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Bipolar Disorder Health Center

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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 which include benzodiazepines such as clonazepam (Klonopin) or lorazepam (Ativan).

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.

Valporate (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. As a mood stabilizer that can be used by a "loading dose" method -- beginning at a very high dose -- valporate allows the possibility of significant improvement in mood as early as four to five days.

Some other antiseizure drugs, notably carbamazepine (Tegretol) and lamotrigine (Lamictal), can have value in treating or preventing manias or depressions. Other antiseizure medicines that are less well-established but still sometimes used experimentally for the treatment of bipolar disorder, include gabapentin (Neurontin), oxcarbazapine (Trileptal), and topiramate (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. Cariprazine (Vraylar) is a newly approved antipsychotic to treat manic or mixed episodes. Aripiprazole (Abilify),  asenapine (Saphris),  clozapine (Clozaril), olanzapine (Zyprexa), quetiapine  (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) are often used, and many other drugs are available. The antipsychotic lurasidone (Latuda) is approved for use -- either alone or with lithium or valproate (Depakote) -- in cases of bipolar I depression. Antipsychotic medicines are also sometimes used for preventive treatment.

Benzodiazepines

This class of drugs includes alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan) 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.

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