What are the treatments for bipolar disorder?
Bipolar disorder is a long-term illness that requires management throughout a person's life. People who have numerous (four or more) episodes of mood changes (rapid cycling) in a year can be much more difficult to treat. Medication is the primary form of treatment, but the additional use of psychotherapy or "talk" therapy is sometimes recommended to help prevent future episodes.
There are many drugs available to treat bipolar disorder. Proposed guidelines for treatment options are based on the three main phases of bipolar disorder, which include the acutemanic/mixed mood states, acute major depressive episodes, and finally the continuation/maintenance phase. As a general rule, avoiding antidepressants and taking two mood stabilizers has proven to be an effective strategy for most patients.
Lithium (brand names Eskalith®, Lithobid®, Lithonate®) is a mood-stabilizing drug. It has proven helpful in controlling mania and depression and preventing depression and manic episodes. Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.
Common side effects of lithium include:
- Frequent need to urinate
- Weight gain
- Increased thirst
- Slight trembling of the hands
Thyroid and kidney problems are a concern, so your doctor will monitor the function of your thyroid and kidneys as well as monitor the levels of lithium in your blood since levels can easily become too high. Anything that lowers the level of sodium in the body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting, or diarrhea may cause a buildup of lithium in the body and toxicity. Be aware of these conditions and alert your doctor if you are on lithium and experience them.
The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:
- Blurred vision
- Irregular pulse
- Extremely fast or slow heartbeat
- Difficulty breathing
- Severe trembling
- Need to pass large amounts of urine
- Uncontrolled eye movements
- Double vision
- Unusual bruising or bleeding
Valproate (Depakote®) is an antiseizure medicine also effective for controlling mania. It is also effective for people with rapid-cycling bipolar disorder. The drug has some side effects, can cause inflammation of the liver and can decrease the amount of platelets (blood cells needed for blood to clot) that the body makes so your doctor will monitor levels of valproate as well as liver function and platelet counts.
Common side effects of valproate include:
- Stomach cramps
- Weight gain
- Slight trembling of hands
Other antiseizure medicines often used to treat bipolar disorder include carbamazepine (Tegretol®) and lamotrigine (Lamictal®). Lamotrigine is used alone or in combination with other mood stabilizer medications. It is more effective at treating the depressed phase of bipolar and/or as a mood stabilizer to reduce "cycling." Lamotrigine is available as a generic drug. It is very well tolerated and is free of side effects for most patients.
Serious side effects of lamotrigine you should report to your doctor include:
- Worsening depression or suicidal thoughts
- Flu-like symptoms, such as body aches or swollen glands
This class of medications is sometimes classified as antipsychotics but is also effective in treating bipolar disorder mania and depression. These include medications such as olanzapine (Zyprexa®), quetiapine (Seroquel®), aripiprazole (Abilify®), lurasidone (Latuda®), ziprasidone (Geodon®), Iloperidone (Fanapt®), brexpiprazole (Rexulti®), cariprazine (Vraylar®), clozapine (Clozaril®), risperidone (Risperidol®) among others.
Common side effects of these medications include:
- Muscle spasms/contractions
- Involuntary movements
- Weight Gain
- Increased glucose and lipids
- Irregular, jerky movements; rigidity; slowness of movement (symptoms known as extrapyramidal symptoms)
Most people with bipolar disorder take more than one medication. In addition to a mood stabilizer, patients may take a medication for agitation, anxiety, insomnia, or depression.
Many antidepressants can be used with mood stabilizing drugs to manage the depression of bipolar disorder. If used alone, an antidepressant can push a person with the condition into a manic state.
Additional treatment options
Other treatment options your doctor may consider include:
- Stimulants are sometimes used to treat depression.
- Thyroid medications can act like mood stabilizers. Studies have shown positive results in reducing symptoms in female patients with hard-to-treat, rapid-cycling bipolar disorder.
- Light therapy uses a light box that gives off a bright light similar to natural sunlight. It can be used to treat depression.
- Electroconvulsive therapy (ECT) passes electric current through the brain to treat severe depression.
- Transcranial magnetic stimulation uses a short electromagnetic coil to pass electric current into the brain; used to treat depression in patients in whom medication has not worked and is an alternative to ECT.
- Vagus nerve stimulator is a device implanted under the skin that sends electrical pulses through the vegas nerve (a nerve that runs from the brainstem through the neck and down to each side of the chest and abdomen). The pulse has been found helpful in treating depressive symptoms.
- Ketamine treatment, given intravenously, along with other medicines has been shown to be helpful in treating bipolar depression.