Psychoactive medications have received a great deal of attention in the media. Drugs like Prozac, Ritalin, or Zoloft have become household words, and many people diagnosed with depression, bipolar disorder, or no diagnosis at all can list the potential side effects of these medications. We live in a very different world than our parents or grandparents and doctors and pharmacists are no longer the keepers of all the information regarding medications as they once were.
Medications used to treat bipolar disorder fall into several main categories. Mood stabilizers, anticonvulsants, antipsychotics and antidepressants are all commonly used. Don’t panic: you don’t have to have a seizure disorder to be psychotic to benefit from medications originally intended for those ailments. Sometimes off-label use (that is, prescribing a medication for a disease or syndrome other than what the medication was developed and intended to be used for) is a great way to gain benefits with fewer side effects.
The oldest and most “tried and true” medication used to treat bipolar disorder is Lithium. This medication is sold under the brand name Eskalith or Lithobid. This medication helps people with Bipolar I (but may be less helpful in the treatment of Bipolar II) as it reduces the frequency, severity, and intensity of mania. Lithium may also relieve depression, and has been shown to have a real positive impact on suicidal thinking. Lithium is often used initially to help end a manic episode, and then continued as a maintenance medication to help prevent future manic episodes. Lithium may have serious side effects on kidney and thyroid functioning, and works best when the level of lithium in the body is kept constant. For these reasons, people who take Lithium must have regular blood tests to check their kidney and thyroid functioning and regular blood tests to determine if the level of lithium is a therapeutic (i.e. effective) one. This can help your doctor adjust your dosage, both up and down, to make sure that your medicine is working for you while you are taking the lowest effective dose you can.
Besides the potential for impact upon kidney and thyroid functioning, Lithium does seem to produce a number of uncomfortable side effects in many people. These include increased thirst, and increased urination, which means that you’ll need to drink more than you might be accustomed to in order to avoid dehydration. Hand tremors or shaking is also common, as is diarrhea, vomiting and sedation or drowsiness. Impairments to memory and concentration are also common.
Anticonvulsants are also very commonly used to treat bipolar disorder. These medications are known by the following brand names: Depakote, Depakene, Lamictal, Topamax, Trileptal, Gabitril, and Tegretol. While Lamictal and Depakote seem to be the mood stabilizers of choice for people struggling with depression and mania, the others listed above seem to be preferred to managing manic symptoms. As with Lithium, these medications do cause multiple side effects, however in general they seem to be well tolerated and effective in helping people with bipolar disorder lead more stable and functional lives.
The most common side effects associated with anticonvulsants medications include hand tremors or shakiness, fatigue, drowsiness, or sedation, weight gain, nausea and rashes. Sometimes additional medications are prescribed to help offset the worst of these side effects. Also, sometimes Lithium is prescribed in tandem with an anticonvulsant to get the best control of both manic and depressed symptoms. Your doctor will send you for blood tests when taking these medications, just like we discussed regarding Lithium: gaining an accurate sense of the level of medication in your body can help your doctor adjust your dosage most accurately.
More recently atypical antipsychotics have been prescribed for relieving the symptoms of bipolar disorder. Some of the names of drugs in this category you may hear include Risperdal, Zyprexa, Abilify, Seroquel, Geodon, and Closaril. These drugs were used initially because in some cases, bipolar symptoms include disordered thought and hallucinations or delusions, or other psychotic processes. Using an antipsychotic gave relief from the thought disorder symptoms, but some doctors and their patients found that maintaining a low dose of an antipsychotic medication also helped with the overall stabilization of mood and behavior. However, these medications also seem to cause side effects in some people: blurry vision, dry mouth, drowsiness, twitches or tics, including muscle spasms or facial tics, and weight gain. Certain antipsychotics, in addition, seem to be associated with an increased risk of diabetes, rapid weight gain, and increasing your cholesterol. Before using these medications, your doctor should carefully screen for heart disease, stroke and diabetes, to be as safe as possible.
Despite how scary all this sounds, good control of bipolar disorder is not impossible, and maintaining a happy, healthy and fulfilling life with this disease is possible. Work closely with your doctor, ask questions and let him or her know your concerns up front. Working together with your team (doctor, therapist, family and friends), you can expect to live well!