Bipolar disorder, also known as manic depressive illness, is a disorder of the brain which leads to unusual shifts in the patient’s mood, energy and affects the ability to lead a normal life. Different from the highs and lows of everyday life, the symptoms and effects of bipolar disorder are severe. Unless treated, it results in damaged relationships, poor performance at work or in school and even suicide. Bipolar disorder can be treated and people who suffer from it can eventually have a fully productive life.
The primary method of treatment for bipolar disorder is pharmacological through medication. The prescriptions for treatment are usually specific to mania or depression. It is a good idea to review some of the most popular classes and specific examples of drugs used in the management and treatment of bipolar disorder.
Lithium
Approved by the FDA in 1970, but discovered in the early 1800s, lithium is the first and most often prescribed mood stabilizer. For many years, scientists could not understand how lithium helped bipolar disorder. However, in 1988 researchers discovered that it affects the nerve cells in the brain and the receptors for the neurotransmitter, glutamate.
Lithium exerts a dual effect on the receptors for the neurotransmitter, thus keeping the glutamate levels at a stable level. From this they realized that too much glutamate causes mania and too little, depression.
However, side-effects associated with lithium treatment, although pervasive due to the fact that lithium is distributed throughout the body, are usually minor and of limited duration. Side effects of lithium treatment include:
Upset stomach
Increased thirst
Hair loss
Water retention
Acne
Weight gain
Tremor
Increased urination
Anticonvulsants
Initially used for patients who were resistant to lithium treatments, anticonvulsants are now an alternative for mono-therapy and as an add-on to other medications. The primary anticonvulsants used in the treatment of bipolar disorder include:
Calcium Channel Blockers: only used to a very minor degree in the management of symptoms of mania associated with bipolar disorder as their effectiveness is rather limited. These medicines include Nimodipine and Verapamil.
Anti-psychotics: Acute episodes of mania present psychosis in as many as two thirds of those suffering from bipolar disorder, thus this class of drugs is used to a great extent. Their main usage is to decrease the symptoms associated with mania until mood stabilizers take full effect. In some cases, anti-psychotics may be used for the long term maintenance of stability. The most common drugs of this class include:
Zyprexa – the first anti-psychotic to be approved by the FDA for the treatment of symptoms associated with bipolar disorder. Research has shown it to be as effective as Lithium but it seems to help with mixed episodes. Weight gain is a problem associated with its usage.
Clozaril/Clozapine – renowned for the speed with which it works to reduce symptoms associated with bipolar disorder. It works in treating severe cases of the disorder, however there is some concern that it may result in a lower white blood cell count.
Seroquel/Quetiapine – the use of these drugs is fairly recent in the treatment of bipolar disorder, initial studies indicate its effectiveness in addressing acute mania and its associated symptoms.
Benzodiazepines: This class of drugs primarily includes central nervous system depressants. Their primary usage is to produce sedation, induce sleep, relieve anxiety, reduce muscle spasms, and prevent seizures. In cases of bipolar disorder, they are used to gain rapid control over symptoms of mania so mood stabilizers have time to take effect. The most common drugs in this class are Xanax, Valium and Ativan.
Studies on Treatments
It is believed that many of these alternative medications, particularly clozapine, can go a long way in treating bipolar disorder. Lithium, as the longest known and most widely used bipolar medication, is still the best and most prescribed treatment. Lithium provides stability which enables the patients to make it through the symptoms and cycles and lithium can be used as an additive for other treatments.
