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Maintenance Treatment for Bipolar Disorder

In bipolar disorder, after remission from an acute episode of mania or depression, a person is at an especially high risk of relapse for about six months. Thus, continuation and maintenance of (ongoing) therapy is often recommended as treatment for bipolar disorder.

Anyone who has experienced two to three episodes of bipolar disorder is considered a long-term -- if not lifetime -- bipolar patient. That person should have maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), drug therapy is continued indefinitely -- often at lower doses.

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It is important to remember this: Even if you have been without bipolar symptoms for several months, do not stop taking your medications. Your doctor may lower your doses, but discontinuation of medications will put you at risk for recurrence of bipolar symptoms.

Lamotrigine, lithium, olanzapine, aripiprazole, risperidone Consta, and quetiapine or ziprasidone (either one in combination with lithium or valproate) are the only drugs that have been approved by the FDA specifically for maintenance therapy for bipolar disorder. However, many other drugs used to treat manic episodes are also used for maintenance treatment.

These drugs include:

A combination of these drugs may also be used.

Lamictal (Lamotrigine) for Bipolar Disorder

Lamictal is approved by the FDA for the maintenance treatment of adults with bipolar disorder. It has been found to help delay bouts of depression, mania, hypomania (a milder form of mania), and mixed episodes in those being treated with standard therapy. It is especially effective in the prevention of bipolar depression. It is the first FDA-approved therapy since lithium for maintenance in bipolar disorder.

Lamictal is considered a mood-stabilizing anticonvulsant and is most commonly prescribed to prevent or control seizures in the treatment of epilepsy. Recent studies have shown it may possess antidepressant effects in bipolar disorder.

Lamictal Side Effects

Lamictal comes in several types of tablets, such as chewable or orally disintegrating. It adds to the effects of other central nervous system suppressants such as alcohol -- and to those found in many antihistamines, cold medications, pain medications, and muscle relaxants. Check with your doctor before taking any of these.

Three out of every 1,000 people taking Lamictal will develop a rash. Sometimes the rash can prove serious or even fatal. If a rash develops, this drug should be stopped immediately.

Common side effects of Lamictal include:

  • Headache
  • Dizziness
  • Diarrhea
  • Dream abnormalities
  • Itching
  • Vision difficulties

Medication errors have occurred in filling Lamictal prescriptions because other drugs have similar names, like Lamisil, lamivudine, Ludiomil, labetalol, and Lomotil. To avoid confusion, make sure the drug name is clearly written on your prescription.

Lithium for Bipolar Disorder

Lithium (brand names include Eskalith or Lithobid) is the most widely used and studied medication for treating bipolar disorder. It has been used for more than 50 years and helps reduce the severity and frequency of manic states. It may also help relieve bipolar depression.

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