Medications for Treatment of Bipolar Disorders

Lithium can lessen the symptoms of mania and depression, especially in people with a family history of bipolar disorder. Lithium can lessen the symptoms of mania and depression, especially in people with a family history of bipolar disorder.Lithium helps prevent mood swings in many people with bipolar disorder. Because lithium takes 4 to 10 days to work, a medication that works more rapidly, such as an antiseizure or a newer (second-generation) antipsychotic medication, is often given to control excited thought and activity. People with a family history of typical bipolar disorders are more likely to respond to lithium.

Lithium can have side effects. It can cause drowsiness, confusion, involuntary shaking (tremors), muscle twitching, nausea, vomiting, diarrhea, thirst, excessive urination, and weight gain. It often worsens a person's acne or psoriasis. However, these side effects are usually temporary and are often lessened or relieved when doctors adjust the dose.

Doctors monitor the level of lithium in the blood with regular blood tests because if levels are too high, side effects are more likely. Long-term use of lithium can cause low levels of thyroid hormone (hypothyroidism) and can impair kidney function. Therefore, thyroid and kidney function must be monitored with regular blood tests, and the lowest effective dose is used.

Lithium toxicityLithium toxicity occurs when the level of lithium in the blood is very high. It causes persistent headaches, mental confusion, drowsiness, seizures, and abnormal heart rhythms. Toxicity is more likely to occur in the following:

• Older adults

• People with impaired kidney function

• People who have lost a lot of sodium through vomiting, diarrhea, or use of diuretic medications (which make the kidneys excrete more sodium and water in urine)

The antiseizure medications valproate and carbamazepinecarbamazepine act as mood stabilizers. They may be used to treat mania when it first occurs or to treat mania and depression when they occur together (mixed episode). Unlike lithium, these medications do not damage the kidneys. However, carbamazepine can greatly reduce the number of red and white blood cells. Rarely, valproate damages the liver (primarily in children) or severely damages the pancreas. With close monitoring by a doctor, these problems can be caught in time. , these medications do not damage the kidneys. However, carbamazepine can greatly reduce the number of red and white blood cells. Rarely, valproate damages the liver (primarily in children) or severely damages the pancreas. With close monitoring by a doctor, these problems can be caught in time.Valproate is usually not prescribed for women with bipolar disorder if they are pregnant or of childbearing age because the medication appears to increase the risk of brain or spinal cord birth defects (neural tube defects), attention-deficit/hyperactivity disorder, and autism in the fetus. Valproate and carbamazepine can be useful, especially when people have not responded to other treatments.

LamotrigineLamotrigine is sometimes used to help control mood swings and treat depression. Lamotrigine can cause a serious rash. Rarely, the rash becomes the life-threatening Stevens-Johnson syndrome. People who are taking lamotrigine should watch for any new rash (particularly in the area around the rectum and genitals), fever, swollen glands, blistering sores in the mouth or on the eyes, and swelling of the lips or tongue. They should report these symptoms to the doctor. To reduce the risk of developing these symptoms, doctors carefully follow the recommended schedule for increasing the dose. The medication is started at a relatively low dose, which is increased very slowly (over a period of weeks) to the recommended maintenance dose. If doses are interrupted for 3 days or more, the schedule for gradually increasing the dose must begin again.

Sudden manic episodes are increasingly treated with second-generation antipsychotics because they act quickly and the risk of serious side effects is less than that with other medications used to treat bipolar disorder. These medications include aripiprazole, asenapine, cariprazine, lumateperone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone.because they act quickly and the risk of serious side effects is less than that with other medications used to treat bipolar disorder. These medications include aripiprazole, asenapine, cariprazine, lumateperone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone.

For bipolar depression, certain antipsychotics may be the best choice. Some of them are given with an antidepressant.

Long-term side effects of antipsychotics may include weight gain and the metabolic syndrome. Metabolic syndrome is excess fat in the abdomen with reduced sensitivity to insulin’s effects (insulin resistance), a high blood sugar level, abnormal cholesterol levels, and high blood pressure. The risk of this syndrome may be lower with aripiprazole and ziprasidone. First- and second-generation antipsychotics are sometimes prescribed during pregnancy with the exception of resistance), a high blood sugar level, abnormal cholesterol levels, and high blood pressure. The risk of this syndrome may be lower with aripiprazole and ziprasidone. First- and second-generation antipsychotics are sometimes prescribed during pregnancy with the exception ofrisperidone, which has been associated with a small increase in the risk of birth defects.

Certain antidepressants (selective serotonin reuptake inhibitors [SSRIs]) are sometimes used to treat severe depression in people with bipolar disorder, but their use is controversial. Therefore, these medications are used only for short periods and usually are given along with a mood-stabilizing medication or an atypical antipsychotic.

Carbamazepine and valproateCarbamazepine and valproate carry the highest risk of causing birth defects and should be avoided during pregnancy. As a precaution, doctors will make a plan to switch to a different medication before any planned pregnancy. Additional details about the risks of these medications:

• Valproate increases the risk of neural tube defects (such as spina bifida) and abnormalities (of the face and skull, limbs, heart, and other cardiovascular structures). It is also associated with low IQ scores and autism spectrum disorders. Its use during pregnancy to treat bipolar disorder is banned in some countries.

• CarbamazepineCarbamazepine also increases the risk of neural tube defects but is used during pregnancy under certain circumstances (for example, when the pregnant parent needs to be treated for epilepsy).

LamotrigineLamotrigine use during pregnancy is generally considered to be safer than using either valproate or carbamazepine.use during pregnancy is generally considered to be safer than using either valproate or carbamazepine.

LithiumLithium use during pregnancy has been associated with an increased risk of a particular type of cardiovascular birth defect called Ebstein anomaly. However, because this risk is quite low, lithium is sometimes continued at the lowest possible dose during pregnancy. use during pregnancy has been associated with an increased risk of a particular type of cardiovascular birth defect called Ebstein anomaly. However, because this risk is quite low, lithium is sometimes continued at the lowest possible dose during pregnancy.

To date, the use of first-generation antipsychotics and tricyclic antidepressants during early pregnancy has posed no cause for concern. There is evidence that most atypical (second-generation) antipsychotics are generally safe in pregnancy, although quetiapine, aripiprazole, olanzapine, and risperidone may carry a modest increase in risk. To date, the use of first-generation antipsychotics and tricyclic antidepressants during early pregnancy has posed no cause for concern. There is evidence that most atypical (second-generation) antipsychotics are generally safe in pregnancy, although quetiapine, aripiprazole, olanzapine, and risperidone may carry a modest increase in risk.

The risk of birth defects also appears to be low for selective serotonin reuptake inhibitors (SSRIs).