While there are hundreds of medications that can be used in thousands of combinations, there are really just three major categories that are specific to bipolar disorder and a few additional drugs that treat symptoms. The three major categories are mood stabilizers, antipsychotics, and antidepressants. While these treat the mania and depression, it is not unusual to also use medications to treat anxiety and insomnia.
No matter which medications are being used, do an online search for additional information on each drug so that you will know what to expect. Learn which symptoms are likely to be side effects and whether they are likely to go away on their own or whether it will be necessary to make a change. Give a fair trial to medications with annoying side effects that usually decrease or go away in time, but be aware that there can be dangerous side effects for people who are sensitive to any of these drugs. Follow the instructions on the prescribing information if there are problems. Don’t hesitate to consult your doctor or pharmacist if you have questions.
While there is a lot of fear and stigma surrounding mood stabilizers, these are most often the backbone of successful treatment. Taking mood stabilizers does not mean that you are crazy–it means that you are making a conscious decision NOT to be crazy.
Lithium is the most common mood stabilizer because it is cheap and also the most likely to work. People who can tolerate lithium seem to have the best chance at successful treatment. I’m not sure if that’s because lithium is such a great drug or if it’s because as one of the $4 drugs at a lot of discount pharmacies, the “I ran out and couldn’t afford the refill” excuse won’t fly. It might even be that lithium has some pretty tough side effects and those who are willing to stick it out are more motivated than others. Whatever the reason, starting with a trial of lithium is usually a good idea. It does take about a month or more to get to a therapeutic level of lithium in the blood, and the side effects at the beginning can be bad (including a tremor that is common to many psych drugs) so it is easy to give up before you know whether the drug is actually working. Try to hold judgment for at least two or three months or until after the blood levels come back in the therapeutic range.
Depakote (or divalproex) is the second major mood stabilizer. My husband uses this in combination with lithium. Depakote can be used either alone or with another mood stabilizer. It is also used for seizures and migraines, so people with either of those conditions might use this for both purposes. My husband has noticed a decrease in headaches since he started taking it.
Lamictal is the third choice for stand-alone mood stabilizer. It seems to be more popular for bipolar 2 (depression with hypomania) but can be prescribed for any form of bipolar. The advertising for this medication says that rather than reducing the range of moods, it increases the time between episodes. This makes sense as a bipolar 2 drug, because the mood swings are already a little less dramatic.
There are other medications that are used as mood stabilizers. Many can be used to treat seizure disorders and some have other primary uses.
There are tons of anti-depressant medications that are commonly used to treat the depressive side of bipolar disorder. Many patients have one or more of these among their regular medications to avoid depressive episodes. At the time I’m writing this, there is some controversy about that use because any of these drugs can cause instability or can trigger a manic episode in some people with bipolar. The trend is to work to eliminate antidepressants between depressive episodes. Studies are being done and by the time you are reading this there may be different theories. Be aware that when antidepressants are started, stopped, or changed in any way there is a very real possibility of things going wrong fast. This is one reason a doctor may decide not to mess with things when a patient is reasonably stable.
The last type of drug is the antipsychotic. These tend to be the heavy-duty drugs that knock some sense into people who have left our reality and taken off into a world of their own. While none of these is universally successful, the right antipsychotic can turn Mr. Hyde into Dr. Jekyll right before your eyes. The older antipsychotics can be very sedating, but there are newer drugs that can control psychosis without that effect. Remember that coming down from a mania, normal affect can seem flat, but this is often just relative and sometimes the human body is simply exhausted from the activity of mania. Give the drugs a chance and consult the doctor before discontinuing.
There are various other medications that might be used but those are used to treat specific symptoms. For example, anti-anxiety medications are frequently prescribed. Learn as much as you can about any drug that the doctor prescribes. Be sure to use the drug companies’ websites, hospital websites, and other reputable sources–there is old and inaccurate information online and in books.
Do not go to see the doctor asking for specific drugs. You do not have a license to prescribe for a reason–the doctor might know about a drug that isn’t as well advertised, but is perfect for your situation. The drug you are considering might not be best for other reasons. The doctor is better informed and can be more objective. Ask questions and make sure the doctor understands all of the symptoms you are seeing and any other health concerns you have, but let the doctor prescribe treatment. That’s why you go to doctors.
There’s more to treating bipolar than taking pills, but finding the right medication and taking it consistently is a good first step.