Bipolar type 2 disorder is considered a less intense form of bipolar type 1 disorder. Patients may be depressed for longer periods of time, and their mania may never reach the extreme high characterized by bipolar type 1.
Medications prescribed for bipolar type 2 are the same as those that are FDA-approved for bipolar type 1. Most of these medications are indicated only for bipolar 1 mania or depression but may be successful for bipolar type 2 as well. A psychiatrist will usually determine dosage and frequency of administration based on the diagnosis of the individual, bipolar symptoms, possible side effects and outcome success.
Mood Stabilizers
The most commonly prescribed FDA-approved medications for bipolar disorder are mood stabilizers. Lithium has been approved since the 1970s for treating episodes of both mania and depression. Side effects may include excessive thirst and urination, seizures, balance and coordination problems, irregular heartbeat, slurred speech, rash and swelling of the legs, ankles, face or tongue. Because lithium can affect the kidneys and thyroid gland, it's important for people taking lithium to have their doctor check the levels of the drug in their bloodstream.
Anticonvulsant medications have also been approved by the FDA for treating bipolar disorder. In addition to preventing seizures, these medication have been found to stabilize moods and control mood swings more effectively than lithium for some patients. FDA-approved mood stabilizers include valproic acid (Depakote), carbamazepine (Tegretol), lamotrigine (Lamictal) and oxcarbazepine (Trileptal). Side effects may include nausea and vomiting, weight gain or anorexia, and stomach cramps. These drugs may also adversely affect the liver, so blood tests must be administered on a regular basis.
Mood stabilizers come with an FDA "block boxed warning" because they may cause suicidal thoughts and behaviors. It's important that people taking mood stabilizers see their doctor regularly and not make any changes to their medication without their doctor's approval.
Atypical Antipsychotics
Originally given to patients with schizophrenia, some atypical antipsychotic medications have been approved for bipolar disorder. They are usually given in conjunction with mood stabilizers and antidepressants and are indicated to treat mania or "mixed" episodes (a combination of depressive and manic episodes).
Atypical antipsychotic medications are newer than "typical antipsychotics" (also called conventional or first-generation antipsychotics). Quetiapine (Seroquel) became the first atypical antipsychotic to receive FDA approval not only for mania, but for the treatment of bipolar depression, in 2006. Other antipsychotics used to treat people with bipolar disorder include olanzapine (Zyprexa), aripiprazole (Abilify), risperidone (Risperdal) and ziprasidone (Geodon).
Atypical antipsychotics approved by the FDA also have "black box" warnings. They may cause increased mortality in elderly patients with dementia, and they may create suicidal thoughts or behaviors in children, adolescents and young adults taking antidepressants for major depression disorder or other psychiatric disorders.
Antidepressants
Because people with bipolar type 2 usually have longer episodes of depression and only go to a specialist when they are depressed, they may be misdiagnosed as having a clinical depression rather than bipolar type 2. It is only when they begin to exhibit mania as their depression "lifts" that an accurate diagnosis may be made. Antidepressants usually take three to four weeks to take effect, and the first antidepressant prescribed is usually successful in approximately 70 percent of people.
The differences between the classes of FDA-approved antidepressants are their chemical structure and the way they affect the chemicals (called neurotransmitters) in the brain.
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and paroxetine (Paxil ), work on the neurotransmitter serotonin. Serotonin and norepinephrine reuptake inhibitors (SSNRIs), such as venlafaxine (Effexor) and duloxetine (Cymbalta), work on both serotonin and the neurotransmitter norepinephrine. Antidepressants that do not have a specific neurotransmitter target, such as bupropion (Wellbutrin), are called "unique."
