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 or more episodes of bipolar disorder generally is considered to have lifelong bipolar disorder, where the goal focuses not only on treating current symptoms but also preventing future episodes. 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 -- sometimes at lower doses.

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.

Aripiprazole (Abilify), lamotrigine (Lamictal),  lithium olanzapine (Zyprexa),  risperidone (Risperdal) Consta, and  quetiapine (Seroquel) or  ziprasidone (Geodon), (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. These medications can differ in their ability to prevent manic versus depressive episodes, as well as in their side effects. 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.

Lamotrigine (Lamictal) 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.

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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, you should consult your doctor  immediately and the drug may need to be stopped promptly.

Common side effects of Lamictal include:

Medication errors have occurred in filling Lamictal prescriptions because other drugs have similar names, like  labetalol,  Lamisil, lamivudine, Lomotil, and Ludiomil. 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.

People with bipolar disorder may take lifelong lithium as maintenance therapy to prevent relapses. When lithium treatment stops, relapses can occur within six months in 90% of patients. Moreover, subsequent lithium treatment may sometimes be less effective, particularly if lithium is stopped abruptly rather than gradually (meaning, over a period of 2 weeks or longer).

Studies show that lithium can significantly reduce the risk of suicide among people with bipolar disorder. It also helps prevent future manic episodes.

Lithium is a simple salt that acts on a person's central nervous system. Doctors don’t know exactly how lithium works to stabilize mood. However, it helps people with bipolar disorder have more control over their emotions and cope better with the problems of daily life.

When lithium is used as part of maintenance therapy for bipolar disorder, your doctor will want to take regular blood tests during your treatment because it can affect kidney and thyroid function. Blood tests will also help your doctor monitor the level of lithium in your blood. Your doctor also will probably suggest you drink two or three quarts of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so its important to consume enough every day.

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Lithium Side Effects

About 75% of people who take lithium for bipolar disorder have some side effects, although they may be minor. Sometimes side effects can be relieved by changing the dose of lithium. Never change your dose or drug schedule on your own. If you are having any problems, talk to your doctor about your options.

Common side effects of lithium include:

Particularly bothersome tremors can be treated with additional medication.

There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to a specific birth defect in heart valve formation occurring in 1 in 1000 to 1 in 2000 patients and should be administered with caution to pregnant women. Also, in a very few people, long-term lithium treatment can interfere with kidney function.

 

WebMD Medical Reference Reviewed by Joseph Goldberg, MD on November 21, 2015

Sources

SOURCES:

WebMD Medical Reference: "Bipolar Disorder (Manic Depressive Disorder)."

WebMD Assess Plus: Bipolar Disorder Assessment. 

National Institute for Mental Health: "Step-BD Womens Studies."  

Massachusetts General Hospital Bipolar Clinic & Research Program. 

MedicineNet: "Bipolar Disorder (Mania)." 

WebMD Medical Reference: "Effects of Untreated Depression."

American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."

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