Understanding Bipolar Disorder Medication
Bipolar disorder is a serious, chronic mental health condition that involves having extreme mood swings.Someone with bipolar disorder can swing between periods of depression and periods of feeling constantly high, irritable, agitated or excited, which is known as mania or hypomania.
If you have bipolar disorder, treatment can help make the episodes of depression and mania shorter, easier to get through and less likely to happen.
Most people with bipolar disorder are treated with a combination of medication and psychotherapy. Psychological treatment on its own is usually not enough. Medication plays a vital role and is used to:
- treat episodes of depression
- treat episodes of mania or hypomania
- prevent these episodes from happening again
Does Lamotrigine Interact With Any Medications Or Other Substances
Certain other drugs can affect the way lamotrigine works in your body by decreasing its effectiveness or delaying its excretion from your body. These include hormonal birth control methods, estrogen-containing contraceptives, hormone treatments, the antibiotic rifampin, seizure medications such as phenobarbital, and valproic acid, which is also used to treat bipolar disorder.
Your doctor will carefully prescribe and monitor your dosage when lamotrigine is taken with other treatments. Avoid alcohol, cannabis, and other substances that can increase dizziness or drowsiness while taking lamotrigine. To rule out dangerous side effects, discuss all other medications or mind-altering substances you consume with your doctor before taking lamotrigine.
One recent British study found that folic acid supplements can cancel out lamotrigines benefits . “No one expected that result, as folic acid usually helps depression, and other medications, like valproate ,” says Dr. Aiken. “More research is needed before we can fully trust this result, but until then, we recommend taking lamotrigine without any folic acid supplements, including those found in multivitamins. Once youre doing well on lamotrigine, if you decided to add folic acid, watch out for a potential loss of benefits.”
Medications For Bipolar Disorder
Bipolar disorder can affect every area of your life. But medications for the condition can help stabilize your mood and reduce your symptoms.
Bipolar disorder is a severe mental health condition in which you experience significant shifts in mood and energy levels. Mood states you might go through may include depression, mania or hypomania, and mixed episodes.
If you dont treat bipolar disorder, the condition can be debilitating. Medications for bipolar can help stabilize your moods so that you can resume daily activities with as few symptoms as possible. Long-term treatment is considered necessary, since bipolar disorder is a chronic condition.
Commonly prescribed medications for bipolar disorder include:
- anticonvulsants
- antipsychotic medications
Healthcare professionals may also prescribe other types of medications to treat bipolar disorder, such as antidepressants to take alongside other medications.
The term mood stabilizer can refer to several different types of medications, all of which may help reduce bipolar symptoms.
Lithium emerged more than 70 years ago as the first mood stabilizer. Healthcare professionals still consider it the first line of treatment for bipolar disorder.
Research has shown that lithium may help prevent both mania and, to a lesser extent, depression.
Lithium can help treat or prevent the following states:
- bipolar depression
- aggressive or self-harming behavior
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Finding The Right Medication
Finding the right combination of medications to treat bipolar disorder can take some time. A doctor considers all of a persons symptoms and tries to find the right medications to match them. A person should be open with their doctor about any new or changing symptoms and side effects. The doctor can then adjust the treatment accordingly.
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 and is highly effective for treating mania. Lithium can also help bipolar depression. 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.
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Bipolar Ii Disorder In Adults: A Review Of Management Options
Assistant Professor for Pharmacy PracticeFlorida A& M University College of Pharmacy and Pharmaceutical SciencesTallahassee, Florida
Interim Associate Dean for Academic Affairs and ProfessorFlorida A& M University College of Pharmacy and Pharmaceutical SciencesTallahassee, Florida
Tallahassee, Florida
US Pharm
Bipolar disorder is characterized by pathologic variations in mood, with periods of mania, hypomania, psychosis, and depression. The two most common types, bipolar I and bipolar II, differ in the presentation of mood variations. The course of bipolar II is less well studied and less understood than bipolar I disorder. Patients with bipolar I disorder have episodes of full mania alternating with episodes of major depression,1,2 whereas patients with bipolar II disorder pre-sent with one or more episodes of major depression with at least one hypomanic episode.1 Bipolar II can also manifest itself as a mixed state, which is the presence of both depressive and mood elevated symptoms simultaneously.3 Patients with bipolar II disorder display fewer manic symptoms than those with bipolar I disorder both conditions may have an equivalent impact on quality of life and may also be associated with increased suicide risk.3 Patients may also present with rapid-cycling bipolar disorder, which consists of at least four discrete episodes of mania or depression in a single year, demarcated by clear periods of remission or by switches to episodes of opposite polarity.4
Antidepressants Should Be Used With Caution
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 Institute of Mental Health showed that adding an antidepressant to a mood stabilizer was no more effective in treating bipolar depression than using a mood stabilizer alone. Another NIMH study found that antidepressants work no better than placebo.
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.
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.
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What Are Potential Side Effects Of Bipolar Medications
Common side effects of these drugs may include:
- Sexual problems
Its imperative to work with your doctor or psychiatrist to manage your drug therapy. Because bipolar disorder symptoms vary greatly from person to person, it can take time to identify the best medication to manage your symptoms. Sometimes, you may need to try a few medications or combinations of medications before finding the right one.
Important Information About Bipolar Disorder Medication
Bipolar medication can cause side effects in some people.
Side effects of antipsychotic medication include:
Side effects of lithium carbonate include:
- muscle weakness
- memory problems
Lithium carbonate can be very effective for bipolar disorder, but it can build up in the body and eventually cause harm to the thyroid, kidneys or central nervous system. If you are taking lithium carbonate, you will need regular blood tests to make sure you are taking the right level.
If you have too much lithium, it can be toxic. If this happens, it usually passes from the body about 2 days after you stop the treatment. Contact the doctor who prescribed the medication immediately if you are taking lithium carbonate and you experience:
- increased thirst
For most people, the benefits of treatment outweigh the risks of being on medication. However, if you or someone you know is considering treatment, ask the treating doctor:
- What are the benefits of bipolar disorder medication?
- What are the risks of medication?
- What are the side effects?
Also discuss what other medications are being taken as some medications can interact with bipolar medication. Never discontinue or adjust doses on your own without talking to your doctor.
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Bipolar Disorder Treatment Options
While there is no cure for bipolar disorder, the medical communitys understanding of the mental disorder and the available treatment options have improved greatly over the years. These treatments focus on managing the symptoms of bipolar disorder when they arise, as well as preventing them in the future.
Prescription medication and other psychotherapies are combined to manage the condition. A patients therapy options can include cognitive behavioral therapy, social rhythm therapy, joining a support group, or talking regularly with a psychiatric mental health care provider about the condition and day-to-day life.
What Medication Is Best For Bipolar Depression
For patients with bipolar disorder, medication will likely be a part of ones treatment plan. Medication can bring mania and depression under control and prevent relapse once mood has stabilized. As people with diabetes need to take insulin to stay healthy, taking medication for bipolar disorder helps maintain a stable mood.
Treatment for bipolar depression has come a long way in a short while. Not so long ago, patients were given sedatives and medications with numerous side effects. Today, mood-stabilizing drugs are a mainstay treatment for bipolar disorder. Doctors may prescribe lithium, an antimanic drug, or an antipsychotic drugor a combination of bothto alleviate symptoms of depression without triggering a manic episode.
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What About Psychotherapy For Help With Bipolar Depression
Along with medications for bipolar depression, patients may benefit from ongoing psychotherapy. This one-on-one therapy combines interpersonal psychotherapy with behavioral techniques to help patients learn how to more effectively manage interpersonal problems, stay on their medications, and normalize their lifestyle habits. The STEP-BD study mentioned earlier found that in addition to medications, adding a structured psychotherapy â such as cognitive behavioral therapy, interpersonal/social rhythm therapy, or family-focused therapy â can speed up treatment response in bipolar depression by as much as 150%.
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Related Resources For Bipolar Disorder
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This article is not medical advice. It is intended for general informational purposes and is not meant to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, immediately call your physician or dial 911.
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Top Mood Stabilizers For Bipolar Disorder
None of them are perfect, but a few rise to the top, according to recent guidelines.
RESEARCH UPDATE
Ive been pouring over textbooks and treatment guidelines, and these four mood stabilizers keep rising to the top.1-6 None of them are perfect, but each has a unique role in bipolar disorder:
Lithium and quetiapine top the lists for all three phases of the illness: mania, depression, and the maintenance phase. Lurasidone and lamotrigine are either untested or ineffective in mania, but they are essential tools for bipolar depression.
Lithium
Lithium stands out for its preventative effects in bipolar disorder, but it also has important benefits outside of the manic-depressive symptom lists. It is the only mood stabilizer that significantly reduces the risk of suicide, and it reduces mortality in other ways as well. Although lithium is often avoided out of concerns of toxicity, it actually lowers the risk of cancer, heart disease, stroke, and viral illnesses.7 All of those occur at higher frequency in bipolar disorder. Vascular disease is the leading cause of death in bipolar disorder,8 and viral illnesses are both a consequence and cause of bipolar symptoms.9
Quetiapine
Lurasidone and Lamotrigine
The Bottom Line
For related content, see Dosing Secrets for the Top Mood Stabilizers.
Disclosures:
Nondrug Therapies Are On The Rise
Electroconvulsant treatment can be effective for bipolar disorder that hasnât responded to medications. Itâs when an electric current is sent through the brain to cause a controlled seizure. But it requires general anesthesia and has side effects such as confusion, headache, and nausea. Now, researchers are studying whether transcranial magnetic stimulation , a noninvasive procedure that uses magnetic fields to stimulate brain nerve cells, is effective. Early research is promising, especially for the depressive stages of bipolar disorder.
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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:
What Are The Types Of Bipolar Disorder
According to the National Institute of Mental Health , there are three types of bipolar disorder.
- It is defined by manic episodes that last a minimum of seven days or manic symptoms severe enough that patients need immediate hospital care.
- In this instance, depressive episodes may occur as well, typically lasting at least two weeks.
- Episodes of depression, with mixed depressive symptoms and manic symptoms at the same time, are also possible.
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The Role Of The Pharmacist
The pharmacist plays a tremendous role in optimizing care for patients with bipolar II disorder. To clinical pharmacists, obtaining an accurate and complete medication history is very important in determining the appropriate therapy, or even identifying underlying medication-related causes of disease cycling. The pharmacist can be a viable component in providing appropriate dosing strategies, reviewing therapeutic regimens for drug interactions, instituting clinical monitoring parameters, and identifying signs and symptoms of medication toxicity. Clinical pharmacists can also provide the patient with discharge counseling. Educating this population on appropriate administration times, possible adverse reactions, and potential drug interactions can increase medication adherence and reduce future hospitalizations.
As an easily accessible resource, community pharmacists are also key players in providing optimal care to patients with bipolar II disorder. Not all institutions employ the services of a pharmacist for discharge counseling, and in this instance outpatient counseling through community pharmacists is very important in increasing medication compliance and adherence. Community pharmacists may also provide information about ways to identify early signs and symptoms of mania or depression so as to help patients seek medical help sooner.
Combining Antipsychotics With Mood Stabilizers
Frequently, an antipsychotic will be prescribed with a mood stabilizer, and research shows that the combination of the two can be more effective than just one alone.
However, the older antipsychotics are often associated with extrapyramidal symptoms, otherwise known as movement-related side effects, such as acute dystonic reactions, parkinsonism, akinesia, and akathisia. They also carry a somewhat greater risk of tardive dyskinesia and neuroleptic malignant syndrome.
However, the atypical antipsychotics arent perfect either these agents may carry a higher risk of metabolic side effects such as weight gain and type 2 diabetes.
Seroquel , Latuda , and Vraylar are the atypical antipsychotics that have an indication for depression in bipolar disorder. Zyprexa and Clozaril also show high levels of efficacy in treating different aspects of bipolar disorder.
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Bipolar Disorder Medication Alone Is Not Enough
Bipolar medication is most effective when used in combination with other bipolar disorder treatments, including:
Therapy. People who take medication for bipolar disorder tend to recover much faster and control their moods much 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.
Exercise.Getting regular exercise can reduce bipolar disorder symptoms and help stabilize mood swings. Exercise is also a safe and effective way to release the pent-up energy associated with the manic episodes of bipolar disorder.
Stable sleep schedule. Studies have found that insufficient sleep can precipitate manic episodes in bipolar patients. To keep symptoms and mood episodes to a minimum maintain a stable sleep schedule. It is also important to regulate darkness and light exposure as these throw off sleep-wake cycles and upset the sensitive biological clock in people with bipolar disorder.
Healthy diet.Omega-3 fatty acids may lessen the symptoms of bipolar disorder. Weight gain is a common side effect of many bipolar medications, so it’s important to adopt healthy eating habits to manage your weight. Avoid caffeine, alcohol, and drugs as they can adversely interact with bipolar medications.
Authors: Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Reviewed by Damon Ramsey, MD
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:
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.
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Antidepressant Medications For Bipolar Disorder
Prescribing antidepressants for bipolar disorder can be controversial some believe they are helpful while others believe that they may actually make it worse, triggering mania and increasing mood cycling. However, something many in the field do agree on is that antidepressants should not be used as mono therapy for bipolar disorder.
And some antidepressant classes such as tricylics or serotonin-norepinephrine reuptake inhibitors may cause a higher switch rate , than selective serotonin reuptake inhibitors and bupropion. SSRIs include: