Manic depression, or bipolar disorder, is a mood disorder where patients have both depression and mania symptoms. Mania and depression are on opposite sides of the mood spectrum: depression is categorized by sadness and hopelessness, while mania is categorized by euphoria and racing thoughts. Treatment options, including medication, vary on which mood the patient exhibits more.
Lithium
Melinda Smith and Jeanne Segal, authors of the HelpGuide website's "Bipolar Medication Guide," state that lithium is the oldest mood stabilizer used for manic depression. Lithium is effective in treating mania, the authors say, and can also treat depression symptoms when combined with an antidepressant. However, lithium does not alleviate symptoms in cases of mixed episodes (where patients have mania and depression symptoms simultaneously) or when the patient has mania that switches to depression rapidly. The medication takes one to two weeks to start relieving the symptoms of manic depression.
Anticonvulsants
Anticonvulsants are another form of mood stabilizer that manages mania symptoms. Smith and Segal list valproic acid, carbamazepine, lamotrigine and topiramate as anticonvulsants that treat manic depression. According to the National Institute of Mental Health (NIMH), valproic acid is effective in treating the forms of manic depression that lithium cannot treat: rapid cycling manic depression, mixed mania (full-blown mania with some symptoms of depression) and mania with psychotic symptoms, like hallucinations and delusions.
Antidepressants
While antidepressants are the primary medication option for unipolar depression, patients with manic depression are advised to be careful. Smith and Segal note that when manic depression patients take an antidepressant alone, the medication can increase mood cycling and causes the patient's depressed mood to switch to mania. If antidepressants are taken for manic depression, they should be combined with a mood stabilizer. NIMH states that bupropion, fluoxetine, sertraline and paroxetine are approved for use by manic depression patients.
Antipsychotic Medications
Another medication option for manic depression is antipsychotic medications, which Smith and Segal recommend for patients who experience a loss of reality during an episode. Antipsychotic medication options include olanzapine, clozapine, quetiapine, ziprasidone, risperidone and ariprazole; these medications are usually combined with a mood stabilizer.
