Medicines

Prescribing for bipolar disorder is a difficult one. Doctors have to judge exactly how to organise your medication so that you end up with a balanced mood.

Achieving a balance is important to prevent patients entering one phase from another, for example, from manic to depressive or visa versa. 

There is a variety of different medications to treat people with bipolar disorder – the ones you end up taking depend on your personal situation.

We can use medication to: 

• Treat severe episodes of mania, depression or hypomania and mixed episodes. This is called acute therapy. 

• Prevent future episodes. This is called maintenance therapy.

So if you have got bipolar disorder, you will probably need to take a combination of medications.

Mood stabilisers
Doctors normally prescribe mood stabilisers both to treat severe episodes and to prevent future ones.

There are many different mood stabilisers. These three are the most common ones taken for bipolar disorder.

Lithium

Lithium can be used in the treatment of manic episodes and in some cases in recurrent depression where other drugs have been unsuccessful, this varies from country to country.

Common side-effects: Blurred vision, dry mouth, mild hand tremor, frequent urination, nausea and vomiting, tiredness, drowsiness, feeling dazed, weight gain.

Valproate

Valproate is better than lithium at treating rapid-cycling bipolar disorder. It can also treat both manic and depressive episodes.

Common side-effects: include dizziness, drowsiness, tremor and nausea.

Carbamazepine

Carbamazepine can also treat both manic and depressive episodes.

Common side-effects: dizziness, drowsiness, nausea, vomiting and rash.

Care needs to be taken with these mood stabilisers. Too little means the medication will not work properly and too much will cause side-effects. We need to keep the amount in your bloodstream within a narrow range. That's why blood samples have to be taken regularly to measure the level of whichever one you are taking.

Antipsychotics
If you are having an episode of mania or depression that is really severe (when the danger of suicide is at its strongest), the traditional mood stabilisers are often combined with antipsychotics.

Antipsychotics are also mood-stabilising medications. They can get rid of manic or depressive symptoms much more quickly. Adding an antipsychotic (or sometimes a sedative) might also help to lessen other symptoms like insomnia, anxiety or agitation.

• Typical antipsychotics were developed first. They are often used to treat acute mania. But there are concerns about the long-term safety of typical antipsychotics.

• Atypical antipsychotics were developed later. Some are used for the treatment of mania and are under investigation for treatment of depressive episodes associated with bipolar disorder.

Various side effects may be associated with atypical antipsychotics.  These vary in their severity from one medicine to another.  You could experience EPS (ExtraPyramidal Symptoms, such as muscle stiffness, tremors and lack of arm movement when walking); interferences in the level of the hormone prolactin (a hormone involved in the production of breast milk and sexual activity); nausea; and weight gain.

Other medications
Aside from the main three mood stabilisers (lithium, valproate and carbamazepine) and antipsychotic medications, there are a few other types of medication that can be prescribed for bipolar disorder.

• Anticonvulsants are another type of medication that can stabilise your mood. Sometimes they are used to treat episodes of mania. They can cause side-effects like drowsiness, diarrhoea, vomiting and headache.
  
  They can also be used to treat other conditions that affect the brain, like schizophrenia and epilepsy. Do not be alarmed if these conditions are mentioned on the packaging – it does not mean you have these conditions.

• Antidepressants are often used to treat depression. But in patients with bipolar disorder they can trigger an episode of mania or cause rapid-cycling. So these medications are usually avoided, or used with care, in bipolar disorder.
  
  Antidepressants are normally given in combination with the mood stabilisers lithium, valproate or carbamezapineor during a depressive episode in bipolar I disorder.

• Benzodiazepines can treat insomnia and agitation. It is easy to get addicted to them, so benzodiazepines are only used for short periods.

• Alternative medicine, vitamins and medication for other illnesses can interact with each other to produce unwanted side-effects. 
  
  Before beginning a medication for bipolar disorder, you need to tell your doctor or pharmacist about all the other medications you are taking, including over-the-counter drugs and supplements. They can tell you if it is likely there will be any problems.