Learn about mood stabilizers and antipsychotic medications, therapy and ECT for treatment of bipolar disorder.

For an individual with bipolar disorder, lifelong treatment is necessary. Regular monitoring and consultation with a health care professional is necessary to establish which medication or combination of medications works best.

Mood Stabilizers for Controlling Mania and Depression

For more than 30 years, lithium has been the treatment of choice for people with bipolar disorder. But with the advent of newer drugs to treat the disorder over the past decade, the American Psychiatric Association (APA) issued revised treatment guidelines for the illness in April 2002.

Lithium evens out moods so that patients don't feel as high or as low, but it's unclear to medical experts precisely how the medication works in the brain. Lithium is not used just for manic attacks, but rather as an ongoing treatment to prevent all types of episodes. It can take up to 14 days to start diminishing severe manic symptoms. It might take a few months of medication before the illness is under control.

When taken regularly, lithium can effectively control depression and mania and reduce the chances of recurrence. However, while it is effective treatment for many people, it doesn't work for everybody.

Regular blood tests are a must for people taking lithium. Too small a dose might not be effective and too large of one might produce unwanted side effects, including weight gain, tremors, excessive thirst and urination, drowsiness, weakness, nausea, vomiting and fatigue.

Sodium intake also affects the amount of lithium in your body. A dramatic reduction in salt intake, excessive exercise and sweating, fever, vomiting or diarrhea may cause a lithium buildup and lead to toxicity. An overdose of lithium can cause confusion, delirium, seizures, coma and may result, although rarely, in death.

In addition to lithium, valproate (Depakote or Divalproex Sodium) is another first-line treatment for bipolar disorder. The anticonvulsants carbamazepine (Tegretol) and oxcarbazepine (Trileptal) also work as mood stabilizers. Be advised, however, that evidence suggests that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20. The data about this possible adverse effect of valproate are controversial. The problem was first noted in young women who took the medication for the treatment of epilepsy. Experts debate whether valproate causes reproductive problems in women with epilepsy and, if so, whether women with bipolar disorder who take the medication are also at risk. In any case, young female patients taking valproate should be monitored carefully by their health care provider for possible hormonal problems and for polycystic ovary syndrome. Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect.

Another anticonvulsant, lamotrigine (Lamictal), has also been shown to be effective in the treatment of bipolar disorder, especially the depressive phase. Thus, for the depressive phase of the illness, American Psychiatric Association treatment guidelines recommend either lithium or lamotrigine. Antidepressant monotherapy is not recommended. As an alternative, especially for more severely ill patients, combination treatment with lithium and an antidepressant is recommended.

Several classes of antidepressant medications are available. These classes include tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Side effects and effectiveness for each class of medication, as well as for the individual brand within it, vary.

It's important to note that antidepressants can trigger mania and possibly precipitate rapid cycling. This is especially true of TCAs and MAOIs. In some cases, individuals receive treatment with antidepressants for what appears to be depression, but then become manic. Health care professionals should ask about prior symptoms of hypomania (episodes that include increased energy, euphoria, and irritability) before prescribing antidepressants. During a treatment evaluation, information about prior experiences with bipolar and other mental illnesses should be shared with a health care professional.

Antipsychotics for Treating Mania

If a patient is experiencing psychotic or manic symptoms during an episode of bipolar disorder, sometimes physicians will also prescribe antipsychotic medicine, alone or in combination with lithium to control symptoms. Likewise, physicians might also prescribe antidepressants in addition to the lithium to counter the depressive phase.

For example, Zyprexa (olanzapine) is an antipsychotic medicine approved by the U.S. Food and Drug Administration (FDA) that may be prescribed for the treatment of schizophrenia and for treatment of acute mania associated with bipolar I disorder. In July 2003, the FDA approved its use in combination with lithium or valproate (Depakote or Divalproex), an anticonvulsant medication, for the treatment of acute bipolar mania. Studies have shown that bipolar patients in manic or mixed episodes treated with Zyprexa in combination therapy demonstrated improved manic and depressive symptoms, when compared to patients treated only with lithium or valproate alone.

Other helpful new drugs include the anti-psychotics aripiprazole (Abilify), quetiapine fumarate (Seroquel), ziprasidone (Geodon) and risperidone (Risperdal). It may take up to three weeks of regular use of any medication before symptoms improve or subside. However, if no changes are apparent within six weeks, a new medication is probably necessary and options should be discussed with a health care professional. (read more: How to Treat an Acute Manic Episode)