Bipolar disorder is characterized by extreme mood swings.
“Bipolar disorder is characterized by periods of weeks or months of either depression or mania,” explains Dr. Mark Weiser, professor and chair of psychiatry at Tel Aviv University in Israel, chief psychiatrist at the Sheba Medical Center and associate director of treatment trials at the Stanley Medical Research Institute in Kensington, Maryland.
These periods of ups and down, called mood swings, are significantly different from the day-to-day highs and lows we all feel as part of normal life.
“I can be in a bad mood today because I had a disagreement with a colleague at work or because I had a fight with my child,” Weiser says. “Or I can be in a good mood because something good happened to me at work or my basketball team won. These are normal mood swings.”
But “the changes in mood in bipolar depression occur over periods of weeks or months, not minutes, hours or days. When manic, patients can be very productive, however because of the poor judgment that is often part of this illness, it’s almost always counterproductive in the end.”
The variability of bipolar disorder can be difficult to treat.
People typically seek care for their depressive episodes, rather than their manic periods, and as such may be misdiagnosed with depression and offered antidepressants. But “the efficacy of antidepressants in bipolar disorder is not well established,” Weiser says.
That said, antidepressants and other classes of medications are used to help stabilize patients with bipolar disorder.
The three most common categories of medications used to control symptoms of bipolar disorder include:
— Mood stabilizers.
Erin Knox, director of experiential pharmacy education at the UCI School of Pharmacy and Pharmaceutical Sciences in Irvine, California, says “mood stabilizers are the mainstays for bipolar disorder and are frequently used in multiple phases of this condition. Many mood stabilizers effectively treat mania, and some can be used to treat bipolar depression.”
Mood stabilizers are also “commonly utilized as long-term, maintenance treatment for this lifelong disorder. They decrease overactive signaling in the brain, helping to stabilize severe mood fluctuations. Mood stabilizers delay or prevent the recurrence of mood episodes, such as mania, hypomania and depression,” Knox explains.
Dr. Doug Misquitta, a psychiatrist in the department of psychiatry and behavioral health at the Ohio State University Wexner Medical Center in Columbus, adds that “these medications can maintain a person’s mood in a good, stable range by helping to minimize manic highs and depressive lows.”
This class of medications includes the following medications. More information about these specific drugs follows in the next few slides.
— Sodium valproate (Depakote).
— Lamotrigine (Lamictal).
Mood stabilizer: lithium
Perhaps the most widely recognized mood stabilizer used for treatment of bipolar disorder is lithium, a chemical with the atomic number 3 on the periodic table of elements. “Lithium is an older medication that can be used for maintenance therapy and can also be used to treat episodes of bipolar depression and mania,” Knox says.
Weiser adds that “lithium is clearly the best (for bipoloar disorder), but can cause side effects,” including:
— Nausea, vomiting or diarrhea.
— Drowsiness or dizziness.
— Hand tremors.
— Increased thirst and urination.
— Dry mouth.
— Hair loss.
— Acne-like rash.
Still, lithium has been proven very useful in supporting people with bipolar disorder because it helps even out the mood highs and lows that characterize the illness.
“People can receive maintenance treatment for years and function at a very high level, but often relapse when they stop medication,” Weiser says.
Mood stabilizer: sodium valproate (Depakote)
Technically listed as an anticonvulsant, this medication is used to treat epilepsy and to alleviate manic symptoms of bipolar disorder. Sometimes referred to as valproic acid, divalproex sodium and valproate sodium, this medication has also been seen “to be very effective for those in the midst of a manic episode,” Misquitta says.
In addition, valproic acid “can be very efficacious in treating the symptoms of the illness and then taken on a long-term basis for maintenance,” Weiser says.
Mood stabilizer: lamotrigine (Lamictal)
Also considered an anticonvulsant, this mood stabilizer is approved for treating bipolar disorder and certain kinds of seizure disorders.
Misquitta says that this drug is “not as effective (as others) in treating acute mania, but can be used to maintain wellness for someone who has a stable mood.”
In addition to mood stabilizers, antipsychotics are often used in treating bipolar disorder, says Yana Paulson, chief pharmacy officer with L.A. Care Health Plan, which is the largest publicly operated health plan in the country. “Antipsychotics may be added along with a mood stabilizer to help with symptoms of psychosis.”
Knox adds that “medications to treat manic episodes, which may include antipsychotic agents, regulate brain chemicals or circuits to decrease severe symptoms of mania, including irritability, racing thoughts and agitation.”
These medications may include:
— Quetiapine (Seroquel). Misquitta notes that while “quetiapine is in the antipsychotic class of medications, it can also be used to treat mania.” In addition to helping treat mood problems, it can also help with sleep, he says, “which can be very helpful as mania often involves increased energy and a decreased ability to sleep.”
— Olanzapine (Zyprexa).
— Asenapine (Saphris).
— Lurasidone (Latuda).
Knox says that “antidepressant medications, which regulate brain chemicals associated with emotion, may be used during an episode of bipolar depression,” but the drawback is they can take several weeks to work.
Common antidepressants include:
— Sertraline (Zoloft).
— Bupropion (Wellbutrin).
— Escitalopram (Lexapro).
Seek tailored advice.
There are certainly a range of medications that can be used to treat bipolar disorder, and some may be used in combination to treat your specific symptoms. The aim of treatments for bipolar disorder “is primarily to manage the symptoms,” Paulson says.
But Paulson notes that what works for you may be different for someone else with the same diagnosis.
“Treatments for bipolar disorder need to be individualized to fit the patient’s specific needs and symptoms. There’s no single treatment option for every patient with bipolar disorder, so while some drugs may not work well for one patient, there are other options to try that could work better.”
What’s more, as with any other medication, you may experience side effects with bipolar medications. Managing that downside of side effects and finding the right combination of treatments can help you live more optimally with bipolar disorder.
Paulson also says that while these bipolar disorder medications can be highly effective, they often need time to work, and depending on the drug, that can mean waiting “anywhere from weeks to months,” before relief sets in.
Because of this long lag time in quelling symptoms in some cases, she says “it’s important to continue working with a doctor to adjust the medications to get the most symptom relief while minimizing side effects.”
Take medications as prescribed.
Once you start feeling better, it might be tempting to stop taking your medications. But experts warn not to do this. “Bipolar disorder is a lifelong condition, so medications should continue to be taken as directed by the doctor even after symptoms go away to make sure symptoms don’t return,” Paulson says.
Even if you’re feeling better, it’s imperative to stick with your treatment regimen as prescribed by your doctor.
Knox agrees that “bipolar disorder is a lifelong condition that requires long-term maintenance treatment. To have the most benefit when treating bipolar disorder, mood stabilizers must be taken continuously.” If they’re not, “mood episodes may become more frequent and more severe without treatment. Therefore, it’s essential to work with your health care providers to identify the best mood stabilizer medication for you.”
This isn’t always easy, though, as some patients “can have poor insight into their illness and the need for medication,” Weiser says. This may lead some to stop taking their medications as prescribed and relapse. “It’s important also to realize that even when taking medication, some patients can relapse,” he notes.
Work closely with your psychiatrist.
If you’re struggling with bipolar disorder or your medications don’t seem to be helping you manage your highs and lows, Misquitta urges you to contact your health care provider.
“Connect with a psychiatrist to discuss medication options and what might be the best fit and to discuss potential side effects. Have regular appointments to monitor progress and adjust treatment over time as needed,” he explains.
Top drugs for bipolar disorder:
— Mood stabilizer: lithium.
— Mood stabilizer: sodium valproate (Depakote).
— Mood stabilizer: lamotrigine (Lamictal).
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