Main Page | Risk Factors | Symptoms | Diagnosis | Treatment | Screening | Reducing Your Risk | Talking to Your Doctor | Living With Bipolar Disorder | Resource Guide
The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about medicines or their potential side effects, contact your doctor.
Psychiatrists are medical doctors (MDs) with expertise in the diagnosis and treatment of disorders of mental health. They can prescribe medicines for medical conditions including bipolar disorder . Some primary care doctors, who do not specialize in psychiatry, may also prescribe these medicines. In less severe cases, they will treat patients in consultation with a psychiatrist.
Medicine known as mood stabilizers are the mainstay of treatment used to help control the mood swings associated with bipolar disorder. Several different types of mood stabilizers are available. You may continue treatment with mood stabilizers for an extended period of time (years). Other medicines are added when necessary, sometimes only for shorter periods of time, to treat acute episodes of mania or depression as needed.
Selective Serotonin Reuptake Inhibitors (SSRIs)
Combination (atypical antipsychotic and SSRIs)
Lithium stabilizes your mood and is often used as initial treatment for preventing manic and depressive episodes. It acts on the central nervous system and helps you to have more control over your emotions. It has been the only medicine consistently shown to be effective in preventing suicide in patients with mood disorders.
Do not drink large amounts of caffeinated beverages (such as coffee, tea, and colas) when you are taking lithium.
Possible side effects include:
Anticonvulsant medicines, such as valproate (Depakote) or carbamazepine (Tegretol), can also have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. In some people, anticonvulsant medicines are combined with lithium, or with each other, for maximum effect.
Researchers are evaluating the safety and efficacy of psychotropic medicines in children and adolescents, in light of their widespread use. There is some evidence that valproate may lead to adverse hormonal changes in teenage girls and polycystic ovary syndrome in women who began taking the medicine before age 20. Young female patients taking valproate should be carefully monitored by their doctors.
Possible side effects include:
There are many different types of benzodiazepine medicines, including clonazepam (Klonopin) and lorazepam (Ativan). They can be helpful in promoting better sleep and reducing agitation. However, since these medicines can be highly addictive and lead tolerance, they are typically only prescribed on a short-term basis or for emergencies.
Possible side effects include:
Zolpidem (Ambien) may be used to treat insomnia . You should take zolpidem just before going to bed since it works quickly. It may work faster if you take it on an empty stomach. You should not take it unless you can get at least 7-8 hours of sleep. If you must wake up before then, you may feel drowsy and experience memory problems because the medicine has not had time to wear off.
Selective serotonin reuptake inhibitors (SSRIs) affect the concentration of the neurotransmitter serotonin, which plays a role in depression . They may occasionally be used in the treatment of bipolar disorder, in combination with other medicines.
Possible side effects include:
There are several other antidepressants that work in a variety of different ways and effect the concentrations of the neurotransmitters (natural substances found in the brain) serotonin, norepinephrine, and dopamine, which are all known to be involved in the regulation of mood.
The exact mechanism of buproprion is poorly understood. But, it is thought to mediated through norepinephrine and dopamine pathways. It is often used in patients who are depressed and unable to tolerate SSRIs. It is also sometimes used in the treatment of bipolar disorder, along with a mood stabilizer.
Possible side effects include:
Venlafaxine (Effexor) and Duloxetine (Cymbalta) are in the class of medicines called serotonin norepinephrine reuptake inhibitors (SNRIs). They work by increasing the amount of both serotonin and norepinephrine. SNRIs are considered a last option for treatment of bipolar disorder and should always be used in conjunction with a mood stabilizer.
Possible side effects include:
Mirtazepine (Remeron), a tetracyclic antidepressant, has a unique mechanism of action. The medicine increases the release of norepinepherine from certain neurons through a complicated process.
Possible side effects include:
In some cases, atypical antipsychotic medicines, such as olanzapine (Zyprexa) and risperidone (Risperdal), are added to a medicine routine to reduce manic symptoms. Quetiapine (Seroquel) has been shown to be effective in reducing the symptoms of both mania and depression in bipolar disorder.
Possible side effects include:
Another medicine, called Symbyax, combines olanzapine and fluoxetine (Symbyax). This has both an atypical antipsychotic and an SSRI antidepressant.
Possible side effects include:
Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the harmful effects of some mood stabilizing medicines on the developing fetus. If you are considering breastfeeding your baby and will be taking medicine at the same time, discuss the possible risks with your doctor before you start. If possible, these discussions should take place prior to a pregnancy. New treatments that have fewer side effects are being studied.
Contact your doctor if your medicine does not seem to be working or if you have any side effects that are troublesome and persistent.
If you are taking medicines, follow these general guidelines:
References
Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published July 23, 2009. Accessed November 22, 2009.
Bipolar disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated September 2008. Accessed September 9, 2008.
Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/. Updated June 2008. Accessed June 28, 2008.
Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/bipolar.cfm. Updated June 2008. Accessed on November 22, 2009.
Carson RC, Butcher JN. Abnormal Psychology and Modern Life . 11th ed. New York, NY: Allyn and Bacon; 2000.
Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: A systematic review of randomized trials. Am J Psychiatry. 2005;162:1805-1819.
Deeks ED, Keating GM. Olanzapine/fluoxetine: a review of its use in the treatment of acute bipolar depression. Drugs. 2008;68:1115-1137.
Estevez RF, Suppes T. Maintenance treatment in bipolar I disorder. In: Yatham LN, Kusumakar V, eds. Bipolar Disorder: A Clinician’s Guide to Biological Treatments. New York, NY: Taylor & Francis Group; 2009: 107-152.
Information for healthcare professionals: Suicidality and antiepileptic drugs. US Food and Drug Administration website. Available at: http://www.fda.gov/ohrms/dockets/ac/08/briefing2008-4344b1_10_01_Trileptal%20Healthcare%20Professional%20Notice.pdf . Updated January 2008. Accessed June 28, 2008.
Miklowitz DJ, Scott J. Psychosoical treatments for bipolar disorder: cost effectiveness, mediating mechanisms, and future directions. Bipolar Disord. 2009;11 Suppl 2:110-122.
Patient information sheet: Olanzapine/fluoxetine (marketed as Symbyax). US Food and Drug Administration website. Available at: http://www.fda.gov/cder/drug/InfoSheets/patient/olanzapine_fluoxetinePIS.htm . Updated September 2006. Accessed June 28, 2008.
Salvadore G, Drevets WC, Henter ID, Zarate CA, Manji HK. Early intervention in bipolar disorder, part II: therapeutics. Early Interv Psychiatry. 2008;2(3):136-146.
United States Pharmacopeial Convention. USP DI. 21st ed. Englewood, CO: Micromedex; 2001.
Yatham LN, Kusumakar V, ed. Bipolar Disorder: A Clinician’s Guide to Biological Treatments. New York, NY: Taylor & Francis Group; 2009.
2/4/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Zyprexa (olanzapine): use in adolescents. US Food and Drug Administration website. Available at: http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198402.htm. Published January 29, 2010. Accessed February 4, 2010.
5/14/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Patorno E, Bohn RL, Wahl PM, Avorn J, Patrick AR, Liu J, Schneeweiss S. Anticonvulsant medications and the risk of suicide, attempted suicide, or violent death. JAMA. 2010;303(14):1401-1409.
Last reviewed December 2009 by Ryan Estévez, MD, PhD, MPH
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © 2007 EBSCO Publishing All rights reserved.