Bipolar disorder is a psychiatric condition, sometimes called "manic depression" that affects approximately 5.7 million Americans, according to the National Institute of Mental Health (NIMH). Bipolar disorder generally appears during the late teen years or early adulthood and is characterized by alternating periods of elevated and depressed mood. Bipolar I is considered to be the more severe form of the spectrum with acute periods of mania and severe depression including a possibility of psychosis. Though often debilitating when left untreated, Bipolar I disorder can be managed with medications aimed at treating either the manic phase or the depressive phase.
Mood Stabilizers
Lithium has been used since the 1970s for the treatment of the manic phase of Bipolar I disorder. Lithium has long been the mainstay of Bipolar I treatment and is generally very effective but requires monitoring of blood levels to ensure effectiveness and avoid toxicity in the kidneys. Thyroid function must also be monitored because lithium can lower thyroid levels, which may lead to worsening of bipolar disorder.
Divalproex sodium and valproic acid were approved by the FDA in 1995 to treat mania in Bipolar disorder. It is considered to be as effective as lithium but has a number of risks which may be undesirable including liver toxicity, pancreatitis, increased testosterone levels creating reproductive disorders in females and the risk of birth defects.
Anticonvulsants
Lamotrigine, gabapentin, topiramax and oxcarbazapine are all types of anticonvulsants sometimes used for Bipolar I disorder. Though these drugs have been widely used, no large clinical studies have confirmed that they are more effective than mood stabilizers. They often carry side effect warnings including sedation, difficulties with memory and weight changes.
Atypical Antipsychotics
Olanzapine, aripiprazole, quetiapine, risperidone and ziprasidone are medications used for the management of manic symptoms of bipolar disorder. They are known as "atypical" antipsychotics because they are different from older, traditional antipsychotice used primarily to treat schizophrenia. Atypical antipsychotics are used in bipolar disorder even if no symptoms of psychoses are present. They may cause side effects such as weight gain, sedation and may contribute to the development of breast tissue and lactation in both men and women. Atypical antipsychotics also carry the risk of the development of extrapyramidal effects such as tardive dyskinesia, a Parkinson's-like syndrome that may be irreversible.
Antidepressants
Antidepressants are used to treat symptoms of depression in bipolar I disorder. Antidepressants such as fluoxetine, paroxetine, sertraline and bupropion can also be used when no symptoms of depression are present because they may help to prevent the development of depression. Taking antidepressants without a mood stabilizer may increase the chance of switching to the manic phase; consequently they are almost always given in combination with medications to treat mania. However, a study funded by NIMH showed that for many people, antidepressants combined with mood stabilizers were no more effective than mood stabilizers alone in the treatment of bipolar depression and are consequently not used for all patients. Antidepressant users may experience side effects such as changes in sleep patterns and eating habits and a decreased sex drive.
