6 Effective Medications Used for Treating Bipolar Disorder

Bipolar disorder is a mental health disorder that is characterized by extreme shifts in mood.(1,2) Symptoms of bipolar disorder can include extremely elevated mood known as mania, to sudden and intense change to feeling depressed and low.(3) Bipolar depression is also known as manic depression or bipolar disease.

Since there is no cure for bipolar, people with the disorder have to be treated on an ongoing basis with a combination of therapy and medication. Seeing a mental health professional regularly is also necessary, even if you are not experiencing any symptoms. Medications are usually recommended as the first line of treatment for bipolar disorder. This helps control the symptoms as quickly as possible.(4,5)

Once your symptoms of Bipolar disorder are under control, and you are able to manage them, you will start maintenance treatment for lowering the risk of a relapse or flare-up. Maintenance treatment also decreases the chances of experiencing minor shifts in mood from turning into depression or mania.

6 Effective Medications Used for Treating Bipolar Disorder

There are many types of medications used for the treatment of bipolar disorder. These include:

Your doctor will prescribe either one or a combination of these medications to achieve maximum effect. Finding the combination of drugs or a single medication that works effectively can take some time. It is a process of trial and error, and you may need to change your medications due to the side effects.

It takes at least eight to ten weeks to see the full impact of each drug, and at a time, only one medication will be changed to help your doctor better monitor your progress and identify which medication is working and which is not working.

Here are the different types of medications that are used in the treatment of bipolar disorder.

  1. Lithium

    One of the most common medications used in treating bipolar disorder is Lithium drugs, such as Lithobid. Lithium is a class of drugs that are known as mood-stabilizing medication and have been used for treating the symptoms of acute mania since the 1970s. Lithium is also effective at limiting the recurrence of extreme mood shifts, that is, the episodes of mania and depression in bipolar disorder.(8,9)

    However, there are some side effects associated with lithium, including digestive issues and weight gain. The drug is also known to impact the kidneys and thyroid gland. This is why during the time period you are taking lithium, your doctor will keep getting regular blood tests done to monitor your kidney and thyroid health.(10)

    Lithium is known to be a category D drug, meaning it has to be avoided if you are pregnant, however, in cases where the benefits of taking lithium far outweigh the risks to the growing fetus and mother. 

  2. Antipsychotics

    Antipsychotic medications are another popular treatment option for bipolar disorder.(11) Some of the commonly prescribed antipsychotics for bipolar disorder are as follows:

    • aripiprazole (brand name: Abilify)
    • risperidone (brand name: Risperdal)
    • olanzapine (brand name: Zyprexa)
    • asenapine (brand name: Saphris)
    • lurasidone (brand name: Latuda)
    • quetiapine (brand name: Seroquel)

    The common side effects of using antipsychotics for bipolar disease include drowsiness, dry mouth, weight gain, decreased libido, and blurry vision. Antipsychotics are also known to have an effect on your attention and memory, and may also cause involuntary body or facial movements.(12,13

  3. Anticonvulsants

    Anticonvulsants are commonly prescribed to treat bipolar disorder, as these medications are mood stabilizers. This class of drugs has been used since the mid-1990s to treat bipolar disease. Anticonvulsant medicines used for treating bipolar include:(14)

    • valproic acid (brand name: Depakene)
    • lamotrigine (brand name: Lamictal)
    • divalproex sodium (brand name: Depakote)

    Just like other classes of drugs, there are some side effects of anticonvulsants as well, including drowsiness, weight gain, and inability to sit still. Anticonvulsant medications are also linked with an increased risk of suicidal behavior and thoughts.(15)

    Valproic acid is also known to cause congenital disabilities, while Lamictal may cause a very dangerous rash. If you are on Lamictal and develop any type of new rash, you must alert your doctor at once. 

  4. Antidepressants

    Antidepressants include serotonin-norepinephrine reuptake inhibitors (SNRIs), serotonin-reuptake inhibitors (SSRIs), tricyclics, and monoamine oxidase inhibitors (MAOIs).(16)

    Antidepressants are usually added to help manage the symptom of depression in bipolar disorder, but they are known to sometimes trigger a manic episode. To lower the risk of causing a manic or mixed episode, antidepressants are usually prescribed together with an antipsychotic or a mood stabilizer.(17)

    As with any other medication used for treating bipolar disorder, you should discuss all the risks and benefits of taking antidepressants for bipolar disorder with your doctor.(18)

    Some of the commonly prescribed antidepressants for bipolar disorder include:

    Serotonin-Reuptake Inhibitors (SSRIs):

    • fluoxetine (brand names: Prozac, Prozac Weekly)
    • escitalopram (brand name: Lexapro)
    • sertraline (brand name: Zoloft)
    • citalopram (brand name: Celexa)
    • paroxetine (brand names: Paxil, Paxil CR, Pexeva)

    Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs):

    • venlafaxine (brand name: Effexor)
    • desvenlafaxine (brand name: Pristiq)
    • duloxetine (brand names: Cymbalta, Yentreve)

    Monoamine Oxidase Inhibitors (MAOIs):

    • tranylcypromine (brand name: Parnate)
    • phenelzine (brand name: Nardil)

    Tricyclics:

    • amitriptyline
    • nortriptyline (brand name: Pamelor)
    • imipramine (brand names: Tofranil, Tofranil-PM)
    • desipramine (brand name: Norpramin)

    Typically, the monoamine oxidase inhibitors are rarely prescribed unless the patient does not respond well to Serotonin-Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors.(19,20) Some of the common side effects of monoamine oxidase inhibitors are reduced libido, increased appetite, dry mouth, sleep disturbance, gastrointestinal issues, and menstrual problems. If you are taking monoamine oxidase inhibitors, it is essential that you avoid taking other medications. You will also need to avoid foods such as cheese and wine. Intake of these can lead to a dangerous but rare condition known as serotonin syndrome.(21

  5. Symbyax

    Symbyax is a medication that combines antipsychotic medication olanzapine and fluoxetine.(22) The medicine has properties of both a mood stabilizer and an antidepressant. Side effects of Symbyax include:

    • Drowsiness
    • Sexual problems
    • Fatigue
    • Dry mouth
    • Increased appetite

    If your doctor prescribes Symbyax for your bipolar disorder, you must ask if getting separate prescriptions for the two components of the medicine will be less expensive. There is nothing different about this combination pill, and it is merely a new formula that has been derived from the two existing drugs.(23

  6. Benzodiazepines

    Benzodiazepines are a group of drugs that have anxiety-relieving properties. These include:

    • diazepam (brand name: Valium)
    • alprazolam (brand name: Xanax)
    • clonazepam (brand name: Klonopin)
    • lorazepam (brand name: Ativan)
    • chlordiazepoxide (brand name: Librium)

    Side effects of benzodiazepines include:

    • Problems with balance
    • Memory issues
    • Reduced muscle coordination
    • Drowsiness

Benzodiazepines should be used with great caution as there is a high risk of dependence associated with this class of drugs.(24

Conclusion

Some of the medications used in the treatment of bipolar disorder, such as valproic acid and lithium, are known to increase the risk of an unborn baby’s risk for developing congenital disabilities. Some of these medications can also reduce the effectiveness of your birth control pills. So if you are using birth control pills to prevent pregnancy, you must discuss this with your doctor.

Also, be sure to talk to your doctor about your medications if you are pregnant or breastfeeding as some of these medications may not be safe for the growing fetus or the newborn infant.

References:

  1. Miklowitz, D.J. and Johnson, S.L., 2008. Bipolar disorder. John Wiley & Sons Inc.
  2. Müller-Oerlinghausen, B., Berghöfer, A. and Bauer, M., 2002. Bipolar disorder. The Lancet, 359(9302), pp.241-247.
  3. Belmaker, R.H., 2004. Bipolar disorder. New England Journal of Medicine, 351(5), pp.476-486.
  4. Sachs, G.S., Printz, D.J., Kahn, D.A., Carpenter, D. and Docherty, J.P., 2000. The expert consensus guideline series: medication treatment of bipolar disorder. Postgrad Med, 1, pp.1-104.
  5. Greenhouse, W.J., Meyer, B. and Johnson, S.L., 2000. Coping and medication adherence in bipolar disorder. Journal of Affective Disorders, 59(3), pp.237-241.
  6. Rapoport, S.I., Basselin, M., Kim, H.W. and Rao, J.S., 2009. Bipolar disorder and mechanisms of action of mood stabilizers. Brain research reviews, 61(2), pp.185-209.
  7. Ghaemi, S.N., Hsu, D.J., Soldani, F. and Goodwin, F.K., 2003. Antidepressants in bipolar disorder: the case for caution. Bipolar disorders, 5(6), pp.421-433.
  8. Goodwin, F.K., 2002. Rationale for long-term treatment of bipolar disorder and evidence for long-term lithium treatment. The Journal of clinical psychiatry, 63, pp.5-12.
  9. O’Connell, R.A., Mayo, J.A., Flatow, L., Cuthbertson, B. and O’Brien, B.E., 1991. Outcome of bipolar disorder on long-term treatment with lithium. The British Journal of Psychiatry, 159(1), pp.123-129.
  10. Gyulai, L., Bauer, M., Bauer, M.S., García-España, F., Cnaan, A. and Whybrow, P.C., 2003. Thyroid hypofunction in patients with rapid-cycling bipolar disorder after lithium challenge. Biological Psychiatry, 53(10), pp.899-905.
  11. Sajatovic, M., Valenstein, M., Blow, F.C., Ganoczy, D. and Ignacio, R.V., 2006. Treatment adherence with antipsychotic medications in bipolar disorder. Bipolar Disorders, 8(3), pp.232-241.
  12. Gelenberg, A.J. and Hopkins, H.S., 1996. Antipsychotics in bipolar disorder. The Journal of clinical psychiatry, 57, p.49.
  13. Tohen, M. and Zarate Jr, C.A., 1998. Antipsychotic agents and bipolar disorder. The Journal of Clinical Psychiatry.
  14. Keck, P.E., McElroy, S.L. and Nemeroff, C.B., 1992. Anticonvulsants in the treatment of bipolar disorder. The Journal of Neuropsychiatry and Clinical Neurosciences.
  15. Grunze, H.C., 2010. Anticonvulsants in bipolar disorder. Journal of mental health, 19(2), pp.127-141.
  16. Ghaemi, S.N., Hsu, D.J., Soldani, F. and Goodwin, F.K., 2003. Antidepressants in bipolar disorder: the case for caution. Bipolar disorders, 5(6), pp.421-433.
  17. Ghaemi, S.N., Boiman, E.E. and Goodwin, F.K., 2000. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J clin Psychiatry, 61(10).
  18. Ghaemi, S.N., Sachs, G.S., Chiou, A.M., Pandurangi, A.K. and Goodwin, F.K., 1999. Is bipolar disorder still underdiagnosed? Are antidepressants overutilized?. Journal of affective disorders, 52(1-3), pp.135-144.
  19. Mallinger, A.G., Frank, E., Thase, M.E., Barwell, M.M., DiazGranados, N., Luckenbaugh, D.A. and Kupfer, D.J., 2009. Revisiting the effectiveness of standard antidepressants in bipolar disorder: are monoamine oxidase inhibitors superior?. Psychopharmacology bulletin, 42(2), p.64.
  20. QUITKIN, F.M., McGRATH, P.A.T.R.I.C.K., LIEBOWITZ, M.R., STEWART, J. and HOWARD, A., 1981. Monoamine oxidase inhibitors in bipolar endogenous depressives. Journal of Clinical Psychopharmacology, 1(2), pp.70-74.
  21. Sternbach, H., 1991. The serotonin syndrome. Am J Psychiatry, 148(6), pp.705-713.
  22. Bobo, W.V. and Shelton, R.C., 2010. Efficacy, safety and tolerability of Symbyax® for acute-phase management of treatment-resistant depression. Expert review of neurotherapeutics, 10(5), pp.651-670.
  23. DEPRESSION, O.B., SYMBYAX® THE FIRST FDA-APPROVED DRUG FOR THE TREATMENT OF BIPOLAR DEPRESSION.
  24. Perlis, R.H., Ostacher, M.J., Miklowitz, D.J., Smoller, J.W., Dennehy, E.B., Cowperthwait, C., Nierenberg, A.A., Thase, M.E. and Sachs, G.S., 2010. Benzodiazepine use and risk of recurrence in bipolar disorder: a STEP-BD report. The Journal of clinical psychiatry.

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