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Medications for Bipolar Disorder

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Updated March 19, 2010

Medications for Bipolar Disorder

Bipolar disorder (sometimes called manic depression) is a mental health disorder characterized by mood swings. People with this disorder experience severe highs (mania) and lows (depression). Some people experience mostly highs, others mostly lows.

If the mood swings follow each other closely (within days), the person is said to suffer from "rapid cycling" bipolar disorder. Other people primarily experience mood swings that are separated by months or years. Some people experienced "mixed" episodes consisting of both sets of symptoms at the same time.

When people are manic, they may be energetic, talkative, and need little sleep. They may switch quickly from one topic to another, as if they cannot get their thoughts out fast enough. This stage often feels good to the person, and they often report feeling "on top of the world." Other people feel irritable and are easy to anger during this stage. Judgment is often impaired, and they may go on shopping sprees and buy things that they can't afford. They may have grand schemes that are unrealistic, and a severe manic episode can include psychotic thinking similar to schizophrenia.

The depressed stage of bipolar disorder is similar to major depression. The person will have little energy and a low mood, slowed thinking and movements, difficulty concentrating, changes in eating and sleeping patterns, feelings of hopelessness and helplessness, and often suicidal thinking.

Medications for Bipolar Disorder: Lithium

Lithium is the medication used most often to treat bipolar disorder. This medication evens out mood swings. It is used not only for manic attacks or flare-ups of the illness, but also as an ongoing maintenance treatment for bipolar disorder. Lithium will usually reduce severe manic symptoms in one to two weeks. It may take weeks to several months before the condition is fully controlled.

Some people have a single episode of mania that is not repeated. Most have more frequent episodes, however, and continued treatment with lithium or another mood stabilizer is advised to keep moods stable. Some people respond to lithium and have no further episodes. Others may have milder mood swings, or less frequent mood swings. Some people with bipolar disorder may not be helped at all by lithium. There's no way to tell without trying it, though.

People taking lithium must have regular blood tests. If too little is taken, lithium will not be effective. If too much is taken, severe side effects may occur. The range between an effective dose and a toxic one is small. Blood lithium levels are checked frequently at the beginning of treatment. Once a person is stable on a maintenance dosage, the lithium level is checked every few months. How much lithium people need to take may vary over time, depending on how ill they are, their body chemistry, and their physical condition.

Antipsychotic medications are sometimes used in the initial phase of treatment for mania and may be able to be discontinued over time as the lithium takes effect. Some of the newer antipsychotic medications are also approved for longer-term use in bipolar disorder. Antidepressants may also be added to lithium during the depressive phase of bipolar disorder. Care must be taken with the use of antidepressants in bipolar disorder, as they can potentially increase switches into mania, particularly without adequate mood stabilization.

Side Effects of Lithium

When first started, lithium can cause side effects such as drowsiness, weakness, nausea, fatigue, hand tremor, or increased thirst and urination. These symptoms may diminish or disappear over time, although some degree of hand tremor may persist. Weight gain may also occur, but crash diets should be avoided because they may raise or lower the lithium level.

Kidney changes may also develop during treatment, such as increased urination. These changes are generally manageable. Your doctor may adjust your dosage or add some additional medications to treat this.

Lithium can also cause changes in the thyroid gland, so thyroid function monitoring is a part of the therapy. To restore normal thyroid function, thyroid hormone may be given along with lithium. Lithium needs to be prescribed with caution when a person has thyroid, kidney, or heart disorders, epilepsy, or brain damage.

Women of childbearing age should be aware that lithium increases the risk of congenital malformations in babies. Caution should be used in women of childbearing age and lithium should be avoided during the first three months of pregnancy if at all possible.

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