Table of Contents
General Reading/Introductory Reading on Bipolar Medications
and Treatment
Low Cost Access to Bipolar Disorder Medications
Recommended Books on Bipolar -related
Psychiatric Medications
Side-Effects of Some Bipolar Medications
Medications Prescribed for Mania (mood stabilizers,
anti-convulsants)
Other Medications Prescribed for Bipolar (adjunct
treatments to mood stabilizers)
Antidepressants (may be used in addition to mood
stabilizers for depressive episodes)
Medications in Trials for the Treatment of Bipolar
Disorder
Sources for Additional Information on Medications
According to The American Psychiatric Association's
"Guideline
For The Treatment Of Patients With Bipolar Disorder" acute episodes
of mania are usually treated with a mood stabilizer (lithium or valproate)
plus an antipsychotic. Once the patient has been stabilized, the psychiatrist
may reassess the continuing need for an antipsychotic medication in addition
to the mood stabilizer. For acute depressive episodes, APA guidelines
recommend a mood stabilizer. Use of anti-depressants must be used judiciously
because of their tendency to trigger a manic episode (although this is
less likely in patients diagnosed with Bipolar II). If used, an anti-depressant
should always be taken in conjunction with a mood stabilizer.
In both the acute and the maintenance phase of treatment, psychotherapy
(always in addition to pharmacological treatment) may be helpful to address
illness management, social/vocational rehabilitation, and adherance to
a treatment plan. Another treatment sometimes used for medication-resistant
bipolar disorder is electroconvulsive therapy (ECT), for depression.
Medications prescribed for mania (mood stabilizers,
anti-convulsants)
- Lithium - the most commonly prescribed
mood stabilizer to treat both manic and depressive episodes. It is most
helpful as a maintenance medication, because it works more slowly than
some of the atypical neuroleptics used to treat acute mania. Common
side effects include: excessive thirst, urinary problems, lack of coordination,
tremors, nausea/vomiting, fatigue, weight gain, hypothyroidism.
- Valproate/Divalproex (Depakote, Depakene)
- an anticonvulsant approved for use as a mood stabilizer medication
in 1995 ((the first approved medication for bipolar in 25 years, since
lithium). Previously it was prescribed only as an epilepsy medication.
Side effects include: liver problems, tremors, weight gain, nausea,
drowsiness, and dizziness.
- Carbamazepine (Tegretol) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: liver problems, skin reactions (rash),
drowsiness, dizziness, blurred vision, unsteadiness, nausea/vomiting.
- Lamotrigine (Lamictal) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: drowsiness, dizziness, blurred vision,
unsteadiness, nausea/vomiting.
- Topiramate (Topamax) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: drowsiness, constipation, numbness/tingling,
loss of coordination, tremors, decreased sweating, changed speech, loss
of concentration.
- Gabapentin (Neurontin) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: dizziness, drowsiness, dry mouth, upset
stomach.
Other Medications Prescribed for Bipolar
(adjunct treatments for mood stabilizers)
- Benzodiazepines (most common include:
alprazolam/Xanax, diazepam/Valium, lorazepam/Ativan, and Clonazepam/Klonopin)
- these drugs are sometimes prescribed in addition to a mood stabilizer
because they reduce tension and improve sleep. However, they are not
by themselves an adequate control for mania. Moreover, they are not
recommended for long term use because of some indications that they
may be addictive.
- Atypical Antipsychotics - may be prescribed
to quickly control acute manic episodes, and may be continued as an
additional maintenance medication if the bipolar patient experiences
psychotic symptoms as part of the disorder. Most of these drugs are
dopamine-blockers, and are used as primary medications for the treatment
of schizophrenia. Major medical side effects can include: hyperglycemia
and/or diabetes, excessive weight gain, heart arrythmias, sexual disfunction,
and raised prolactin levels.
- Calcium Channel Blockers (examples: Verapamil,
Diltiazem, Nifedipine, and Nimodipine) - these medications are not prescribed
very often for the treatment of bipolar disorder. They slow the uptake
of calcium ions into cells, relaxing blood vessels and reducing stress
on the heart. Side effects include: dizziness, nausea, headache, and
flushing.
Antidepressant Medications (may be used
in addition to mood stabilizers to control depressive episodes)
Antidepressants, particularly the older ones, have been known to induce
a manic episode in people with bipolar disorder. Because of this, they
are used with caution, and always with a mood stabilizer. Clinical recommendations
discourage the use of an antidepressant for anyone who has had at least
one dangerous episode of mania (New England Journal of Medicine, 2004:351:5:479).
Preliminary research indicates that the newer SSRI medications may be
less likely to cause a manic episode. As with most medications, an antidepressant
can take 3-6 weeks to show effects.
- Tricyclic Antidepressants
- Selective Serotonin Reuptake Inhibitors
(SSRIs)
- Monoamine Oxidase Inhbitors (MAOIs)
- Bupropion (Wellbutrin, Zyban)
NIMH and Government
Clinical Trials - New Medications for the Treatment of Bipolar
| Compound |
Trade Name |
Method of Action and Proposed Effect |
FDA Trials Phase |
| RU 486 |
Mifepristone |
glucocorticoid antagonist; antidepressant |
Phase II |
| Riluzole |
Rilutek |
glutamate antagonist; antidepressant |
Phase II |
| Pramiprexole |
Miraprex |
dopamine agonist; antidepressant |
Phase II |
| Tamoxifen |
|
PKC inhibitor; mood stabilizer |
Phase II |
| Felbamate |
Felbatol |
glutamate antagonist; antidepressant |
Phase II |
Sources for Additional Information on Medications
More information on Medications:
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