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Medications for Bipolar Disorder

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Which antidepressants are prescribed for bipolar disorder?

Antidepressants are commonly prescribed to treat depressive disorders. However, in bipolar disorder, a primary mood stabilizer is recommended. According to the 2002 APA guidelines, the first-line treatment for acute depression in bipolar patients is lithium or Lamictal (lamotrigine). Since the guideline was issued, however, Lamictal by itself has been shown to be more effective in preventing future episodes of depression (and to a lesser extent mania) than treating acute episodes of bipolar depression.

The only FDA-approved medications for acute bipolar depression are Seroquel or olanzapine-fluoxetine combination (Symbyax). Lithium or Lamictal are sometimes added to other medicines to try to enhance an overall antidepressant effect.

If an antidepressant is needed with bipolar disorder, it’s usually added after an anti-manic drug has first been started. Fewer antidepressants have been studied in bipolar depression than unipolar depression. Examples of well-studied antidepressants in bipolar depression include Prozac (fluoxetine), Wellbutrin (bupropion), and Zoloft (sertraline).

In about 10% to 20% of people with bipolar disorder, antidepressants may cause shifts from depression into a manic or hypomanic episode. Because of this risk, your health care provider should monitor you closely if you take an antidepressant.

 

How can I be sure the bipolar medication will work for me?

It's impossible to predict how well a particular bipolar medication will work for you. You may need to try several different kinds and different dosages. Getting the right medication or combination of medications for your bipolar disorder can take some time. You can't expect to feel better overnight.

It can be frustrating, but don't give up. Eventually, you and your health care provider should be able to find a prescription that works for you.

Medication Tips for Bipolar Disorder

If you have bipolar disorder, adopt good habits for taking your medication. Take it at the same time every day. It's easiest if you do it along with some other activity, like brushing your teeth, eating breakfast, or getting into bed. Getting a weekly pillbox can make it easy to see if you've missed a dose.

Be sure to talk to your pharmacist or doctor about the best time of day to take your bipolar medications. Some are best taken in the morning or at bedtime and others with meals or after meals.

For those rare occasions when you miss a dose, know what you should do. Ask your health care provider. Don't assume that doubling up is a good idea.

Side Effects of Bipolar Drugs

The medications available to treat bipolar disorder aren't perfect. They can cause side effects that vary depending on which medications you use. These side effects can include:

  • Nausea
  • Tremors
  • Hair loss
  • Sexual problems
  • Weight gain
  • Liver failure
  • Renal failure
  • Diarrhea
  • Abdominal pain

Some medications can affect your liver function or white blood cell or platelet counts (which can lead to increased susceptibility to infection or bleeding). You may need regular tests to make sure that you're staying healthy.

Many side effects will fade after a few weeks of treatment. If you're still having unpleasant problems after that, see your health care provider. Don't assume you're just stuck with unwanted symptoms. Changing your dosage, adding another medicine to control the side effects, or trying a different medication altogether may help.

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