Severe bipolar disorder can manifest in different ways. Sometimes, severe bipolar illness means that the behavior of the person with the disorder is disruptive to those around him or leads to harm in the person with bipolar disorder. Another way in which bipolar disorder can be severe is when it is resistant to typical medication treatment strategies. Treatment of severe bipolar disorder is generally achieved through maximizing medication management and in appropriate cases, combining medications to achieve the best possible therapeutic results with the fewest side effects.
Lithium
Lithium is an effective drug with a long history in the treatment of bipolar disorder It can begin to work in as little as a week as opposed to taking several weeks, which is characteristic of other drugs to treat bipolar disorder. When taking lithium, patients must have regular lab tests as lithium has a therapeutic blood concentration that must be maintained in order for treatment to be successful.
Valproic Acid
Valproic acid is a type of anticonvulsant medication that while not originally developed for the treatment of bipolar disorder, has become more popular since the mid-1990s Valproic acid may be more useful in treating certain kinds of bipolar disorder than lithium, which is still considered the gold standard treatment. Like lithium, valproic acid blood levels must be monitored periodically to ensure a therapeutic level is achieved.
Other Anticonvulsants
Carbamazpine is not FDA-approved for the treatment of bipolar disorder, but is often used for this purpose In some cases, it may be more effective for patients with rapid cycling bipolar disorder than lithium. Also, carbamazapine may be particularly useful in patients with acute mania as a major feature of their bipolar disorder as opposed to depressive features. Lamotrigine is a newer anticonvulsant medication that has shown positive effects in treating bipolar disorder, especially in people who have depression as a major feature of their bipolar illness.
Atypical Antipsychotics
Atypical antipsychotics were introduced into clinical practice in the 1970s and 1980s, and new drugs are under constant development. Examples of this type of drug include olanzapine and quetiapine. Atypical antipsychotics tend to be more effective in the management of manic symptoms of bipolar than in treating the depressive symptoms. This is why atypical antipsychotics are sometimes combined with other drugs in order to achieve a normal mood in the person with bipolar disorder.
Other Drugs
Benzodiazepines, such as lorazepam or clonazepam, are useful in treating the manic phase of bipolar disorder. In patients with severe, treatment-refractory bipolar disorder, benzodiazepines may have a more frequent role than in patients whose symptoms are controlled on maintenance therapy with antipsychotics or anticonvulsants. Oxcarbazepine is a drug with a similar chemical structure to carbamazapine, but with few side effects. It is used primarily in the treatment of epilepsy but is also used as a mood stabilizer in patients with bipolar disorder.
References
- "US Pharmacist;" Pharmacotherapy for Bipolar Disorder; Mark D. Watanage, Pharm.D., Ph.D.; November 2007
- "CNS Spectrums: The International Journal of Neuropsychiatric Medicine;" Update on the Etiology and Treatment of Schizophrenia and Bipolar Disorder; Peter F. Buckley, M.D.; February 2008
- "Expert Opinion on Pharmacotherapy;" Treatment Refractory Bipolar Disorder: Classification to Aid in Clinical Management; P. Gajwani; August 2009
