Mood Disorder Bipolar Medications: Lithium, Anticonvulsants and Atypical Antipsychotics

Although there are many subcategories of bipolar disorder, all sufferers typically struggle both with the destructive “highs” of manic states and the emotionally paralyzing lows of depression.

Manic episodes may be extreme and include psychotic behavior or may manifest with less severe symptoms of fast or “pressured” speech, racing thoughts and self-destructive, risky behaviors such as overspending and sexual promiscuity. When the pendulum swings the other way, episodes of bipolar depression can rob sufferers of their enjoyment of life and present the danger of suicidal behavior (APA 2000).

Drug Therapies Used in the Treatment of Bipolar Disorder

Although the mood stabilizing properties of the element Lithium had been noted since the 1800s, it was not until the late 1940s the first paper was published on the use of Lithium to treat what was then known as manic depression. Being an element, Lithium could not be patented, and was paid little attention to by the pharmaceutical industry. In 1970, Lithium was finally approved by the FDA for the treatment of bipolar disorder.

Lithium, although an effective treatment for many bipolar patients, is an extremely toxic element and the level that results in toxicity for many patients was very close to, even sometimes overlapping the therapeutic level. A patient’s dosage and physiologic response had to be closely monitored on a continual basis (Callaway 2007).

In the 1980s and 1990s anti-convulsants such as Depakote, Topamax, Tegretol and others were found to also be effective in stabilizing the mood of bipolar patients, reducing the extremes of emotional highs and lows of this patient population.

Although effective for many, these drugs also had drawbacks of potential toxicity (not nearly as severe as Lithium toxicity) and patients who take anti-convulsants require specific blood levels of the drugs and regular monitoring of physiologic functioning (McElroy & Keck 1995).

Newer atypical drugs including risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripriprazole (Abilify) and olanzapine (Zyprexa) are often used as mood stabilizers and have been found to be particularly helpful for acutely manic patients.

Mood Stabilizers and Antidepressants

Symbyax, a combination of olanzapine and fluoxetine, is an example of where some of the controversy arises in the treatment of bipolar disorder. Psychiatrists are cautious about prescribing antidepressants with mood stabilizing drugs for bipolar disorder. This caution stems from a concern over potentially elevating a bipolar patient’s mood to the point of spawning a manic episode.

There is also controversy over whether antidepressants really provide any additional benefit when combined with mood stabilizers. This topic is further explored in the Suite101 article, Antidepressants & Bipolar Disorder, which summarizes the results of a new study on the efficacy of this combined drug regimen. The original research appeared in the April issue of the New England Journal of Medicine (Sachs 2007).

Additional Information

This article is not meant to be used to treat bipolar or any other mental disorder. If you are suffering psychologically please see a mental health professional.

Sources

American Psychiatric Association (200) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

Callaway, Enoch (2007) Asylum: A mid-Century Madhouse and Its Lessons About our Mentally Ill Today. Greenwood Publishers.

McElroy S. & Keck Jr, P. (1995) Antiepileptic Drugs, in Schatzberg A, Nemeroff CB (ed) Textbook of Psychopharmacology, American Psychiatric Press.

National Alliance on Mental Illness (NAMI) Fact Sheet on Depakote (Valproic Acid).

Sachs, G. Nierenberg, A., Calabrese, J., Marangell, L. et al. (2007). Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression. The New England Journal of Medicine.

General information also obtained from the package inserts for each drug mentioned in this article.

Jul 16, 2008 8:36 AM

Sarah Pigott :

I had a boss for about 8 years who had suffered from bipolar disorder very badly and was still on Lithium. We set up a solicitor's practice with him, myself and my husband. He was the only person qualified to run a practice, though my husband is now fully qualified. We really ran the practice from day one and I lived in fear of the law society or the legal aid board finding out that the boss was not fulfilling his supervisory role properly. He turned against me at an early stage and after some initial unpleasant episodes where he seemed to be undermining me to keep me in a subservient admin position he rarely talked to me. He seemed to be having crisis after crisis and was constantly telling other people about all his problems, mainly concerning seemingly non-existant relationships with women, and talking about his illness. He never shared any of this with either me or my husband and I began to lose my confidence in myself, because he criticised me in front of people and refused to confide in me. He was also obstructive about billing cases and made out I was a nagging bore when all I wanted to do was make money so that we could be paid a decent amount for all the commitment we were putting in.
This has all been a bit of a nightmare, but I would like to turn it into something positive by writing about it. I did at one time think he had undiagnosed Narcissistic Personality Disorder, but I think NPD and Bipolar are one and the same thing depending on how you look at it. This is certainly an issue worth exploring. Also how much does Lithium affect the short term memory and the hormones and lead to bizarre behaviour ?