Lithium carbonate is a medication used frequently as a first line treatment for bipolar disorder. It is toxic in high doses. Toxic levels are more likely with kidney or heart disease, dehydration, or use of diuretic drugs or ACE inhibitors, a class of drugs often used for high blood pressure. Long term use can damage the kidneys. Even though lithium is the first line and generally most effective treatment, for some people alternatives may be preferable.
Anti-epileptic drugs are medications usually used in the treatment of seizure disorders. They may act as mood stabilizers, helping to prevent relapse into major depression or mania. Lamotrigine has been shown to help prevent relapse compared to placebo, according to an analysis published in the journal Bipolar Disorders in 2007. A rare--but feared--side-effect of lamotrigine is Stevens-Johnson Syndrome, a potentially fatal disease of the skin. Other side effects include gastro-intestinal (GI) upset, insomnia and a skin rash. The analysis also noted that divalproex decreased relapse; it may be less effective than lithium. Side effects may include weight gain, sleepiness, GI upset, hair loss and tremor. Oxcarbazepine and carbemazepine are structurally similar drugs, but the former has less side effects. These drugs can cause GI upset, dizziness and sleepiness.
Antipsychotic drugs are generally used to treat psychotic disorders, such as schizophrenia. Olanzapine and quetiapine both decrease relapse of bipolar disorder. Olanzapine may be as effective as lithium, according to a 2005 study in the American Journal of Psychiatry. Side effects of olanzapine include weight gain, constipation, sleepiness and dry mouth. Quetiapine has similar side effects. Aripiprazole is another antipsychotic that may be useful in bipolar disorder. Side effects include restlessness, tremor, anxiety, weight gain and dry mouth. Asenapine is another such drug; side effects include sedation, weight gain, dizziness and insomnia.
Electroconvulsive Therapy and Psychotherapy
Electroconvulsive therapy is a procedure in which a person is completely sedated under general anesthesia and an electrical current is applied to the head, inducing a seizure. It is used for a number of disorders including major depression. In bipolar disorder, it is not used independently of drug treatments, but in addition to it. Psychotherapy is also used in addition to drug therapy and may be helpful to the individual with bipolar disorder and the family.