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The role of medication in bipolar disorder treatment
Medication is the foundation of bipolar disorder treatment. It brings mania and depression under control and helps prevent relapse once your mood has stabilized. Many people don’t like the idea of taking medication long-term. But just as a diabetic needs to take insulin in order to stay healthy, taking medication for bipolar disorder will help you maintain a stable mood.
But while medication for bipolar disorder is important, don’t rely on it alone to manage your symptoms. Medication is most effective when used in combination with other bipolar disorder treatments, including therapy, self-help coping strategies, and healthy lifestyle choices.
Tips for getting the most out of medication for bipolar disorder
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Work with your doctor. It can take awhile to find the right medication and dose. Be patient, but don’t settle for a medication that makes you feel lousy, either. Tell your doctor about any unwanted side effects. You may benefit from switching medications or adjusting the dose. However, changing or stopping medication can be dangerous, so always talk to your doctor first.
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Take advantage of natural mood stabilizers. Your lifestyle has an impact on your symptoms. If you make healthy daily choices, you may be able to reduce your reliance on medication. Mood stabilizers that don’t require a prescription include keeping a strict sleep schedule, exercising regularly, practicing relaxation techniques, and developing a solid support system.
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Consider therapy and medication. Research shows that people who take medication for bipolar disorder tend to recover much faster and control their moods better if they also get therapy. Therapy gives you the tools to cope with life's difficulties, monitor your progress, and deal with the problems bipolar disorder is causing in your personal and professional life.
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Continue taking medication, even after you feel better. The likelihood of having a relapse is very high for those who stop taking medication for bipolar disorder. If you have experienced two or more episodes of depression or mania, experts recommend taking mood-stabilizing medication indefinitely.
Finding the right bipolar disorder medication
Everyone responds to medication differently, so you may have to try several bipolar disorder drugs before you find the one that works for you. Because of the many adjustments that must be made based on your individual response, you will need to work closely with your healthcare provider.
Once you've zeroed in on the right drug or drug cocktail, it may still take time to determine the optimal dose. In the case of mood stabilizing medications such as lithium, the difference between a beneficial dose and a toxic one is small. Frequent office visits and careful monitoring of symptoms and side effects will help you stay safe.
Learn about your bipolar disorder medication
When starting a new medication for bipolar disorder, educate yourself about how to take it safely. Questions to ask your doctor about any new prescription include:
- Are there any medical conditions that could be causing or exacerbating my mood swings?
- What are the side effects and risks of the medication you are recommending?
- When and how should I take this medication?
- Are there any foods or other substances I will need to avoid?
- How will this drug interact with my other prescriptions?
- How long will I have to take this medication?
- Will withdrawing from the drug be difficult if I decide to stop?
- Will my symptoms return when I stop taking medication?
Once you find a bipolar disorder drug and dose that works for you, you can extend the length of time between check-ins with your doctor. However, because the course of bipolar disorder is unpredictable, self-monitoring is essential throughout your treatment. Contact your doctor right away if you notice an increase in symptoms or any new or unusual side effects. These may be signs that you need to switch medications or adjust your dose.
How often should I talk with my doctor?
During acute mania or depression, most people talk with their doctor at least once a week, or even every day, to monitor symptoms, medication doses, and side effects. As you recover, you will see your doctor less often. Regardless of scheduled appointments or blood tests, call your doctor if you have:
- Suicidal or violent feelings
- Changes in mood, sleep, or energy
- Changes in medication side effects
- Need for over-the-counter medication (cold or pain medicine)
- An acute medical illness or need for surgery, extensive dental care, or changes in other medicines you take
- A change in your medication situation, such as pregnancy
Source: Treatment of Bipolar Disorder: A Guide for Patients and Families (PDF)
Taking medication for bipolar disorder responsibly
All prescription drugs come with risks, but if you take your bipolar disorder medications responsibly, you can minimize them and maximize your chances of treatment success.
Take your medication as prescribed
You may be tempted to stop taking your bipolar disorder medication if you're experiencing side effects. Or conversely, you may want to stop taking your pills because you feel great and don't think you need them anymore. However, stopping maintenance medication comes with a high risk of relapse. Stopping cold turkey is even more risky.
Before you make any medication changes, talk to you doctor. If you don't like the way the drug makes you feel or if it's not working, there may be other options you can try. And if you decide that medication is not for you, your doctor can help you taper off your drugs safely.
Keep track of side effects
Track any side effects you’re experiencing. Using a log, record what your symptoms are, when you’re experiencing them, and how bad they are. Bring the worksheet to your doctor. He or she may have suggestions for minimizing the side effects. If side effects are severe, your doctor may switch you to another drug or change your dose.
Be aware of potential drug interactions
You should always check for drug interactions before taking another prescription medication, over-the-counter drug, or herbal supplement. Drug interactions can cause unexpected side effects or make your bipolar disorder medication less effective or even dangerous. Mixing certain foods and beverages with your bipolar medication can also cause problems.
Talk to your doctor about special precautions for the medication or medications you’re taking. You can also learn about potential interactions by reading drug labels or talking to your pharmacist.
Tips for managing bipolar disorder medications
- Use a daily reminder/medication saver system to make sure you are taking all of the necessary medications.
- Throw away old medications or those you are no longer taking.
- Realize that medications work best when you are making other healthy choices. Don’t expect a pill to fix a bad diet, lack of exercise or an abusive or chaotic lifestyle.
- Reduce or discontinue the use of alcohol. Alcohol is a depressant and makes recovery even more difficult. It can also interfere with the way your medication works.
Lithium: The first mood stabilizer for bipolar disorder
Mood stabilizers are medications that help control the highs and lows of bipolar disorder. They are the cornerstone of treatment, both for mania and depression. Lithium is the oldest and most well-known mood stabilizer. It is highly effective for treating mania.
Lithium can also help bipolar depression, particular when combined with another medication such as an antidepressant. However, it is not as effective for mixed episodes or rapid cycling forms of bipolar disorder. Lithium takes from one to two weeks to reach its full effect.
Common side effects of lithium
The following side effects are common on lithium. Some may go away as your body adapts to the medication.
- weight gain
- drowsiness
- tremor
- weakness or fatigue
- nausea, vertigo
- diarrhea
- stomach pain
- thyroid problems
- memory and concentration problems
- excessive thirst; increased urination
The importance of regular blood tests
If you take lithium, it’s important to have regular blood tests to make sure your dose is in the effective range. Doses that are too high can be toxic. When you first start taking it, your doctor may check your blood levels once or twice a week. Once the right dose has been determined and your levels are steady, blood tests will be less frequent.
However, it’s still important to get blood tests every two to three months, since many things can cause your lithium levels to change. Even taking a different brand of lithium can lead to different blood levels.
Other factors that influence your lithium levels include:
- Weight loss or gain
- Changes in sodium intake
- Drugs such as diuretics, aspirin, and ibuprofen
- Dehydration
- Menstrual cycle
- Seasonal changes (levels may be higher in the summer)
What can I do to avoid toxic lithium levels from developing?
- Make sure that you go for the blood tests whenever they are needed.
- Don't suddenly change the amount of salt in your diet; it is especially important not to suddenly reduce your salt intake.
- Make sure that you drink enough fluids, especially if you are exercising heavily or in hot weather when you will sweat more.
- Remember that alcoholic drinks can make you lose water overall. This is particularly important to bear in mind if you are on holiday abroad: you may feel like drinking more alcohol, and the weather may be hot so you sweat more.
- See a doctor straight away if you get any of the physical illnesses or symptoms listed above. Always tell any doctor or pharmacist that you are taking lithium before you are prescribed, or buy, any new medicines.
Source: Netdoctor.co.uk
Anticonvulsant mood stabilizers for bipolar disorder
Anticonvulsants are used in the treatment of bipolar disorder as mood stabilizers. Although they were originally developed for the treatment of epilepsy, they have been shown to relieve the symptoms of mania and reduce mood swings.
Valproic acid (Depakote)
Valproic acid, also known as divalproex or valproate, is a highly-effective mood stabilizer. Common brand names include Depakote and Depakene. Valproic acid is often the first choice for rapid cycling, mixed mania, or mania with hallucinations or delusions. It is a good medication option if you can’t tolerate the side effects of lithium.
Common side effects include:
- drowsiness
- weight gain
- dizziness
- tremor
- diarrhea
- nausea
Other anticonvulsant medications for bipolar disorder
Other anticonvulsants that can be used as mood stabilizers include:
- Carbamazepine (Tegretol)
- Lamotrigine (Lamictal)
- Topiramate (Topamax)
Natural
mood stabilizers for bipolar disorder
There are many things you can do to stabilize your mood and stay well. The way you live your life is just as important, if not more so, than the medication you take. Making healthy choices for yourself can make a huge difference in how you feel.
Read: Bipolar Support and Self-Help: Living and Coping with Bipolar Disorder
Antidepressant medications for bipolar disorder
Although antidepressants have traditionally been used to treat episodes of bipolar depression, their use is becoming more and more controversial. A growing body of research calls their safety and efficacy of into question.
Antidepressants should be used with caution
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Antidepressants don’t work very well for bipolar depression. Mounting evidence suggests that antidepressants aren’t effective in the treatment of bipolar depression. A major study funded by the National Institutes of Mental Health found that antidepressants work no better than placebo.
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Antidepressants can trigger mania in people with bipolar disorder. If antidepressants are used at all, they should be combined with a mood stabilizer such as lithium or valproic acid. Taking an antidepressant without a mood stabilizer is likely to trigger a manic episode.
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Antidepressants can increase mood cycling. Many experts believe that over time, antidepressant use in people with bipolar disorder has a mood destabilizing effect, increasing the frequency of manic and depressive episodes.
What should I do if I’m currently taking an antidepressant?
First, and most importantly, don’t panic! DO NOT stop taking your antidepressant suddenly, as this can be dangerous. Talk to your doctor about slowly tapering off the antidepressant. The tapering process should be done very slowly, usually over the course of several months, in order to reduce adverse withdrawal effects.
While antidepressants may be helpful in certain circumstances, they should always be used with caution. Stop taking them immediately if any symptoms of mania or hypomania develop. Furthermore, it is best to discontinue them once symptoms are under control.
Treating bipolar depression with mood stabilizers
The new focus in bipolar depression treatment is on optimizing the dose of mood stabilizers. If you can stop your mood cycling, you might stop having depressive episodes entirely. If you are able to stop the mood cycling, but symptoms of depression remain, the following medications may help:
- Lamictal (lamotrigine)
- Seroquel (quetiapine)
- Zyprexa (olanzapine)
- Symbyax (a pill that combines olanzapine with the antidepressant fluoxetine)
Antipsychotic medications for bipolar disorder
If you lose touch with reality during a manic or depressive episode, an antipsychotic drug may be prescribed. They have also been found to help with regular manic episodes. Antipsychotic medications may be helpful if you have tried mood stabilizers without success. Often, antipsychotic medications are combined with a mood stabilizer such as lithium or valproic acid.
Antipsychotic medications used for bipolar disorder include:
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ariprazole (Abilify)
- Ziprasidone (Geodon)
- Clozapine (Clozaril)
Common side effects of antipsychotic medications for bipolar disorder
- Drowsiness
- Weight gain
- Sexual dysfunction
- Dry mouth
- Constipation
- Blurred vision
Other medications for bipolar disorder
Benzodiazepines
Mood stabilizers and antidepressants can take up to several weeks to reach their full effect. While you’re waiting for your medication to kick in, your doctor may prescribe a benzodiazepine to relieve any symptoms of anxiety, agitation, or insomnia you might be having. Benzodiazepines are fast-acting sedatives which work within 30 minutes to an hour. Because of their high addictive potential, benzodiazepines should only be used until your mood stabilizer or antidepressant begins to work. Those with a history of substance abuse should be particularly cautious.
To learn more about benzodiazepines, read Anxiety Medication.
Calcium channel blockers
Calcium channel blockers are sometimes prescribed for bipolar disorder. Traditionally used to treat heart problems and high blood pressure, they also have a mood stabilizing effect. They have fewer side effects than traditional mood stabilizers, but they are also less effective. However, they may be an option for people who can’t tolerate lithium or the anticonvulsants.
Thyroid medication
People with bipolar disorder often have abnormal levels of thyroid hormone. Thyroid dysfunction is particularly prevalent in rapid cyclers. Lithium treatment can also cause low thyroid levels. In these cases, thyroid medication is added to the drug treatment regimen. Thyroid medication also shows promise as a treatment for bipolar depression.
Related Articles
Treatment for Bipolar Disorder
Getting Help and Choosing Treatments
Helping a Loved One with Bipolar Disorder
Bipolar Disorder in Children, Teens, and Family Members
More Helpguide Articles:
- Understanding Bipolar Disorder: Signs, Symptoms, and Treatment of Manic Depression
- Bipolar Support and Self-Help: Living and Coping with Bipolar Disorder
- Suicide Prevention: Signs of Suicide and How to Help a Suicidal Person
- Feeling Suicidal? Coping with Suicidal Thoughts and Help to Get You Through
Related links for bipolar disorder medications
General information about bipolar disorder medications
What Are the Major Drugs Used For Bipolar Disorder? – Covers the primary medications used to treat manic depression. Includes dosage information, side effects, and drug interactions. (University of Maryland Medical Center)
Medication for Bipolar Disorder – In-depth look at bipolar disorder drugs, including the different types, special considerations and precautions, and questions to ask your doctor. (Psychology Information Online)
Generic and Brand Name Drugs: Understanding the Basics (PDF) – Learn about generic and brand name drugs for bipolar disorder and how to make smart medication choices. (Depression and Bipolar Support Alliance)
Mood stabilizer medications for bipolar disorder
Lithium – Learn all about lithium, including common side effects, risks, how to take it safely and effectively, and why regular blood tests are necessary. (Netdoctor.co.uk)
About Medications: Lithium – Find questions and answers about lithium and its use in the treatment of bipolar disorder. Covers side effects and safety guidelines. (National Alliance on Mental Illness)
Mood Stabilizers – Introduction to the mood stabilizers for manic depression and how to choose the right one. Includes the latest research on the effectiveness of different medications. (PsychEducation.org)
Bipolar Meds - The Mood Stabilizers – Describes mood stabilizers and their use in bipolar disorder. Includes research and usage guidelines for lithium and divalproex sodium. (McMan's Depression and Bipolar Web)
Antidepressant medications for bipolar disorder
Wrestling with Bipolar Disorder - Covers the negative effects of antidepressant medication on the course of bipolar disorder, and new drug options for the depressive phase. (Psychology Today)
Antidepressants in Bipolar Disorder: The Controversies – Summary of the research on antidepressant medication for the treatment of bipolar disorder, including information about the risks. (PsychEducation.org)
Antipsychotic medications for bipolar disorder
Antipsychotics and Bipolar Disorder – Guide to the use of antipsychotic medication in the treatment of bipolar disorder. Includes side effects and the latest research. (Netdoctor.co.uk)
Bipolar Meds - The Antipsychotics – Covers the history of antipsychotic medications and their use in treating mania and depression. (McMan's Depression and Bipolar Web)
Delving Deeper into Bipolar Disorder Diagnosis and Treatment
Management of Bipolar Disorder – Discusses the signs of bipolar disorder, co-occurring conditions, medication treatment recommendations, and drug interactions to watch for. (American Academy of Family Physicians)
Medication Treatment of Bipolar Disorder (PDF) – Part of The Expert Consensus Guideline Series, this reference tools offers a comprehensive look at drug treatment guidelines for bipolar depression. (Postgraduate Medicine Special Report)
