Medications for Bipolar Disorder

Mood stabilizers, such as lithium carbonate, sodium divalproex, or carbamazepine, are the mainstays of treatment of patients with bipolar disorder. Additionally, an antipsychotic agent, such as Seroquel, Abilify, Risperdal or haloperidol, may be used if psychotic features or aggressive agitation is present. Lastly, benzodiazepines may be used to improve sleep and to modulate agitation.

Lithium carbonate is effective in approximately 60-70% of adults, adolescents and children with bipolar disorder and remains the first line of therapy in many settings. Lithium will usually bring most people out of a manic episode. For those people who cannot tolerate lithium carbonate or its side effects, though, there are other treatment options for mania. Depakote is the most commonly prescribed treatment alternative to lithium, and should be considered. Anti-psychotic medication is also often prescribed.

As mentioned in the previous section, medication compliance is an important issue. People with bipolar disorder can be maintained indefinitely on lithium with relatively few harmful side effects and generally lead a productive, active life. Regular contact with the mental health professional is usually an important aspect to the equation. This allows the patient to "touch base" with them, check lithium serum levels, and ensure proper medical compliance with treatment recommendations (if not with the client, then with a family member or spouse). Decreased lithium levels often lead to a relapse of the individual to a manic or depressive episode. The prescribing physician should be familiar with possible side effects of lithium treatment, as well as the long-term effects of lithium treatment (which can include renal and thyroid problems). Ongoing evaluation should be conducted on these potential physiological side effects as necessary. (read: Mood Stabilizers - How to Minimize Serious Side Effects

More on the types of medications for bipolar disorder
An in-depth look at bipolar medications (including bipolar medications for children, during pregnancy and for rapid-cyling)

Electroconvulsive Therapy (ECT) for Treatment of Mania and Depression

Although electroconvulsive therapy (ECT) is well documented as an effective and safe treatment option in patients with depressive or psychotic states, most clinicians do not consider this a first-line intervention. ECT often is initially administered on an inpatient basis because it most frequently is used in severe or refractory cases, and these patients are likely to require hospitalization more often. Still, ECT may be initiated at any point in treatment because each ECT treatment can be performed in a day treatment setting, usually requiring at least a 4-hour visit for the pre-ECT preparations, delivery of the ECT therapy, and monitoring afterward during the recovery time from both the ECT session and anesthesia. All ECT treatments require the presence of an anesthesiologist or anesthetist throughout the administration of therapy.

ECT has been demonstrated to be both safe and therapeutic in adolescents and children. One favorable aspect of ECT is its more rapid onset of therapeutic response versus medications, specifically in days rather than weeks. One drawback to ECT is the associated memory loss surrounding the time just before and after treatments. An ECT treatment episode may involve 3-8 or more sessions, usually at a rate of 1 session every other day or 3 sessions per week. Despite the rapid effect of ECT on mood and psychotic symptoms, medications are still required in the maintenance phase of treatment.

Self-Help for Bipolar Disorder

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Support groups, though, offer an excellent adjunct to continuing medication check-ups once a month, and a way to gain emotional and social support through the community. These groups also allow others to ensure the client is doing well and promotes the client's independence and stability. Many support groups exist within communities throughout the world which are devoted to helping individuals with this disorder share their commons experiences and feelings.

Such support groups are recommended to individuals suffering from this disorder, especially if they have found therapy unhelpful or too expensive.

Guidelines from Professional Medical Organizations Detailing the Treatment of Bipolar Disorder

1. Expert Consensus Guidelines: Medication Treatment of Bipolar Disorder
2. Treatment Guidelines for Bipolar I Depression
3. Practice Guideline for the Treatment of Patients with Bipolar Disorder (Second Edition)

next: An In-Depth Look at Bipolar Medications