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Bipolar I Disorder

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What Are the Treatments for Bipolar I Disorder?

Manic episodes in bipolar I disorder require treatment with drugs, such as mood stabilizers and antipsychotics, and sometimes sedative-hypnotics (benzodiazepines such as Ativan or Klonopin). 

Mood Stabilizers

Lithium: This simple metal in pill form is especially effective at controlling mania that involves classical euphoria rather than mixtures of mania and depression simultaneously. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for maintenance treatment than for sudden manic episodes. Blood levels of lithium as well as tests to measure kidney and thyroid functioning must be monitored to avoid side effects.

Depakote: This antiseizure medication also works to level out moods. It has a more rapid onset of action, often making it more effective for an acute episode of mania than lithium. It is also often used "off label" for prevention of new episodes. Only mood stabilizers that can be used with the loading dose method -- beginning at a very high dose -- allow the possibility of significant improvement in mood as early as four to five days.

Some other antiseizure drugs, notably Tegretol and Lamictal, can have value in treating or preventing manias or depressions. Other antiseizure medicines that are less well-established for the treatment of bipolar disorder, include Trileptal, Neurontin, and Topamax.

Antipsychotics

For severe manic episodes, traditional antipsychotics (such as Haldol, Loxapine, or Thorazine) as well as newer antipsychotic drugs -- also called atypical antipsychotics -- may be necessary. Abilify, Risperdal, Saphris, Seroquel, Geodon, and Zyprexa are often used, and many other drugs are available. The antipsychotic Latuda is approved for use -- either alone or with lithium or Depakote -- in cases of bipolar I depression. Antipsychotic medicines are also sometimes used for preventive treatment.

Benzodiazepines

This class of drugs includes Xanax, Ativan, and Valium and is commonly referred to as minor tranquilizers. They are sometimes used for short-term control of acute symptoms associated with mania such as agitation or insomnia, but they do not treat core mood symptoms such as euphoria or depression.

Antidepressants

Common antidepressants such as Prozac, Zoloft, and Paxil have not been shown to be as effective for treating depression in bipolar disorder as in unipolar depression. In a small percentage of people, they can also set off or worsen a manic episode in a person with bipolar disorder. For these reasons, the first-line treatments for depression in bipolar disorder involve medicines that have been shown to have antidepressant properties but also no known risk for causing or worsening mania.  The three FDA-approved treatments for bipolar depression are Seroquel or Seroquel XR, Symbyax (olanzapine-fluoxetine) combination and LAtuda. Other mood-stabilizing treatments that are sometimes recommended for treating acute bipolar depression include lithium, Depakote, and Lamictal (although none of these medicines is FDA-approved specifically for bipolar depression). If these fail, after a few weeks a traditional antidepressant or other medicine may sometimes be added. Psychotherapy, such as cognitive-behavioral therapy, may also help.

People with bipolar I disorder (mania or depression) have a high risk for recurrences and usually are advised to take medicines on a continuous basis for prevention.

Electroconvulsive Therapy (ECT)

Despite its scary reputation, electroconvulsive therapy (ECT) is an effective treatment for both manic and depressive symptoms. ECT is seldom used to treat bipolar I disorder, but can be helpful if medicines fail or can't be used.

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