Medication Management of Bipolar Disorder
The information provided below is not comprehensive, but rather provides a general overview of the most common associated features.
Since the physiology of Bipolar I Disorder is still not fully established (as with most psychiatric disorders), there are many different medications that can be used to treat it.
MOOD STABILIZERS
Examples: Lithium, Depakote, Carbamazepine (Tegretol), Lamotrigine (Lamictal)
Lithium
*This is one of the best drugs to treat Bipolar Disorder and one of the only drugs that has sufficient supporting evidence for it's suicide protective properties.
*This medication requires routine blood work when initiating therapy to ensure levels are not sub-therapeutic or toxic (see below for associated side effects).
Education: Can take with food if there is nausea, keep steady sodium intake in diet, avoid excessive amounts of caffeine, avoid becoming dehydrated, do not take with NSAIDS (Advil, Ibuprofen, Motrin, Naproxen, etc)
Lithium Toxicity
1.5-2.0 (mild) – Nausea, vomiting, diarrhea, lethargy, drowsiness, tremor
2.0-2.5 (moderate) – Severe nausea, vomiting, diarrhea, confusion, ataxia, slurred speech, EKG changes
>2.5 (severe) – seizures, impaired consciousness, syncope, coma, renal insufficiency – can be fatal
The following 3 medications are also anti-seizure medications.
Depakote
*This medication requires routine blood work when initiating therapy to ensure levels are not sub-therapeutic or toxic (see below for associated side effects).
Side Effects: Liver failure (dark urine, tiredness, yellowing of skin/eyes), tremor, sleepiness, weight gain, dizziness, GI upset, and alopecia. This medication can also interfere with other medications.
Toxicity: Confusion, somnolence, dizziness, hallucinations, irritability, headache, ataxia
Carbamazepine (Tegretol)
*This medication has many drug-to-drug interactions. It is known as a strong inducer, which means it will metabolize many other drugs in the system faster and may make them ineffective. This medication also requires lab work.
Side Effects: Should not be used in people with renal problems. Sedation, confusion, blurred vision, aplastic anemia (a sign is increased bleeding), reduction in birth control effectiveness, SIADH, and Steven Johnson’s Syndrome (a significant rash).
Lamotrigine (Lamictal)
*This medication takes a long time (weeks) to titrate to an effective dose, and if days of the medication are missed, the individual will need to re-start at the lowest dose again and work their way back up.
Side Effects: Should not be used in people with renal problems. Steven Johnson’s Syndrome (a significant rash), sedation, tremor, double vision, impaired gait, blood dyscrasias
ANTIPSYCHOTICS
*Many of the second-generation antipsychotics can help manage Bipolar I Disorder, but third-generation anti-psychotics are often a better first-line treatment because of their better side effect profile.
Examples: aripiprazole (Abilify), lurasidone (Latuda), cariprazine (Vraylar), quetiapine (Seroquel), brexpiprazole (Rexulti)
*All antipsychotics basically have the same side effects listed, but each medication produces them to a different degree. This is why is important to discuss medications with a professional that can discern these differences.
Side Effects: Extrapyramidal Symptoms (drug-induced Parkinson’s, akathisia, dystonia), Tardive Dyskinesia, Metabolic Syndrome (diabetes, weight gain, increased cholesterol, weight gain), sedation, orthostasis (dizziness upon standing), anticholinergic (dry mouth), cardiac (QTC prolongation), hematologic complications (decreased white blood cell count), sexual dysfunction.
SLEEP MEDICATIONS:
*Used to induce sleep at the onset of a manic episode or during a manic episode.
ANTIHYPERTENSIVES:
*Used in conjunction with other medications, antihypertensives can help reduce agitation and aggression.
Examples: propranolol, clonidine
Side Effects: can cause decreased blood pressure. Stand up slowly and if you get dizzy sit back down and drink fluids. Consult with your provider if you have Asthma.
*There are many other medications that can help augment medications or relieve signs and symptoms of Bipolar I Disorder.
MOOD STABILIZERS
Examples: Lithium, Depakote, Carbamazepine (Tegretol), Lamotrigine (Lamictal)
Lithium
*This is one of the best drugs to treat Bipolar Disorder and one of the only drugs that has sufficient supporting evidence for it's suicide protective properties.
*This medication requires routine blood work when initiating therapy to ensure levels are not sub-therapeutic or toxic (see below for associated side effects).
Education: Can take with food if there is nausea, keep steady sodium intake in diet, avoid excessive amounts of caffeine, avoid becoming dehydrated, do not take with NSAIDS (Advil, Ibuprofen, Motrin, Naproxen, etc)
Lithium Toxicity
1.5-2.0 (mild) – Nausea, vomiting, diarrhea, lethargy, drowsiness, tremor
2.0-2.5 (moderate) – Severe nausea, vomiting, diarrhea, confusion, ataxia, slurred speech, EKG changes
>2.5 (severe) – seizures, impaired consciousness, syncope, coma, renal insufficiency – can be fatal
The following 3 medications are also anti-seizure medications.
Depakote
*This medication requires routine blood work when initiating therapy to ensure levels are not sub-therapeutic or toxic (see below for associated side effects).
Side Effects: Liver failure (dark urine, tiredness, yellowing of skin/eyes), tremor, sleepiness, weight gain, dizziness, GI upset, and alopecia. This medication can also interfere with other medications.
Toxicity: Confusion, somnolence, dizziness, hallucinations, irritability, headache, ataxia
Carbamazepine (Tegretol)
*This medication has many drug-to-drug interactions. It is known as a strong inducer, which means it will metabolize many other drugs in the system faster and may make them ineffective. This medication also requires lab work.
Side Effects: Should not be used in people with renal problems. Sedation, confusion, blurred vision, aplastic anemia (a sign is increased bleeding), reduction in birth control effectiveness, SIADH, and Steven Johnson’s Syndrome (a significant rash).
Lamotrigine (Lamictal)
*This medication takes a long time (weeks) to titrate to an effective dose, and if days of the medication are missed, the individual will need to re-start at the lowest dose again and work their way back up.
Side Effects: Should not be used in people with renal problems. Steven Johnson’s Syndrome (a significant rash), sedation, tremor, double vision, impaired gait, blood dyscrasias
ANTIPSYCHOTICS
*Many of the second-generation antipsychotics can help manage Bipolar I Disorder, but third-generation anti-psychotics are often a better first-line treatment because of their better side effect profile.
Examples: aripiprazole (Abilify), lurasidone (Latuda), cariprazine (Vraylar), quetiapine (Seroquel), brexpiprazole (Rexulti)
*All antipsychotics basically have the same side effects listed, but each medication produces them to a different degree. This is why is important to discuss medications with a professional that can discern these differences.
Side Effects: Extrapyramidal Symptoms (drug-induced Parkinson’s, akathisia, dystonia), Tardive Dyskinesia, Metabolic Syndrome (diabetes, weight gain, increased cholesterol, weight gain), sedation, orthostasis (dizziness upon standing), anticholinergic (dry mouth), cardiac (QTC prolongation), hematologic complications (decreased white blood cell count), sexual dysfunction.
SLEEP MEDICATIONS:
*Used to induce sleep at the onset of a manic episode or during a manic episode.
ANTIHYPERTENSIVES:
*Used in conjunction with other medications, antihypertensives can help reduce agitation and aggression.
Examples: propranolol, clonidine
Side Effects: can cause decreased blood pressure. Stand up slowly and if you get dizzy sit back down and drink fluids. Consult with your provider if you have Asthma.
*There are many other medications that can help augment medications or relieve signs and symptoms of Bipolar I Disorder.
If you would like to be evaluated for Bipolar Disorder or seek pharmacological treatment.