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Medications for Bipolar Disorder

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Which medications are used to stabilize moods?

According to the American Psychiatric Association's (APA) most recent guidelines for treating bipolar disorder -- which haven't been formally updated since 2002 -- the first-line therapy for bipolar patients with severe mania or mixed episodes is an antipsychotic medication combined with either lithium or  the anticonvulsant Depakote (valproate).

Lithium is one of the oldest and least expensive mood-stabilizing mediations for bipolar disorder. Lithium is administered as a salt available under the generic names of lithium carbonate and lithium citrate. Available in capsule, tablet, or liquid form, lithium may have the trade name of Lithobid, Lithane, Lithonate, Lithotabs, Cibalith-S, and others.

Findings show that lithium is effective in reducing symptoms and frequency of episodes with a response rate of 70% to 80% for the initial manic phase of bipolar disorder. In addition, studies show that lithium effectively reduces the risk of suicide at least six fold.

If you take lithium, you will need regular blood tests and monitoring of your kidney and thyroid function for drug toxicity levels.

 

Are anticonvulsants used to stabilize the moods of bipolar disorder?

Some, but not all, anticonvulsants offer more treatment options for those with bipolar disorder. Anticonvulsants may be combined with lithium or with other anticonvulsants for optimal effect.

Some commonly used anticonvulsants include Lamictal (lamotrigine), Depakote (valproic acid), and Tegretol (carbamazepine). Other anticonvulsants, such as Trileptal (oxcarbazepine), Neurontin (gabapentin) and Topamax (topiramate) have not been established as having anti-manic or antidepressant properties. But they are sometimes considered experimental treatments in bipolar disorder. Certain of these medicines may have value for other types of psychiatric symptoms such as anxiety, pain, or binge eating. 

 

What other medications help stabilize moods with bipolar disorder?

Antipsychotic medications are used alone or in combination with other mood stabilizers in patients with bipolar mania. Acute mania may be treated with older antipsychotic medications such as Haldol (haloperidol), Adasuve or Loxitane (loxapine), and Risperdal (risperidone). Many newer atypical antipsychotics are also used for bipolar disorder. These drugs include Abilify (aripiprazole), Geodon (ziprasidone), Saphris (asenapine), Seroquel (quetiapine fumarate), and Zyprexa (olanzapine). Symbyax, the SSRI antidepressant (fluoxetine) combined with the antipsychotic olanzapine, also has been shown to treat bipolar depression, as has Seroquel. In addition, Latuda (lurasidone) is an antipsychotic FDA-approved to treat bipolar depression either alone or with lithium or Depakote (valproic acid).  

Sometimes benzodiazepines are prescribed to help patients with acute mania and also to relieve insomnia. These drugs belong to a group of medications called central nervous system (CNS) depressants, which act on neurotransmitters to slow down normal brain function. CNS depressants are commonly used to treat anxiety and sleep disorders and are sometimes prescribed as adjunctive therapy with bipolar disorder.

Commonly used benzodiazepines include Klonopin (clonazepam), Ativan (lorazepam), Xanax (alprazolam), and Valium (diazepam). These drugs all carry the risk of being habit-forming/addictive medications.

Some of the newer sleep medications such as Lunesta (eszopiclone) and Sonata (zaleplon) may cause fewer problems with memory and thinking as compared to benzodiazepines and may be prone to become habit-forming.

 

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