Bipolar

Disorder
1

Bipolar Disorder and The Medications Used for Treatment

Aimee Miller

14 February 2018

CS102

Mrs. Asbury
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Bipolar Disorder and The Medications Used for Treatment.

Bipolar disorder is a mental illness that consists of alternating periods of mania, and

depression, formerly called manic depression. This disorder used to be only defined by long

periods of mania followed by long periods of major depression. Now that more studies have been

conducted, this disorder is becoming better understood. Scientists and physicians have now

determined that bipolar disorder is not the “cut and dry” diagnosis as it once was. There is a

bipolar spectrum with varying types of the disorder, though it may be easy to assume that one

disorder is lesser than the other, this is not the case. The disorders on this spectrum are all

equally debilitating and life-altering.

In the bipolar spectrum there are at least four types of bipolar disorder, the first is bipolar

I disorder. Bipolar I disorder is the classic diagnosis with symptoms of extreme mania lasting at

least several days usually followed by major depressive episodes that sometimes last a couple of

weeks. Persons with bipolar I disorder sometimes have episodes so extreme that they suffer a

break from reality, this is called psychosis. When someone with bipolar I disorder suffers from

psychosis they tend to lose touch with reality and often hallucinate which can sometimes lead to

misdiagnosis of schizophrenia. Bipolar II disorder is like bipolar I disorder but rather than having

mania they suffer from periods of hypomania followed by longer episodes of major depression.

Hypomania is a less severe form of mania and while it often presents as its own episode, it can

sometimes present during episodes of major depression, this is called an episode with mixed

features. Cyclothymic disorder is also on the spectrum, people with cyclothymic disorder

experience episodes of hypomania along with episodes of mild depression. To be diagnosed with

cyclothymic disorder, you must have been having symptoms for at least two years. Other types
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of disorders on the spectrum are disorders often induced by alcohol, drugs, or other diseases,

sometimes even strokes can cause disorders on the spectrum.

Bipolar disorder has many treatments: medications, psychotherapy, electroconvulsive

therapy (ECT), and even transcranial magnetic stimulation (TMS). The different types of

medications that can be used to treat bipolar disorder are: mood stabilizers, antipsychotics,

antidepressants, antidepressant-antipsychotics, and anti-anxiety medications. A person’s

symptoms and diagnosis determine the types and dosages taken and a lot of medication treatment

is trial and error. Often a physician will try several different types of medications before a proper

treatment plan can be put into place, this can sometimes take months or even years since a lot of

medications have a titration period.

Mood Stabilizers are often used to control mania and hypomania and the extreme mood

swings and irritability that they cause. Commonly used mood stabilizers are lithium (Lithobid),

valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol), and

lamotrigine (Lamictal). Lithium was the first mood stabilizer to be discovered in 1817 but it was

not until 1871 (in Denmark) that it treated mania. The first publication on Lithium and its effects

on mania was not published until the 1940s and until the 1970s and 1980s it was the only

treatment available. Lithium is a chemical element that occurs in nature that is combined with

oxygen and carbon. There are many precautions that need to be taken to take lithium safely:

sodium levels need to be monitored closely, dosages are imperative since lithium affects the liver

and kidneys, and some over-the-counter anti-inflammatory medications can react badly with it.

Anticonvulsants such as lamotrigine (Lamictal) and divalproex sodium (Depakote) were

originally created to treat epilepsy but over time scientists discovered that they influence mood

disorders such as mania. Lamotrigine has been studied for many years as an anti-seizure
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medication (since the 1990s) and has been found to have very few side effects. There is one

potentially dangerous side effect that has been documented however called Stevens-Johnson

syndrome which is a potentially life-threatening rash. Because of the risk of Stevens-Johnson

syndrome lamotrigine needs to be used on a titration schedule and doses cannot be missed. Most

mood stabilizers need to be titrated due to potentially harmful side effects. During a titration

period the patient’s physician needs to monitor them very closely, often with blood tests, to

watch for early signs of side effects.

Antipsychotics are another medication often used in the treatment of bipolar disorder. A

few examples of antipsychotics are: olanzapine (Zyprexa), quetiapine (Seroquel), risperidone

(Risperdal), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), or asenapine

(Saphris). These are often used alongside another treatment medication, such as a mood

stabilizer, to treat persistent mania or depression that is not entirely controlled. Originally created

to treat schizophrenia, antipsychotics have been treating bipolar disorder since their release in the

1950’s.

Antidepressants are used to treat breakthrough depressive symptoms in bipolar patients.

These medications are almost always accompanied to a mood stabilizer since they can trigger

manic episodes. There are antidepressant-antipsychotic medication treatments available as well

that reduce the amount of pills a patient will take. An example of an antidepressant-antipsychotic

is Symbyax: created in 2009 to treat depression that does not respond to other treatments.

Another medication that is used in the treatment of bipolar disorder are anti-anxiety medications.

These are used for short-term therapy for symptoms of anxiety that are common in patients that

suffer from manic episodes.

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These medications are mostly deemed safe to take if monitored carefully by a medical

professional. Without a proper diagnosis these medications can be dangerous so communication

and proper testing is key. There are some treatments without medications that have been proven

to be helpful such as psychotherapy though this is often combined with medication. Bipolar

disorder, though it is a lifelong mental illness, can be managed and most people with this

diagnosis can live long productive lives.

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References

https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/

https://www.ncbi.nlm.nih.gov/pmc/articles/

http://psycheducation.org/treatment/mood-stabilizers/

https://www.psycom.net/depression.central.cyclothymia.html

https://www.mirecc.va.gov/visn22/Facts_about_Mood_Stabilizers_Veteran_and_Family_Hand
out.pdf

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/

https://ps.psychiatryonline.org/doi/pdf/

https://www.ncbi.nlm.nih.gov/pubmed/

http://copnt13.cop.ufl.edu/doty/pep/pharmanote/

https://www.verywell.com/anxiety-medications

https://www.verywellmind.com/lithium-the-first-mood-stabilizer