A number of medications are used to treat bipolar disorder. The types and doses of medications prescribed are based on a patient’s particular symptoms. Lithium has been used as a mood stabilizer to treat bipolar disorder since 1970. It evens out the highs and lows of the disorder and, sometimes, is prescribed for unipolar depression when other drugs don’t work.
Other medications may include:
- Mood stabilizers. You’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. In addition to lithium, other examples of mood stabilizers include valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
- Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
- Antidepressants. A doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
- Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
- Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.
Most people with bipolar I or bipolar II will need mood stabilizers to control their manic or hypomanic episodes.
For these episodes, doctors may prescribe one of the following mood stabilizers:
- Tegretol (carbamazepine)
- Depakote (divalproex sodium)
- Lamictal (lamotrigine)
- Lithobid (lithium)
- Depakene (valproic acid)
Antipsychotic drugs may be used to control episodes of depression or mania, especially when delusions or hallucinations are occurring.
Examples of drugs in this class include:
- Abilify (aripiprazole)
- Saphris (asenapine)
- Symbyax (olanzapine and fluoxetine)
- Latuda (lurasidone)
- Zyprexa (olanzapine)
- Seroquel (quetiapine)
- Risperdal (risperidone)
- Geodon (ziprasidone)
There’s a certain amount of trial and error associated with finding the right medical treatment for bipolar disorder.
Medical Side Effects
The use of lithium long-term can affect the thyroid, leading to low levels of thyroid hormone production. This can be treated with thyroid supplements.
One of the challenges associated with medication for bipolar disorder is the potential for a wide variety of side effects — some of which may be serious.
In addition to their potential for side effects, many of the drugs used to treat bipolar disorder can interact with birth control pills or may have health implications for women who are pregnant or might become pregnant.
Dr. Andrew Weil is the world’s leading proponent of integrative medicine, a philosophy that is considerably different from a blanket endorsement of alternative medicine.
As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine “combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.”
In other words, integrative medicine “cherry picks” the very best, scientifically validated therapies from both conventional and CAM systems. In his New York Times review of Dr. Weil’s latest book, “Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being,” Abraham Verghese, M.D., summed up this orientation well, stating that Dr. Weil, “doesn’t seem wedded to a particular dogma, Western or Eastern, only to the get-the-patient-better philosophy.”
Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.
Dr. Andrew Weil is a best-selling author who has spent the last 30 years researching and developing, practicing and teaching others about his unique and healing-oriented approach to healthcare, which encompasses the body, mind and spirit. While he often advocates for minimized use of medications, he still agrees that certain serious mental health illnesses will require some use of medication:
“Never discontinue taking lithium, even when you feel good (that’s what the drug is supposed to do for you). But you may be able to lower your dose and thus reduce the risk of side effects by increasing your consumption of omega-3 fatty acids (fish oil). Research published in 1999 in the Archives of General Psychiatry suggested that high doses of omega-3s can help stabilize the moods of people with bipolar disorder (although it didn’t directly address the question of whether patients might reduce their medication). More studies aimed at confirming those findings are underway and may tell us more about the benefits of fish oil among bipolar patients.”
The principles of integrative medicine:
- A partnership between patient and practitioner in the healing process
- Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response
- Consideration of all factors that influence health, wellness and disease, including mind, spirit and community as well as body
- A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically
- Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms
- Use of natural, effective, less-invasive interventions whenever possible
- Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease
- Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development.
Controversy Over the Use of Antidepressants
At the moment there is no clear yes-or-no answer regarding whether antidepressants actually work in bipolar depression. The assumption for years has been that they do indeed work, just as they often do in unipolar depression. However, the evidence for their effectiveness in bipolar depression is actually surprisingly limited. On the other hand, most clinicians are quite convinced that antidepressants can treat bipolar depression. They have often seen rapid and obvious response to these medications in patients whom they believe to have bipolar disorder.
In 2013 the International Society for Bipolar Disorders (ISBD) issued a very clear set of recommendations regarding the use of antidepressants to address bipolar disorder. In short, the study concluded that antidepressants should not be used except in patients who have: 1) done well on them before; 2) get worse when they’re stopped; and 3) have Bipolar II (noting that even this is controversial). Other researchers argue that antidepressants should never be used without the addition of mood stabilizers.
On the other hand, one research group has produced several studies showing sustained benefit from antidepressants in patients with bipolar II, even without a mood stabilizer on board. Their 2008 study is probably the most dramatic yet.In patients with Bipolar II, they compared venlafaxine (Effexor) versus Lithium as the sole treatment. Patients on venlafaxine clearly improved more than those on lithium.
There is also no strong literature supporting the efficacy of older antidepressants; moreover, much of the literature suggesting that antidepressants induce mania arose primarily with tricyclic antidepressants (TCAs). However, whether TCAs and monoamine oxidase inhibitors (MAOIs) truly precipitate mania remains unclear; some studies, such as the NIMH Collaborative Depression Study, found that depression in and of itself increases the risk for mania in BD, which virtually completely confounds antidepressant effects.