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Bipolar Disorder: Managing Mania

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Treatments for Mania in Bipolar Disorder

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Lithium continued...

You should notify your doctor if you experience persistent symptoms from lithium or if you develop diarrhea, vomiting, fever, unsteady walking, fainting, confusion, slurred speech, or rapid heart rate.

Be sure to tell your doctor about any history of cancer, heart disease, kidney disease, epilepsy, and allergies. And make sure your doctor knows about all other drugs you are taking. Do not avoid products that contain sodium or are "low sodium," since low dietary intake of sodium can cause the body to retain too much lithium and make lithium blood levels too high.  While taking lithium, use caution when driving or using machinery and limit alcoholic beverages.

If you miss a dose, take it as soon as you remember it -- unless the next scheduled dose is within two hours (or six hours for slow-release forms). If so, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

There are a few serious risks to consider. Lithium may cause weakened bones in children, although it's rare.  Lithium also can rarely (1 in 1000 to 1 in 2000 cases) cause a particular type of heart valve birth defect and therefore its use in pregnancy is determined on a case-by-case basis. Breastfeeding isn't recommended if you are taking lithium. People on high blood pressure drugs called diuretics, especially thiazide diuretics, need to be extra careful because dangerous levels of lithium can build up in the blood. Also, in a very few people, long-term lithium treatment can interfere with kidney function.

 

Anticonvulsant Drugs for Bipolar Disorder

Several specific anticonvulsant drugs -- Depakote, Tegretol and Lamictal -- are used as mood stabilizers to treat or prevent the mood symptoms of bipolar disorder. Doctors discovered this use for the drugs when they noted improvements in mood stability among people with epilepsy. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania or prevent recurrent episodes.  There are also several other anticonvulsant drugs -- such as Trileptal, Topamax, and Neurontin -- which are not proven treatments for mood symptoms in bipolar disorder, but are nevertheless sometimes prescribed by doctors either experimentally or for symptoms other than mood (such as anxiety or pain).

What It Is: Anticonvulsants are drugs prescribed to calm hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other mental disorders. They are sometimes favored over lithium or used in combination with lithium or antipsychotic drugs for people who have rapid cycling -- four or more episodes of mania and depression in a year.

What to Expect: Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the medicine you take. In general, however, these medicines take at least several weeks or longer to judge their effect.

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