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Understanding Bipolar Disorder -- Treatment

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and, while their safety and effectiveness for the condition is controversial, antidepressants. 

Typically, treatment entails a combination of at least one mood-stabilizing drug and/or atypical antipsychotic, plus psychotherapy. The most widely used drugs for the treatment of bipolar disorder include lithium carbonate and valproic acid (also known as Depakote). Lithium carbonate can be remarkably effective in reducing mania, although doctors still do not know precisely how it works. Lithium may also prevent recurrence of depression,but its value seems greater against mania than depression, and therefore it is often given in conjunction with other medicines known to have greater value for depression symptoms, sometimes including antidepressants.  

Understanding Bipolar Disorder

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Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamazapine, another antiepileptic drug. These drugs may be used alone or in combination with lithium to control symptoms. In addition, newer drugs are coming into the picture when traditional medications are insufficient. Lamotrigine, another antiepileptic drug, has been shown to have value for preventing recurrences of either manias or depressions, but some evidence shows it may be especially useful against depressions. 

Other antiepileptic drugs, such as gabapentin, oxcarbazepine, or topiramate, are regarded as experimental treatments that are not well-established, but may sometimes have value for symptoms of bipolar disorder or other conditions that often occur with it. 

Haloperidol, previously a mainstay of treatment for psychotic mania, or more recently, other newer antipsychotic medications, such as olanzapine or risperidone, are often given to patients who fail to respond to lithium or divalproex, or to treat acute symptoms of mania -- particularly psychosis -- before lithium or divalproex can take full effect (which may be from one to several weeks). Another antipsychotic, Latuda, is approved for use in bipolar I depression.

Some of these drugs can be toxic and should be closely monitored through blood tests to ensure that adequate levels have been reached and to detect any bad reactions early on. Because it is often difficult to predict which patient will react to what drug or what the dosage should ultimately be, the psychiatrist will often need to experiment with several different medications when beginning treatment.

While antidepressants remain widely prescribed for bipolar depression, most antidepressants have not been adequately studied in patients with bipolar depression. Of the larger studies that have been conducted, however, a combination of the antidepressant Prozac (fluoxetine) and the antipsychotic drug Zyprexa (olanzapine) improved symptoms of bipolar depression.  Other FDA-approved treatments for the depressed phase of bipolar disorder include Seroquel or Seroquel XR and Latuda.

In general, your doctor may try to keep the use of antidepressants limited and brief; there is evidence that some antidepressants -- given alone or in combination with other drugs -- may trigger a manic episode or cause cycles between depression and mania to be more rapid. If an antidepressant is not clearly having a beneficial effect for bipolar depression, there is usually little rationale to continue it.  

The family or spouse of a patient should be involved with any treatment. Having full information about the disease and its manifestations is important for both the patient and loved ones.

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