Bipolar Medications

There are several classes of prescription medications available today for the treatment of bipolar disorder. Bipolar medications that are typically prescribed fall into three primary categories: mood stabilizers/anticonvulsants, antipsychotics, and antidepressants. Because bipolar disorder is diagnosed on a scale and every case is treated as a unique one, different medication classes have demonstrated different levels of efficacy depending on the individual nature of the case. Also, bipolar medications have their own unique sets of potential side effects, and patients are likely to find some of these side effects more tolerable than others.

MOOD STABILIZERS/ANTICONVULSANTS
Mood stabilizers are often used as a first line of treatment for bipolar disorder, because they help to reduce the violent shifts in mood that are characteristic of the condition. This class of drugs also includes medications with both mood stabilizing and antidepressant effects. These drugs can be particularly effective in bipolar patients who require medications to treat their depressive phases as well as their manic ones.

Lithium Carbonate
Lithium is one of the oldest drugs used in the treatment of bipolar disorder, and works by inhibiting the chemical reactions that strengthen and amplify the messages that are sent to the brain. However, patients using lithium for the treatment of bipolar disorder must be closely monitored by a medical professional. Lithium has been known to cause heart and renal disease, and should not be used during pregnancy or lactation.

Valproic Acid
Brand names: Depakote, Depakote ER, Depakene, Depacon, and Stavzor
Valporic acid was originally created as a product of the herb Valerian, which is commonly taken as a sleep aid. Valporic acid is one of the more effective bipolar disorder medications, working via the inhibition of the neurotransmitter called GABA. GABA is the neurotransmitter that regulates the muscles of the body, and inhibiting it can have an anticonvulsive effect. The possible side effects of Valporic acid include pancreatitis and suicidal ideation.

Lamotrigine
Brand name: Lamictal
Lamotrigine is used in the treatment of bipolar disorder in remission, meaning that it is used for maintenance in bipolar patients who are not currently experiencing mania. Lamotrigine helps to prevent future manic symptoms from occurring. It has few interactions with other drugs, and has few reported side effects. However, if an unusual rash is seen on the skin during the use of Lamotrigine, it must be reported to a doctor immediately.

Carbamazepine
Brand names: Tegretol, Biston, Calepsin, Carbatrol, Epitol, Equetro, many others
Carbamazepine works by inhibiting the ability of neurons to send messages over great distances, making less neurons available to fire if the brain experiences a manic episode. Carbamazepine is widely used to treat bipolar disorder, both in the acute and remissive phases. Carbamazepine has several known interactions with other drugs, however, and must be closely monitored by a physician, particularly if the drug is used in conjunction with another mood stabilizer. The most common side effects reported by patients using Carbamazepine include drowsiness, weight gain, and issues remembering things. It is not recommended during pregnancy, but is considered safe for use by breastfeeding mothers.

ANTIPSYCHOTICS
Generally, antipsychotic drugs are used in the treatment of bipolar disorder in patients who are experiencing an acute manic phase, because these drugs are able to begin working very quickly. In settings where a patient is in an emergency room because of an immediate danger to him/herself or others, antipsychotic drugs can be administered as an injection or a wafer that dissolves quickly on the tongue. A typical regimen of bipolar medications might include both anticonvulsants and antipsychotics.

Olanzapine
Brand names: Zyprexa, Zyprexa Zydis, Zalasta, Zolafren, Olzapin, Rexapin
Olanzapine is used to treat both the manic and depressive symptoms of bipolar disorder. It is available for short and medium term use, and can be purchased in a fast-acting form for acute episodes. Because Olanzapine is highly sedative, it is often taken immediately before bedtime. The most commonly reported side effects of Olanzapine are sedation and insomnia, although some patients have also reported dyskinesia, involuntary movements of the muscles.

Aripiprazole
Brand name: Abilify
Aripiprazole is used in the treatment of severe manic bipolar episodes. It is able to rapidly inhibit psychomotor activities, making it commonly used in emergency rooms to calm patients who are an immediate danger to themselves. In longer-term usage, Aripiprazole can cause weight gain and diabetes. Depression has also been noted in some patients. Generally, the drug is not used on its own in the maintenance treatment of bipolar disorder, and is rather used in conjunction with a mood stabilizer.

Risperidone
Brand name: Risperdal
Risperidone works by blocking the dopamine receptors present in the brain, which can treat the manic and mixed states of bipolar disorder. Risperidone reaches peak concentration in the blood quickly, making it effective for use in halting aggressive and dangerous behavior. Risperidone has been associated with weight gain in 26-38% of patients. Anxiety and nausea are also commonly reported as side effects.

Quetiapine
Brand names: Seroquel, SeroquelXR, Ketipinor
Although doctors are not completely sure how Quetiapine works, it is believed to inhibit multiple receptors in the brain, including those for dopamine, histamine, and serotonin. Quetiapine has the distinction of being the first drug approved by the FDA to be used daily for the treatment of both the manic and depressive phases associated with bipolar disorder, and is one of the few bipolar medications with this indication. Quetiapine is also available in an extended release form. When used as a treatment for bipolar disorder, Quetiapine must be taken before bedtime due to its heavily sedative effect. The side effects of Quetiapine are typical for this drug class, and include symptoms such as headache and dry mouth.

Ziprasidone
Brand names: Geodon, Zeldox
Ziprasidone is a relatively new drug, having been approved by the FDA in 2001. It is used for the treatment of acute manic phases in bipolar patients, but it must be used under the close supervision of a doctor, as it has also been reported to have induced manic phases in some patients. Ziprasidone is either injected into the muscles, or taken orally with food. Ziprasidone should not be used by patients with heart problems, at has been reported to have induced arrhythmia in some patients.

ANTIDEPRESSANTS
In general, antidepressants function by keeping serotonin in the system longer. This can help to lessen the depressive phases of bipolar disorder. However, the use of antidepressants in the treatment of bipolar disorder is controversial, and must be done under a doctor's supervision. When antidepressants have been used as bipolar medications, they have been known to trigger manic episodes.

Fluoxetine
Brand name: Prozac
Fluoxetine is the third most prescribed antidepressant in the United States, and has been in use since the 1970s. It has been shown to be highly effective in treating depression, but should not be used by patients with impaired liver function. Other common side effects include nausea and insomnia.

Paroxetine
Brand names: Seroxat, Paxil
Paroxetine is used in the treatment of acute depression, and is often considered a second line treatment due to having weight gain as a commonly reported side effect. Paroxetine is also associated with an increased risk of suicidal ideation, and should not be used by women who are pregnant or may become pregnant.