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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.
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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.
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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.
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Newer anticonvulsant medications, including lamotrigine (Lamictal ® ),
gabapentin (Neurontin ® ), and topiramate (Topamax ® ), are being studied
to determine how well they work in stabilizing mood cycles.
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Anticonvulsant medications may be combined with lithium, or with each other, for
maximum effect.
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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.)
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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
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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.
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Cognitive behavioral therapy helps people with bipolar disorder learn to change
inappropriate or negative thought patterns and behaviors associated with the
illness.
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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.
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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.
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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.
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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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