Bipolar Disorder: Medications

Medications are the most standard way bipolar symptoms are managed.  Medications seem to work best at managing symptoms and holding them off while taking them.  Some people do great on some medications and other people do better on others.  It is important to work closely with your doctor to find and maintain the medicines and dosages that work best for you.  You need to work closely with your doctor to monitor any side effects and the efficacy of the medicines as sometimes several are needed to manage the symptoms.

There are 4 principles of medication management:

  1. Medicines should be taken as ordered by the doctor, that is, when and how much is prescribed.  Any side effects should be noted and how your symptoms are affected.
  2. Any developing side effects should be reported to your doctor as soon as possible so as to avoid any discomfort or damage. However, do not stop taking the medicine cold turkey without first consulting your doctor as this could cause even more discomfort and damage than the side effects and even more likely induce mood swings again.
  3. Alcohol, illicit drugs, and other prescribed medications may cause your medication for bipolar disorder to be ineffective and may increase side effects. You should report all other medications and substances you are taking to your doctor to ensure that none adversely interact with the medication prescribed for bipolar disorder.
  4. Effective medical management of bipolar requires tracking your symptoms and reporting them and your side effects to your doctor so medications can be changed or dosages altered to best manage the disorder. As an added note it is good to keep in touch with your pharmacist for the same reasons and as a defense against side effects from over the counter drug interactions as that can lessen the efficacy of your prescriptions also.

The first phase of treatment is to eliminate any mania, hypomania or depression that the patient is experiencing.  This could take anywhere from six weeks to six months at a minimum.  It could take longer to find the medications that work best to keep the symptoms away.  It took about eighteen months for my doctor and me to find what worked for me so that I was stable.

Then because I was either sensitive to the medication or desensitized quickly it became an ongoing cycle to change medications now and then to maintain my stability.  This second phase is one of continuation making an effort to stay stable the doctor and patient work closely together to find what works best after the initial damaging symptoms are conquered.

The maintenance phase is much like with diabetes or hypertension.  It is most likely a lifetime of juggling medications to keep the symptoms away.  Mania, hypomania and depression are important to avoid for the patient to function best in his or her daily life.  Preventing reoccurrence is best for your mental health as you avoid any risk of losing control of your choices or bringing on any serious consequences from poor decision making.  You also avoid the possibility of hospitalization.

Medications for bipolar disorder are different than things like antibiotics.  You need to take them on good days and bad to maintain the wellbeing they provide.  The key is to understand they are for maintenance not a cure like penicillin.  It is more like vitamins where you take them to give your body what it is missing for its welfare on a daily basis.

There are three basic categories of medications that are used to treat bipolar symptoms. These medications are mood stabilizers, antidepressants, and antipsychotics.  Mood stabilizers are the foundational prescriptions that help prevent mania and depression mood swings.  They help bring the patient to a more emotionally centered place.  It makes it easier to make decisions without being overwhelmed by emotion.  Depending on the severity of the symptoms antidepressants and/or antipsychotics may be used as well.

Mood stabilizers are a maintenance medication because while they do lessen or eliminate mood swings they do not cure the cause of the mood swings unfortunately so they do need to be taken daily.  Even though you feel better taking the mood stabilizers you cannot stop taking them they are just keeping you stable.

Lithium Carbonate, Carbamazepine, and Sodium Valproate are the most common mood stabilizers either used alone or used with other prescriptions to eliminate the mood swings.

Antidepressants can cause a hypomanic or manic mood swing if a mood stabilizer is not included in the treatment.  But when a mood stabilizer is used an antidepressant can be a powerful tool for the doctor to treat the severe depression that can come with bipolar disorder. There is no one better antidepressant than another it is just a matter of finding the one that works for you without side effects and bumps in mood stabilization.  The three common antidepressants are:

  • Selective serotonin reuptake inhibitors (SSRI’s) – sertraline, paroxetine, fluoxetine
  • Tricyclics – imipramine, amitriptyline, dolthiepin, desipramine
  • Monoamine oxidase inhibitors (MAOI’s) – phenelzine, tranylcypromine

Antipsychotics are also used with mood stabilizers and antidepressants if needed.  They are often used to eliminate hallucinations or delusions, reduce inappropriate grandiosity, decrease impulsivity or irritability, or induce sleep if needed. Some common antipsychotics are haloperidol, chlorpromazine, thioridazine, risperidone, and olanzapine.

Another often used medication is clonazepam, which is classed as a benzodiazepine. This is used to help induce sleep, reducing psychomotor agitation and slowing racing thoughts or pressured speech.

It’s so important to work closely with your doctor to note how effective the medications are in treating the symptoms and to make changes to eliminate side effects as much as possible.  It is also important to keep taking medications as directed and not stop taking them until talking to your doctor.

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