Bipolar Disorder Health Center

Understanding Bipolar Disorder -- Treatment

Bipolar disorder is treated with three main classes of medication: mood stabilizers, antipsychotics, and 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 divalproex). 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, including antidepressants. 

Valproic acid is a mood stabilizer that is helpful in treating the manic or mixed phases of bipolar disorder, along with carbamezapine, an antiepileptic agent. 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 is 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. 

Antipsychotic agents, such as olanzapine, aripiprazole, risperidone and several others, are FDA-approved for the treatment of bipolar disorder. Often, they are used to manage psychotic symptoms, which can accompany manic or depressive episodes, but they are also used to stabilize mood.

When the depressive phase of bipolar disorder occurs, an antidepressant is sometimes used along with a mood stabilizer. If a traditional antidepressant is going to be used, selective serotonin reuptake inhibitors (SSRIs) are sometimes preferred, as is the drug bupropion, because these agents have fewer side effects than older drugs and have at least preliminary research supporting their use in bipolar depression.

Among the SSRIs are Celexa, Lexapro, Paxil, Prozac, and Zoloft. Other antidepressants include the tricyclics (including Desipramine, Imipramine, and Amitriptyline) although these are used infrequently. Newer antidepressants include Effexor, Cymbalta, and Remeron, but not all of these have been rigorously studied for bipolar depression. In general, your doctor may try to keep the use of antidepressants limited and brief, because prolonged use may sometimes trigger a manic episode or cause cycles to be more rapid.

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 -- particular psychosis -- before lithium or divalproex can take full effect (which may be from one to several weeks).

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 almost impossible to predict which patient will react to what drug or what the dosage should be, the psychiatrist will often need to experiment with several different medications when beginning treatment.

 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.