According to the American Psychiatric Association's latest guidelines, medications that are appropriate for the treatment of bipolar disorder include mood stabilizers ( lithium or divalproex) and anti-psychotics (Zyprexa, quetiapine (Seroquel), ziprasidone or risperidone). These may be prescribed alone or in combination, and different medications may be appropriate during either manic or depressive phases of bipolar. Side effects of bipolar medications are common, so it is important to report any symptoms to your doctor so that appropriate adjustments may be made.
Common Side Effects
Bipolar medications can produce a variety of common side effects. Some of these may be mild in nature and could dissipate after a brief adjustment period, while others may be more severe and persistent. Common side effects include nausea, diarrhea, dry mouth, drowsiness, blurred vision, loss of appetite, increase in appetite, fatigue and sleep disturbances. Symbyax, a combination selective serotonin re-uptake inhibitor (SSRI)/ anti-psychotic medication approved for the treatment of bipolar depression may also cause problems with attention span, an overall sedated feeling and peripheral edema (swelling of the extremities). Long-term use of mood stabilizers may also be associated with pancreatitis, liver toxicity, renal impairment and cardiac abnormalities.
Extra-pyramidal Side Effects
Extra-pyramidal side effects are neurological symptoms related to movement, including akathisia (inner feelings of restlessness), dystonia (sudden, painful muscle stiffness), muscle rigidity, tremor and motor restlessness (sometimes referred to as drug-induced Parkinson symptoms). Tardive dyskinesia can also develop with long-term use of bipolar medications, causing side effects such as facial grimacing, swaying movements of the body, and random movements of the tongue, lips, jaw, limbs and toes. A review published in a 2008 issue of "Journal of Clinical Psychopharmacology" reports that bipolar patients -- particularly those in a bipolar depression phase -- are likely to suffer from acute, neurological movement disorders induced by anti-psychotic medications (even the newer atypical anti-psychotics). Other studies have shown that the addition of the anti-psychotic risperidone for adjunctive use with a mood stabilizer (such as Lithium) significantly increases the prevalence of extra-pyramidal symptoms.
Weight Gain
Weight gain is a reported side effect of many bipolar medications, including mood stabilizers and anti-psychotics. A review in a 2008 issue of the "Journal of the American Psychiatric Nurses Association" notes that 35 percent of people with bipolar disorder are obese, the highest of any mental disorder. Doctors are not sure exactly how these drugs may be causing weight gain, since it can be difficult to determine how much of the weight gain is due, directly or indirectly, to side effects from the drugs versus how much is the result of demographic, mental and lifestyle factors of bipolar patients. For example, up to 18 percent of those diagnosed with bipolar also have a concurrent binge-eating disorder, and up to 10 percent have bulimia nervosa. Gender, socioeconomic status, physical inactivity, and frequency of manic and depressive episodes may also play a role. Weight gain may also increase the risk of even more serious side effects; the risk of developing diabetes is reportedly 2 to 3 times higher in bipolar patients than among those in the general population. While this finding could be attributed to medications, it could also be a byproduct of obesity.
Hypothyroidism
Medications such as Lithium can trigger hypothyroidism (a condition in which low levels of thyroid hormone are released into the body), causing numerous side effects including hair loss, dry skin, hoarse voice, depression, sensitivity to cold and weight gain.
References
- American Psychiatric Association: Guidelines for Bipolar Treatment
- "Journal of Clinical Psychopharmacology;" Antipsychotic-induced extrapyramidal side effects in bipolar disorder and schizophrenia: a systematic review; K Gao et al.; April 2008
- "Journal of the American Psychiatric Nurses Association;" Bipolar Disorder and Weight Gain: A Multifactorial Assessment; Susan Simmons-Alling; 2008
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