Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
A variety of medications are available by prescription. These medications are usually referred to as mood stabilizers. Other classes of medications, including anticonvulsant medications and atypical antipsychotic medications, may also be helpful in treating bipolar disorder.
Many people start by taking lithium, which has been used for many years to
treat bipolar disorder.
Other possibilities for medical treatment are antiseizure medications that function as mood stabilizers. Antiseizure medicines that are sometimes used to treat bipolar disorder as well include carbamazepine (Tegretol), valproic acid (Depakote), lamotrigine (Lamictal), and oxcarbazepine (Trileptal).
The atypical antipsychotic medications, including olanzapine (Zyprexa), risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), Ziprasidone (Geodon), and Clozapine (Clorazil), used to treat psychosis are sometimes used to treat bipolar disorder; these medications have been shown to be effective for
All medications have side effects, and each person with bipolar disorder needs close monitoring for the side effects while taking the medication.
Antidepressant medication is sometimes taken with a mood-stabilizer medication during depressive episodes. Taking the antidepressant medication alone
might trigger mania.
The choice of medications is customized for each person.
Be sure to tell your health care professional about any other medical conditions you have.
Tell your health care professional about all medications you take, including over-the-counter drugs and herbal preparations. These may interact with the medications used for bipolar disorder. For example, the herbal preparation known as St. John's wort may reduce the effectiveness of some medications. Also, since it is itself an antidepressant, it may trigger a manic episode in a person with BD who is not on another mood stabilizer.
Women also should discuss any plans for pregnancy and breastfeeding with their health care professional, because a change in medication may be necessary.
Lithium: The exact way lithium works in controlling the mood swings of bipolar disorder is unknown.
Lithium may take as long as two weeks to take full effect.
It may have an "anti-suicide effect."
Levels of the drug must be closely monitored with blood tests.
Drink plenty of fluids and do not restrict intake of salt while taking lithium because dehydration can cause the level of the drug in the blood to be dangerously high.
If you have kidney or heart problems, you may be started on another medication instead.
Most common side effects are thirst, increased urination, diarrhea, nausea, tremors, and dizziness.
Carbamazepine (Tegretol): This medication reduces the excitability of brain cells and helps to control the symptoms of bipolar disorder.
It is especially good for those who cycle between mania and depression very quickly.
This drug may be used alone or in combination with another medication.
Levels of medication and blood cell counts are monitored.
Do not use this drug if you have a liver or blood disease.
Do not drink alcohol if you are taking this drug.
Side effects include dry mouth, constipation, drowsiness, nausea, trouble urinating, and low blood count (rare).
Valproic acid (Depakote): This drug works for bipolar disorder by controlling abnormal electrical activity in the brain that may cause mood swings.
This medication can be used alone or in combination with another medication.
Blood levels should be monitored.
Liver function is tested occasionally.
Do not drink alcohol with this drug; the combination may cause excessive sleepiness.
Its most common side effects are drowsiness, nausea, diarrhea, tremor, and weakness.
Lamotrigine (Lamictal): This medication appears to be most useful for the depressed phase of bipolar disorder.
This drug usually is used in combination with another medication.
Do not take this drug if you have kidney, lung, or heart problems.
Possible side effects, though rare, include severe rash, lip and tongue swelling, balance problems, and vision changes.
Olanzapine (Zyprexa): This medication is approved for treatment of both acute mania and maintenance once the symptoms are under control.
This medication may be used in combination with an antidepressant for treatment of depression in bipolar disorder.
One must be cautious of hyperglycemia in patients on any of the "atypical antipsychotics," of which Zyprexa is one. Patients who are known to have diabetes need to watch for poorer control of their blood sugar. Weight gain is possible, with or without problems with blood sugar.
There may be increased levels of blood lipids (fats) and weight gain, especially in children and adolescents who are prescribed this medication.
There is a possibility of so-called extrapyramidal side effects (EPS) at higher doses of this medicine. Oversedation or at least decreased alertness may occur.
This medicine may be safer in pregnant women who have bipolar disorder than some of the other medications mentioned above.
Risperidone (Risperdal): This is another of the atypical antipsychotic medications, and it has been approved by the U.S. Food and Drug Administration (FDA) for use in acute mania.
At higher doses, this medicine may cause restlessness, tremor, or other EPS symptoms.
Other side effects are similar to those of olanzapine.
Quetiapine (Seroquel): This is another of the atypical antipsychotic medications which has been FDA-approved to treat both the depressive episodes and acute manic episodes in bipolar disorder.
This medication may be used alone or in combination with other medications.
The most common side effects are sedation and dry mouth.
Recent studies suggest that this medication is unlikely to increase the chance of suicidal thoughts.