The Role Of Cannabinoids
Acute cannabis intoxication transiently produces perceptual distortions, psychotic symptoms and reduction in cognitive abilities in healthy persons and in severe mental disorder, and may impair the ability to safely operate a motor vehicle.
Cannabis use is common in bipolar disorder and is a risk factor for a more severe course of the disease by increasing frequency and duration of episodes. It is also reported to reduce age at onset.
What’s The Standard Treatment For Bipolar Depression
Lithium and the anticonvulsants lamotrigine and valproate are mood stabilizers that are sometimes used “off label” as treatments for bipolar depression, although none of these has been established as an FDA-approved first-line treatment for bipolar depression. For many years, psychiatrists have traditionally added an antidepressant to a mood stabilizer if a mood stabilizer alone is ineffective however, research shows that antidepressants are often not effective for bipolar depression.
A mood-stabilizing medication works on improving social interactions, mood, and behavior and is recommended for both treatment and prevention of bipolar mood states that swing from the lows of depression to the highs of hypomania or mania. According to the American Psychiatric Association , lithium, lamotrigine, valproate, carbamazepine, and most atypical antipsychotic medications are approved by the FDA for treating one phases of bipolar disorder.
In some patients with bipolar disorder, a mood stabilizer may be all that’s needed to modulate the depressed mood. However, in bipolar patients who do not respond to one mood stabilizer, another mood stabilizer or an atypical antipsychotic is sometimes added to the treatment regimen.
Anticonvulsants For Bipolar Disorder
Three anticonvulsant drugs, used as mood stabilisers, are licensed to treat bipolar disorder:
- carbamazepine also known as Tegretol. This is sometimes prescribed to treat episodes of mania. It can be prescribed if lithium is ineffective or unsuitable for you. For more information, see our page on carbamazepine.
- valproate also known as Depakote, Epilim. This can be used to treat episodes of mania and is typically a long-term treatment. It can be prescribed if lithium is ineffective or unsuitable for you. Your doctor is unlikely to prescribe you valproate if you’re able to become pregnant. This is because it can lead to significant risks in pregnancy. For more information, see our page on valproate.
- lamotrigine also known as Lamictal. This is licensed to treat severe depression in bipolar disorder, but NICE does not recommend it for treating mania. If you’re pregnant and taking lamotrigine, NICE recommends regular check-ups. For more information, see our page on lamotrigine.
For more information, see our pages on mood stabilisers.
Medication can help keep your moods on an even keel, but it is trial and error.
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Drug Selection And Use
Choice of drug treatment for bipolar disorders Bipolar Disorders Bipolar disorders are characterized by episodes of mania and depression, which may alternate, although many patients have a predominance of one or the other. Exact cause is unknown, but heredity… read more can be difficult because all drugs have significant adverse effects, drug interactions are common, and no drug is universally effective. Selection should be based on what has previously been effective and well-tolerated in a given patient. If there is no prior experience , choice is based on the patients medical history and the severity of symptoms.
For severe manic psychosis, in which immediate patient safety and management is compromised, urgent behavioral control usually requires a sedating 2nd-generation antipsychotic Second-generation antipsychotics Antipsychotic drugs are divided into conventional antipsychotics and 2nd-generation antipsychotics based on their specific neurotransmitter receptor affinity and activity. SGAs may offer… read more , sometimes supplemented initially with a benzodiazepine such as lorazepam or clonazepam 2 to 4 mg IM or orally 3 times a day.
For less severe acute episodes in patients without contraindications , lithium is a good first choice for both mania and depressive episodes. Because its onset is slow , patients with significant symptoms may also be given an anticonvulsant or a 2nd-generation antipsychotic.
Can Bipolar Disorder Medication Make You Get Worse
Certain antidepressants can trigger mood episodes in some people with bipolar disorder if they are taken alone. They are typically used in combination with antipsychotics.
Youll want to tell your doctor about all the medications you take. Also, if you want to discontinue any medications included in your treatment plan, youll want to first consult with your healthcare team.
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Challenges Of Bipolar Treatment
The treatments for bipolar disorder, while very effective, pose some specific challenges for the person:
- Mood variations in bipolar disorder are not predictable, so it is sometimes difficult to tell if a person is responding to treatment or naturally emerging from a bipolar phase.
- A person with bipolar disorder cannot always reliably inform the doctor about the state of the illness.
- The person is likely to need more than one medication during the course of the disease. This increases the risk for side effects. Noncompliance is common.
- People may have more than one mental health or medical problem and need different drugs to treat each condition. Such medications can interact with drugs used to treat bipolar disorder or increase side effects.
- Treatment strategies for children and the elderly have not been intensively studied and have not been clearly defined.
- People need to monitor their condition on a lifelong basis.
What Meds Treat Bipolar
Several types of medications can be used to treat bipolar disorder. The most common ones are generally called mood stabilizers. They work by restoring the balance of the chemicals in your brain.
Mood stabilizers work best if you take them consistently. Sometimes people stop taking them during a manic episode becauselets face itmanic episodes can feel great, and who wants to miss that? If you stop taking your meds though, it will take longer for them to kick in once another depressive episode hits.
Here are some of the most popular mood stabilizers:
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How To Use Aripiprazole
Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking aripiprazole and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor, usually once daily. The dosage is based on your medical condition, response to treatment, age, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use . To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor’s instructions carefully.
The manufacturer directs to swallow this medication whole. However, many similar drugs can be split/crushed. Follow your doctor’s direction on how to take this medication.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/cup. Do not use a household spoon because you may not get the correct dose.
Do not increase your dose or use this drug more often or for longer than prescribed. Your condition will not improve any faster, and your risk of side effects will increase.
It may take several weeks before you get the full benefit of this drug. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day.
Will The Medicine Work For Me
Your doctor canât predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different doses to figure out the right approach. And that can take time.
It can be frustrating, but don’t give up. Eventually, you and your doctor should be able to find a prescription that works for you.
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Tips For Finding The Right Medication For Your Child
Having your child start a medication for bipolar disorder might seem overwhelming, but educating yourself about the different options may help ease some of your anxiousness.
Many people living with bipolar disorder respond well to medication and find it helpful for managing their symptoms.
Remember: When it comes to starting or continuing a medication regimen, communication is key!
Its important that young patients and their guardians know they have the right to ask their healthcare professionals questions at any time. Doctors and pharmacists want you to have all the information you need when making decisions about your childs care.
Questions to consider before the appointment:
- Does my child have any other known health conditions?
- Is my child currently on any other medications that may interact with a new one?
- Does my child have any known medication allergies?
- Have other members of my family been on this medication before? How did they respond?
Questions to ask your doctor or pharmacist:
Questions to discuss with your child:
- Do you trust this doctor?
- How do you feel about potentially starting a medication?
- Are you willing to be totally honest with me about any side effects?
- Are you willing to try your best to take your medication as directed?
- Do you understand there are foods and substances that can interact in dangerous ways with these medications?
- If this treatment option isnt working, can you agree to let me know so we can seek alternatives?
Antidepressant Use In Bipolar Disorder
Use of antidepressants in bipolar disorder is controversial antidepressants may trigger mania or rapid cycling in people with bipolar disorder. However, antidepressant drugs may be useful during the depressive phase in certain patients provided the antidepressants are used with a mood stabilizer or atypical antipsychotic. For example, olanzapine and fluoxetine is available as a combination drug.
Patients who present acutely in a full manic or hypomanic episode should have antidepressants discontinued. Antidepressants are not recommended to be used alone in any phase of bipolar disorder
Keep in mind that people with bipolar II disorder may be misdiagnosed with depression only because they do not experience full-fledged mania or only present to their doctor in the depressive phase. If these patients take antidepressants without mood stabilizers, it can trigger a manic episode.
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What Are The Types Of Bipolar Disorder
There are four types of bipolar disorder, which are based on the types of mood episodes you experience. For instance, manic episodes typically involve having extremely elevated mood and energy levels for at least seven days, according to the NIMH. Hypomanic episodes are less extreme than manic ones, but also involve having a lot of energy and elevated moods for at least four days, the Cleveland Clinic explains. Depressive episodes, on the other hand, occur when you feel intense sadness, indifference, or hopelessness for at least two weeks, so you might have little energy or lose interest in activities you typically enjoy.
Depending on your symptoms, you may be diagnosed with one of the following types of bipolar disorder, per the NIMH:
Medicines For Bipolar Disorder
Several medicines are available to help stabilise mood swings.
These are commonly called mood stabilisers and include:
- anticonvulsant medicines
- antipsychotic medicines
If you’re already taking medicine for bipolar disorder and you develop depression, your GP will check you’re taking the correct dose. If you’re not, they’ll change it.
Episodes of depression are treated slightly differently in bipolar disorder, as taking antidepressants alone may lead to a relapse.
Most guidelines suggest depression in bipolar disorder can be treated with just a mood stabiliser.
But antidepressants are commonly used alongside a mood stabiliser or antipsychotic.
If your GP or psychiatrist recommends you stop taking bipolar disorder medicine, the dose should be gradually reduced over at least 4 weeks, and up to 3 months if you’re taking an antipsychotic or lithium.
If you have to stop taking lithium for any reason, talk to your GP about taking an antipsychotic or valproate instead.
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Lithium For Bipolar Disorder
Its typically a long-term treatment, usually prescribed for at least six months.
For lithium to be effective, the dosage must be correct. You’ll need regular blood and health checks while taking lithium, to make sure the levels are right for you.
For more information, see our page on lithium.
I was really quite unwell. Then my psychiatrist changed my medication. I began taking lithium and it really worked for me. I started feeling better pretty quickly.
Important Help And Support
In the manic phase of bipolar disorder, patients may engage in risky activities, such as fast driving or certain risky sports. They should be monitored and prevented from taking chances, especially in a car. Drinks and foods containing caffeine — tea, coffee, and cola– should be allowed in moderation. Avoid alcohol at all times. It is very important for a patient experiencing manic symptoms to receive prompt psychiatric assessment. Family members may need to contact the doctor, because oftentimes patients in a manic or hypomanic episode have little insight into their illness and may refuse treatment. But prompt intervention, including possible medication adjustments at an early point in an episode, may prevent further problems and the need for hospitalization.
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What Does It Mean To Be Bipolar
Once called manic depression, bipolar disorder is a mental health condition characterized by unusual shifts in mood, energy, activity levels, concentration and an inability to carry out daily tasks. Moods can range from highs where you feel extremely energized, elated or unusually irritable to lows which can lead to sadness, indifference, or hopelessness.1
Although bipolar disorder is a lifelong condition, its possible to manage mood swings and other symptoms by following a treatment plan that, in most cases, includes medications and psychotherapy.
In general, bipolar disorder is much better controlled if treatment is continuous and tailored to each person since different people respond to treatment in different ways, says Diana Samuel, MD, assistant professor of clinical psychiatry at the Columbia University Medical Center. The combination of psychotherapy and medications together tends to be more effective, providing improvement in symptoms sooner.
Types Of Bipolar Disorder
The primary types of bipolar disorder, based on DSM-5 criteria, include:
Bipolar I Disorder: People with bipolar I disorder have had at least one fully manic episode with periods of major depression and hypomania usually occurring during their course. Periods of psychosis can occur in the manic phase. A severe manic episode may involve suicidal or violent behavior, aggressiveness, psychosis , and putting others at risk of harm. Bipolar I disorder has also been referred to as manic-depression.
Bipolar II Disorder: People with bipolar disorder II do not experience full-fledged mania. Instead they experience periods of hypomania . These hypomanic periods alternate with episodes of major depressive disorder. Psychosis does not occur in hypomania. Patients with bipolar II disorder may be incorrectly diagnosed with just major depression because the hypomania period is often not easily recognized, or patients only seek help in the depressive phase.
Symptoms for both bipolar I and bipolar II may be mixed, with manic and depressive symptoms occurring at the same time. Rapid-cycling between symptoms can occur, as well as catatonia . Anxious distress may also be a component of either bipolar I or II, with symptoms of depression with abnormal restlessness, with worry about events and loss of control.
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Whats The Safest Medication For Bipolar Disorder
The safest bipolar disorder medication is one that controls the symptoms of the condition and causes the fewest or most tolerable side effects. Because theres no one-size-fits-all approach to bipolar disorder treatment, a plan may look different for everyone.
For most people, lithium is highly effective at controlling mood and can even lower suicidal ideation. Also, your doctor will want to monitor your well-being regularly to ensure no concerns regarding thyroid or kidney function.
People at high risk for heart disease or diabetes may want to avoid antipsychotics, which may cause a metabolic disturbance. Others may find theyre helpful at controlling their symptoms.
Youll want to work with your healthcare team at finding the safest option that controls your symptoms and minimizes unpleasant side effects.
Not taking bipolar disorder medication can have serious effects, too. Even if your condition is well controlled, stopping your medication can cause symptoms to return.
People with bipolar disorder are also at
- other mental health concerns
- thyroid disease
Treatment For Rapid Cycling
The first step in treating rapid cycling is to try to identify and resolve other factors, such as drug abuse or hypothyroidism , which may have caused this condition. Antidepressants, particularly SSRIs, may contribute to rapid cycling and are usually tapered off.
Rapid cycling can be challenging to control and there is no consensus on how which drugs are most effective in treating it. People may need to try different medications to see what works.
In general, lithium and valproate are the first-line treatments for rapid cycling associated with bipolar I disorder, and lamotrigine for bipolar II disorder. Atypical antipsychotics such as aripiprazole, olanzapine, and quetiapine may also be tried. ECT may be useful in some situations.
In addition, other measures should be taken:
- People should avoid anti-anxiety drugs, alcohol, caffeine, and stimulants.
- People should avoid exposure to bright light.
- All efforts should be made to help the person sleep normally.
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Whats The Connection Between Bipolar Disorder And Substance Use Disorder
If a person has bipolar I disorder, they are 2 to nearly 6 times more likely to also have a substance use disorder.5 This suggests there are common risk factors for bipolar disorder and addiction.
They are both more likely to occur in an individual and can occur simultaneously because of shared risk factors combined with the complex interactions where each disorder can influence the other. This does not mean that one disorder directly causes the other, although each disorder may worsen or exacerbate the other.11
Substance use disorders and bipolar disorders occur in the same area of the brain involved with reward, making decisions, and impulse control.10 Having one is a risk factor for having the other. They also share a number of risk factors, including:11,12
- Genetic vulnerabilities and family history.
- Traumatic and/or stressful life experiences, including childhood adversity and trauma
- Traumatic brain injury.
- Anxiety disorders and PTSD.
The interplay between bipolar disorder and substance use is complex, and stress can increase the risk that those with bipolar disorder will use substances and those with a substance use disorder might experience more frequently occurring or worsened mania/hypermania or depressive episodes.13