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Bipolar Disorder (cont.)

Medications

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 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 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, 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.
Most common side effects are thirst, increased urination, diarrhea, nausea, tremors, and dizziness.

Carbamazepine (Tegretol): This medication reduces the excitability of brain cells and helps to control the symptoms of bipolar disorder.

It is especially good for those who cycle between mania and depression very quickly.
This drug may be used alone or in combination with another medication.
Levels of medication and blood cell counts are monitored.
Do not use this drug if you have a liver or blood disease.
Do not drink alcohol if you are taking this drug.
Side effects include dry mouth, constipation, drowsiness, nausea, trouble urinating, and low blood count (rare).

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 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 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 approved to treat both the depressive episodes and acute manic episodes in bipolar disorder