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This page is designed to give you information about drugs that can be used as part of the treatment of bipolar disorder. It is important to be well informed about prescription medications you are taking, but this is not a "do-it-yourself" manual. Self-medication can be dangerous. Interpretation of both the signs and symptoms of bipolar disorder, and medication side effects, are jobs for the professional. The prescription and management of medication, in all cases, must be done by a responsible physician, working closely with the patient and his/her treating psychologist, and sometimes involving the patient's family. This is the only way to ensure that the most effective use of medication is achieved with minimum risk of side effects or complications. Go Directly to Medication ListOftentimes an individual is taking more than one medication and at different times of the day. It is essential to take the correct dosage of each medication. An easy way to ensure this is to use a 7-day pill box, available at the prescription counter in any pharmacy, and to fill the box with the proper medications at the beginning of each week. The following information is contained on this page:
OverviewThree groups of antidepressant medications are most often used to treat depressive disorders: tricyclics, monoamine oxidase inhibitors (MAOIs), and lithium. Lithium was the treatment of choice for bipolar disorder and some forms of recurring, major depression. However, more recently doctors have also been using anticonvulsants for bipolar disorder. Your physician must consider your personal health history and response to medications in determining what is best for you. Sometimes different medications are tried, and sometimes the dosage must be increased to be effective. People often are tempted to stop medication too soon. It is important to keep taking medication until your doctor says to stop, even if you feel better beforehand. Some medications must be stopped gradually to give your body time to adjust. For individuals with bipolar disorder, medication may have to become part of everyday life to avoid disabling symptoms. That is, antimanic medications are designed to stop a manic episode in progress, but they are also preventative. Taking the medication helps prevent another manic episode. Depending on the frequency and severity of episodes, your physician may recommend ongoing treatment with antimanic medication to prevent future episodes. As is the case with any type of medication prescribed for more than a few days, antimanic medications have to be carefully monitored to see if you are getting the correct dosage. Your doctor will want to check the dosage and its effectiveness regularly. Never mix medications of any kind--prescribed, over-the counter, or borrowed--without consulting your doctor. Be sure to tell your dentist or any other medical specialist who prescribes a drug if you are taking antimanic medication. Some of the most benign drugs when taken alone can cause severe and dangerous side effects if taken with others. Be sure to call your doctor if you have a question about any drug or if you are having a problem you believe is drug related. Also, never take alcohol with medications of any kind, unless your physician has told you it is safe to do so. Alcohol interacts with many different medications. Bipolar meds - Topic List Other Psychology Links
Symptom Relief, Not CureJust as aspirin can reduce a fever without clearing up the infection that causes it, psychotherapeutic medications act by controlling symptoms. Like most drugs used in medicine, they correct or compensate for some malfunction in the body. Psychotherapeutic medications do not cure mental illness. In many cases, these medications can help a person get on with life despite some continuing difficulty coping with problems. In the case of bipolar disorder, the antimanic medications help control, or minimize the effects of a manic episode. However, the person still has to learn self-monitoring skills, to identify an episode as it is developing, and psychotherapy is helpful to learn to adjust to the limitations of the disorder, as well as focusing on depressive symptoms and issues. How long someone must take a psychotherapeutic medication depends on the disorder. Many depressed and anxious people may need medication for a single period perhaps for several months and then never have to take it again. But. for manic-depressive illness, medication may have to be take indefinitely or, perhaps, intermittently. Like any medication, psychotherapeutic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Some may need larger dosages than others do. Some experience annoying side effects, while others do not. Age, sex, body size, body chemistry, physical illnesses and their treatments, diet, and habits such as smoking, are some of the factors that can influence a medication's effect. Bipolar meds - Topic List Other Psychology Links
Questions for Your DoctorTo increase the likelihood that a medication will work well, patients and their families must actively participate with the doctor prescribing it. You must tell the doctor about your past medical history, other medications being taken, anticipated life changes such as planning to have a baby and, after some experience with a medication, whether it is causing side effects. When a medication is prescribed, you should ask the following questions, recommended by the US Food and Drug Administration (FDA):
Here, medications are described by their generic (chemical) names and by their trade names (brand names used by drug companies). This page describes antimanic medications. Treatment evaluation studies have established the efficacy of the medications described here; however, much remains to be learned about these medications. The National Institute of Mental Health, other Federal agencies, and private research groups are sponsoring studies of these medications. Scientists are hoping to improve their understanding of how and why these medications work, how to control or eliminate unwanted side effects, and how to make the medications more effective. Bipolar meds - Topic List Other Psychology Links
Antimanic MedicationsBipolar disorder (manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression). Cycles may be predominantly manic or depressive with normal mood between cycles. Mood swings may follow each other very closely, within hours or days, or may be separated by months to years. These "highs" and "lows" may vary in intensity and severity. When someone is in a manic "high," s/he may be overactive, over talkative, and have a great deal of energy. S/he will switch quickly from one topic to another, as if s/he cannot get thoughts out fast enough; the attention span is often short, and s/he can easily be distracted. Sometimes, the "high" person is irritable or angry and has false or inflated ideas about his/her position or importance in the world. S/he may be very elated, full of grand schemes which might range from business deals to romantic sprees. Often, s/he shows poor judgment in these ventures. Mania, untreated, may worsen to a psychotic state. Depression will show in a "low" mood, with lack of energy, changes in eating and sleeping patterns, feelings of hopelessness, helplessness, sadness, worthlessness, and guilt, and sometimes thoughts of suicide. LithiumThe medication used most often over the years to combat a manic "high" is lithium. It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions, so that it is used not just for acute manic attacks or flare-ups of the illness, but also as an ongoing treatment of bipolar disorder. Lithium will diminish severe manic symptoms in about 5 to 14 days, but it may be anywhere from days to several months until the condition is fully controlled. Antipsychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to take effect. Likewise, antidepressants may be needed in addition to lithium during the depressive phase of bipolar disorder. Someone may have one episode of bipolar disorder and never have another, or be free of illness for several years. However, for those who have more than one episode, continuing (maintenance) treatment on lithium is usually given serious consideration. Some people respond well to maintenance treatment and have no further episodes, while others may have moderate mood swings that lessen as treatment continues. Some people may continue to have episodes that are diminished in frequency and severity. Unfortunately, some manic-depressive patients may not be helped at all. Response to treatment with lithium varies, and it cannot be determined beforehand who will or will not respond to treatment. Regular blood tests are an important part of treatment with lithium. A lithium level must be checked periodically to measure the amount of the drug in the body. If too little is taken, lithium will not be effective. If too much is taken, a variety of side effects may occur. The range between an effective dose and a toxic one is small. A lithium level is routinely checked at the beginning of treatment to determine the best lithium dosage for the patient. Once a person is stable and on maintenance dosage, a lithium level should be checked every few months. How much lithium a person needs to take may vary over time, depending on the severity of the bipolar disorder, body chemistry, and physical condition. Anything that lowers the level of sodium (table salt is sodium chloride) in the body may cause a lithium buildup and lead to toxicity. Reduced salt intake, heavy sweating, fever, vomiting, or diarrhea may do this. An unusual amount of exercise or a switch to a low-salt diet are examples. It's important to be aware of conditions that lower sodium and to share this information with the doctor. The lithium dosage may have to be adjusted. When a person first takes lithium, s/he may experience side effects, such as drowsiness, weakness, nausea, vomiting, fatigue, hand tremor, or increased thirst and urination. These usually disappear or subside quickly, although hand tremor may persist. Weight gain may also occur. Dieting will help, but crash diets should be avoided because they may affect the lithium level. Drinking low-calorie or no-calorie beverages will help keep weight down. Kidney changes, accompanied by increased thirst and urination, may develop during treatment. These conditions are generally manageable and are reduced by lowering the dosage. Because lithium may cause the thyroid gland to become underactive (hypothyroidism) or sometimes enlarged (goiter), thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone is given along with lithium. Because of possible complications, lithium may either not be recommended or may be given with caution when a person has existing thyroid, kidney, or heart disorders, epilepsy, or brain damage. Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies born to women taking lithium. Special caution should be taken during the first 3 months of pregnancy. Lithium, when combined with certain other medications, can have unwanted effects. Some diuretics substances that remove water from the body increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium. Signs of lithium toxicity may include nausea, vomiting, drowsiness, mental dullness, slurred speech, confusion, dizziness, muscle twitching, irregular heart beat, and blurred vision. A serious lithium overdose can be life-threatening. If you are taking lithium, you should tell all your doctors, including dentists, about all the other medications you are taking. With regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives. AnticonvulsantsNot all patients with symptoms of mania benefit from lithium. Some have been found to respond to another type of medication, the anticonvulsant medications that are usually used to treat epilepsy. Carbamazepine (Tegretol) is the anticonvulsant that has been most widely used. Individuals with bipolar disorder who cycle rapidly, (changing from mania to depression and back again over the course of hours or days, rather than months) seem to respond particularly well to carbamazepine. Early side effects of carbamazepine, although generally mild, include drowsiness, dizziness, confusion, disturbed vision, perceptual distortions, memory impairment, and nausea. They are usually transient and often respond to temporary dosage reduction. Another common but generally mild adverse effect is the lowering of the white blood cell count which requires periodic blood tests to monitor against the rare possibility of more serious, even life-threatening, bone marrow depression. Also serious are the skin rashes that can occur in 15 to 20 percent of patients. These rashes are sometimes severe enough to require discontinuation of the medication. In 1995, the anticonvulsant divalproex sodium (Depakote) was approved by the Food and Drug Administration for manic-depressive illness. Clinical trials have shown it to have an effectiveness in controlling manic symptoms equivalent to that of lithium; it is effective in both rapid-cycling and non-rapid-cycling bipolar. Though divalproex can cause gastrointestinal side effects, the incidence is low. Other adverse effects occasionally reported are headache, double vision, dizziness, anxiety, or confusion. Because in some cases divalproex has caused liver dysfunction, liver function tests should be performed prior to therapy and at frequent intervals thereafter, particularly during the first six months of therapy. Bipolar meds - Topic List Other Psychology Links
Medication precautions with children, the elderly and womenSpecial ConsiderationsChildren, the elderly, and pregnant or nursing women have special concerns and needs when taking psychotherapeutic medications. Some effects of medications on the growing body, the aging body, and the childbearing body are known, but much remains to be learned. Research in these areas is ongoing. ChildrenThere are many treatments that can help children. This includes medication, but psychotherapy, behavioral therapy, social skills training, family therapy, and group therapy should be explored before deciding to prescribe medications for children. The therapy used for an individual child is based on the child's diagnosis and individual needs. When the decision is reached that a child should take medication, active monitoring by all caretakers (parents, teachers, others who have charge of the child) is essential. Children should be watched and questioned for side effects (many children, especially younger ones, do not volunteer information). They should also be monitored to see that they are actually taking the medication and taking the proper dosage. The long term effects of many psychotherapeutic medications on children is not known, especially in newly developed medications. The ElderlyPersons over the age of 65 make up 12 percent of the population of the United States, yet they receive 30 percent of prescriptions filled. The elderly generally have more medical problems and often are taking medications for more than one of these problems. In addition, they tend to be more sensitive to medications. Even healthy older people eliminate some medications from the body more slowly than younger persons and therefore require a lower or less frequent dosage to maintain an effective level of medication. The elderly may sometimes accidentally take too much of a medication because they forget that they have taken a dose and take another dose. The use of a 7-day pill box is especially helpful to an elderly person. The elderly, and their friends, relatives, and caretakers, need to pay special attention and watch for adverse (negative) physical and psychological responses to medication. Because they often take more medications (including prescription drugs, over-the-counter preparations, and home or natural remedies) the possibility of negative drug interactions is higher. Pregnant, Nursing, or Childbearing-Age WomenIn general, during pregnancy, all medications (including psychotherapeutic medications) should be avoided where possible, and other methods of treatment should be tried. A woman who is taking a psychotherapeutic medication and plans to become pregnant should discuss her plans with her doctor; if she discovers that she is pregnant, she should contact her doctor immediately. During early pregnancy, there is a possible risk of birth defects with some of these medications, and for this reason: 1) Lithium is not recommended during the first 3 months of pregnancy. 2) Benzodiazepines are not recommended during the first 3 months of pregnancy. The decision to use a psychotherapeutic medication should be made only after a careful discussion with the doctor concerning the risks and benefits to the woman and her baby. Small amounts of medication pass into the breast milk. This is a consideration for mothers who are planning to breast-feed. A woman who is taking birth-control pills should be sure that her doctor is aware of this. The estrogen in these pills may alter the breakdown of other medications by the body. For more detailed information, talk to your doctor or mental health professional, consult your local public library, or write to the pharmaceutical company that produces the medication or contact: US Food and Drug Administration Bipolar meds - Topic List Other Psychology Links
Index of MedicationsIf a medication's trade name does not appear in this list, look it up by its generic name or ask your doctor or pharmacist for more information. As we gather more information on specific medications, links will take you from the medication name to additional information on that specific drug. Otherwise, more information is available through the references listed at the bottom of the page. Antimanic Medications
ReferencesAHFS Drug Information, 91. Gerald K. McEvoy, Editor. Bethesda, Maryland: American Society of Hospital Pharmacists, Inc., 1991. Bohn J. And Jefferson J.W., Lithium and Manic Depression: A Guide. Madison, Wisconsin: Lithium Information Center, rev. ed. 1990. Goodwin F.K. and Jamison K.R. Manic-Depressive Illness. New York: Oxford University Press, 1990. Medenwald J.R., Greist J.H., and Jefferson J.W. Carbamazepine and Manic Depression: A Guide. Madison, Wisconsin: Lithium Information Center, rev. ed., 1990. Physicians' Desk Reference, 52nd edition. Montvale, New Jersey: Medical Economics Data Production Company, 1998. Bipolar meds - Topic List Other Psychology Links
AcknowledgmentsThanks and acknowledgment are extended to the National Institute of Mental Health, which was a primary resource for information on this page. Bipolar meds - Topic List Other Psychology Links
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