People with bipolar disorder often benefit most from a combination of medication and counseling/therapy. The medication can be divided into 2 types: those which treat the mania, and those which treat the depression.
What will happen when my doctor prescribes medication for me?
Normally the mania is treated first, as some antidepressants may "force" you into a chemical high. The treatment varies depending on the severity of the mania (how "high" or euphoric you become). Once that has settled slightly - usually within a few weeks - you will be ready to treat the depression as well.
What types of medication are there?
The main types of medication used to treat bipolar disorder are:
You won't necessarily be taking all of these. The combination (or "cocktail") prescribed to you will be tailored to your individual needs, and will probably change as your treatment progresses. The list looks scary (particularly the names!), but you will only be given what is necessary.
The goal is to put you into "remission" - that is, getting you to a place where you have no symptoms and are fully functioning again. You may not reach 100%, but they can get you pretty close.
Unfortunately it won't happen overnight. Finding the right balance of drugs can take weeks, sometimes months, but the result is worth it. Keep in close contact with your psychiatrist so alterations can be made as soon as necessary.
It is important to keep taking the medication even if you feel better, because mania can remove the feeling of problems and there is a high relapse rate if you stop prematurely.
Mood stabilizers
Mild to moderate mania was usually treated mainly with lithium salts. Lithium starts to work after 10-14 days. (
Anticonvulsants are becoming more popular now.)
Lithium has been used as a first line treatment for acute mania for more than 50 years. Research shows that it is most effective in people with a family history of the illness, and in those experiencing a Bipolar I sequence of swings between mania and depression who return to normal function between episodes.
Antipsychotics
Moderate to severe mania cases sometimes require antipsychotic drugs such as risperidone (Risperdal) and quetiapine (Seroquel) during the peak of the mania. Once the mania has subsided, the antipsychotic drugs can be gradually tapered off while the mood stabilizer or anticonvulsant continues.
Anticonvulsants
Anticonvulsants such as divalproex sodium (Depakote) may be used instead of lithium. They work faster and a higher dosage can be given to stabilize acute mania more quickly.
Antidepressants
Depression is usually treated with
antidepressants such as fluoxetine (Prozac). They can take a few weeks to start working fully.
Side-effects
Don't worry too much about potential side-effects. Most of them are very mild, and if not you can be switched to a different medication or dosage.
Your psychiatrist is specially trained to evaluate and prescribe only what is required to keep you in balance, but remember that your co-operation is essential: only you can say whether the medication is effective and if you are experiencing any side-effects.
Lithium
Common side-effects include:
- high blood pressure
- water retention
- constipation
These are usually dose-related, and can be reduced or removed entirely by changing the amount of lithium you take.
The two uncommon side-effects are:
- hypothyroidism (mimics depression)
- kidney damage (very rare)
Your doctor will keep a close eye on you to ensure that neither of these affect you.
Anticonvulsants (Depakote)
Common side-effects include:
- weight gain
- thinning of blood
- menstrual irregularity
- gastrointestinal problems
All except the blood-thinning tend to vanish or be minimal after the first 6 months. Don't take aspirin-based painkillers at the same time as Depakote.
An uncommon side-effect is liver damage. Regular monitoring through blood tests will prevent this.
Antipsychotics (Risperdal, Seroquel)
The most common side-effects are:
- sedation
- weight gain
- memory problems
- headaches
- dizziness
These have the tendency to weaken with time, being most pronounced during the first week of treatment. (Weight gain, unfortunately, is likely to continue while you take the drug.)
Uncommon side-effects:
- heart arrhythmia
- impotence
- tardive dyskinesia
Whatever you do, and whatever medications you are given, please keep taking them until you and your doctor agree you can stop. It's very easy to think you can shrug off being bipolar once you feel better. No matter how badly you want to toss out your meds, think of everything you went through before and ask yourself if you reallywant to risk feeling like that again.
(If it helps, remember that other people such as insulin-dependent diabetics also have to take medication every day. No-one enjoys it, but it has to be done.)