medications.
The most common side effects are sedation and dry mouth.
Recent studies suggest that this medication is unlikely to increase the chance of suicidal thoughts.
