| Medications
Medications for bipolar disorder are prescribed by psychiatrists—medical
doctors (M.D.s and D.O.s) with expertise in the diagnosis and
treatment of mental disorders. While primary care physicians who
do not specialize in psychiatry also may prescribe these medications,
it is recommended that people with bipolar disorder see a psychiatrist
for treatment.
Medications known as "mood stabilizers" usually are
prescribed to help control bipolar disorder. Several different
types of mood stabilizers are available. In general, people with
bipolar disorder continue treatment with mood stabilizers for
extended periods of time (years). Other medications are added
when necessary, typically for shorter periods, to treat episodes
of mania or depression that break through despite the mood stabilizer.
Before starting a new medication for bipolar disorder, always
talk with your psychiatrist and/or pharmacist about possible side
effects. Depending on the medication, side effects may include
weight gain, nausea, tremor, reduced sexual drive or performance,
anxiety, hair loss, movement problems, or dry mouth. Be sure to
tell the doctor about all side effects you notice during treatment.
He or she may be able to change the dose or offer a different
medication to relieve them. Your medication should not be changed
or stopped without the psychiatrist's guidance.
- Lithium, the first mood-stabilizing medication approved by
the U.S. Food and Drug Administration (FDA) for treatment of
mania, is often very effective in controlling mania and preventing
the recurrence of both manic and depressive episodes.
- Anticonvulsant medications, such as valproate (Depakote ®
) or carbamazepine (Tegretol ® ), also can have mood-stabilizing
effects and may be especially useful for difficult-to-treat
bipolar episodes. Valproate was FDA-approved in 1995 for treatment
of mania.
- Newer anticonvulsant medications, including lamotrigine (Lamictal
® ), gabapentin (Neurontin ® ), and topiramate (Topamax
® ), are being studied to determine how well they work in
stabilizing mood cycles.
- Anticonvulsant medications may be combined with lithium, or
with each other, for maximum effect.
- Children and adolescents with bipolar disorder generally are
treated with lithium, but valproate and carbamazepine also are
used. Researchers are evaluating the safety and efficacy of
these and other psychotropic medications in children and adolescents.
( There is some evidence that valproate may lead to adverse
hormone changes in teenage girls and polycystic ovary syndrome
in women who began taking the medication before age 20, according
to research published in the Annuals of Neurology Therefore,
young female patients taking valproate should be monitored carefully
by a physician.)
- Women with bipolar disorder who wish to conceive, or who become
pregnant, face special challenges due to the possible harmful
effects of existing mood stabilizing medications on the developing
fetus and the nursing infant, according to research published
in the Journal of Clinical Psychiatry . Therefore,
the benefits and risks of all available treatment options should
be discussed with a clinician skilled in this area. New treatments
with reduced risks during pregnancy and lactation are under
study.
For more information see
About.com:
Bipolar Disorder: Medications.
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|
Treatment
of Bipolar Depression Research has shown that people with
bipolar disorder are at risk of switching into mania or hypomania,
or of developing rapid cycling, during treatment with antidepressant
medication. Therefore, "mood-stabilizing" medications
generally are required, alone or in combination with antidepressants,
to protect people with bipolar disorder from this switch . Lithium
and valproate are the most commonly used mood-stabilizing drugs
today. However, research studies continue to evaluate the potential
mood-stabilizing effects of newer medications.
- Atypical antipsychotic medications, including clozapine (Clozaril
® ), olanzapine (Zyprexa ® ), risperidone (Risperdal
® ), quetiapine (Seroquel ® ), and ziprasidone (Geodon
® ), are being studied as possible treatments for bipolar
disorder. Evidence suggests clozapine may be helpful as a mood
stabilizer for people who do not respond to lithium or anticonvulsants.
Other research has supported the efficacy of olanzapine for
acute mania, an indication that has recently received FDA approval.
Olanzapine may also help relieve psychotic depression.
- If insomnia is a problem, a high-potency benzodiazepine medication
such as clonazepam (Klonopin ® ) or lorazepam (Ativan ®
) may be helpful to promote better sleep. However, since these
medications may be habit-forming, they are best prescribed on
a short-term basis. Other types of sedative medications, such
as zolpidem (Ambien ® ), are sometimes used instead.
- Changes to the treatment plan may be needed at various times
during the course of bipolar disorder to manage the illness
most effectively. A psychiatrist should guide any changes in
type or dose of medication.
- Be sure to tell the psychiatrist about all other prescription
drugs, over-the-counter medications, or natural supplements
you may be taking. This is important because certain medications
and supplements taken together may cause adverse reactions.
- To reduce the chance of relapse or of developing a new episode,
it is important to stick to the treatment plan. Talk to your
doctor if you have any concerns about the medications.
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| Other
Treatments
- In situations where medication, psychosocial treatment, and
the combination of these interventions prove ineffective, or
work too slowly to relieve severe symptoms such as psychosis
or suicidality, electroconvulsive therapy (ECT) may be considered.
ECT may also be considered to treat acute episodes when medical
conditions, including pregnancy, make the use of medications
too risky. ECT is a highly effective treatment for severe depressive,
manic, and/or mixed episodes. The possibility of long-lasting
memory problems, although a concern in the past, has been significantly
reduced with modern ECT techniques. However, the potential benefits
and risks of ECT, and of available alternative interventions,
should be carefully reviewed and discussed with individuals
considering this treatment and, where appropriate, with family
or friends.
- Herbal or natural supplements, such as St. John's wort (Hypericum
perforatum) , have not been well studied, and little is
known about their effects on bipolar disorder. Because the FDA
does not regulate their production, different brands of these
supplements can contain different amounts of active ingredient.
Before trying herbal or natural supplements, it is important
to discuss them with your doctor. There is evidence that St.
John's wort can reduce the effectiveness of certain medications,
according to the Journal of the American Medical Association
. In addition, like prescription antidepressants, St. John's
wort may cause a switch into mania in some individuals with
bipolar disorder, especially if no mood stabilizer is being
taken
- Omega-3 fatty acids found in fish oil are being studied to
determine their usefulness, alone and when added to conventional
medications, for long-term treatment of bipolar disorder.
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Psychosocial
Treatments As an addition to medication, psychosocial treatments—including
certain forms of psychotherapy (or "talk" therapy)—are
helpful in providing support, education, and guidance to people
with bipolar disorder and their families. Studies have shown that
psychosocial interventions can lead to increased mood stability,
fewer hospitalizations, and improved functioning in several areas.
A licensed psychologist, social worker, or counselor typically
provides these therapies and often works together with the psychiatrist
to monitor a patient's progress. The number, frequency, and type
of sessions should be based on the treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder
are cognitive behavioral therapy, psychoeducation, family therapy,
and a newer technique, interpersonal and social rhythm therapy.
NIMH researchers are studying how these interventions compare
to one another when added to medication treatment for bipolar
disorder.
- Cognitive behavioral therapy helps people with bipolar disorder
learn to change inappropriate or negative thought patterns and
behaviors associated with the illness.
- Psychoeducation involves teaching people with bipolar disorder
about the illness and its treatment, and how to recognize signs
of relapse so that early intervention can be sought before a
full-blown illness episode occurs. Psychoeducation also may
be helpful for family members.
- Family therapy uses strategies to reduce the level of distress
within the family that may either contribute to or result from
the ill person's symptoms.
- Interpersonal and social rhythm therapy helps people with
bipolar disorder both to improve interpersonal relationships
and to regularize their daily routines. Regular daily routines
and sleep schedules may help protect against manic episodes.
- As with medication, it is important to follow the treatment
plan for any psychosocial intervention to achieve the greatest
benefit.
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| Thyroid
Function People with bipolar disorder often have abnormal
thyroid gland function. Because too much or too little thyroid
hormone alone can lead to mood and energy changes, it is important
that thyroid levels are carefully monitored by a physician.
People with rapid cycling tend to have co-existing thyroid problems
and may need to take thyroid pills in addition to their medications
for bipolar disorder. Also, lithium treatment may cause low thyroid
levels in some people, resulting in the need for thyroid supplementation.
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A Long-Term
Illness That Can Effectively Be Treated Even though episodes
of mania and depression naturally come and go, it is important
to understand that bipolar disorder is a long-term illness that
currently has no cure. Staying on treatment, even during well
times, can help keep the disease under control and reduce the
chance of having recurrent, worsening episodes.
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