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| Bipolar Disorder |
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Treatment
of Bipolar Disorder
Treatment of bipolar disorder aims to control the
current episode of mania or depression, and then
reduce future mood swings.
Treatment of Manic episode
A manic episode must be quickly controlled, especially
if it includes psychotic symptoms, bizarre behaviour
and the risk of harm to the person or to others.
Antipsychotic drugs will bring the person 'down'
fast. Brand names of these drugs include Zyprexa,
Risperdal, Largactil and Serenace, but a number
of others might be used. Some antipsychotics can
have uncomfortable side-effects or undesirable long-term
adverse events, so they are usually used only during
the acute phase while slower-acting mood-stabilising
drugs are taking effect. Mood stabilisers such as
lithium, Epilim and Tegretol are also useful for
treating acute mania.
Controlling mood swings
Mood swings in bipolar disorder are controlled by
mood-stabilising drugs. The most widely used mood
stabiliser is lithium (brand names: Lithicarb,
Quilonum SR). An Australian psychiatrist, John Cade,
discovered the benefit of lithium as a treatment
for manic depression but no-one knows exactly how
it works. Lithium acts slowly, taking at least a
week to take effect; so faster-acting antipsychotic
drugs are also used initially to treat acute manic
episodes.
To prevent further episodes, it is necessary to
sustain a steady level of lithium in the blood.
This level is checked by weekly blood tests until
it has stabilised, after which it is checked every
3 months or so. Lithium is very effective in preventing
mood swings and people on the drug have half as
many relapses as those who aren't. Twenty per cent
of people on lithium have no relapses at all.
Lithium can have side-effects including nausea,
diarrhoea, memory problems, frequent urination,
thirst, weight gain and tremor. If they occur, lowering
the dose can reduce side effects. High doses can
cause serious side-effects such as slurred speech,
muscle twitching, unsteadiness, lethargy and vomiting.
This is called lithium toxicity, and if these symptoms
occur, the person should see a doctor immediately.
Lithium toxicity can have damaging effects on the
kidney so it is very important to monitor blood
levels and kidney function during lithium therapy.
Long-term use of lithium can affect the thyroid
gland, causing it to enlarge to form a goiter and
to under-function. This can be corrected using thyroid
hormone tablets.
Fluctuations in the body's salt levels may interfere
with the blood level of lithium, so it is important
to check with a doctor if considering a low-salt
diet, if it is very hot and the person is sweating
a lot, or if the person has a high temperature.
Some medications, including anti-arthritis drugs
and diuretics (fluid tablets) can unexpectedly raise
lithium levels and even cause lithium toxicity.
Always check with the doctor or pharmacist before
taking any medication while taking lithium. Lithium
can cause problems in pregnancy, so discuss family
planning with a doctor before becoming pregnant.
Anticonvulsants such as carbamazepine (Tegretol,
Teril) and sodium valproate (Epilim) have mood stabilising
effects like lithium and may be used for acute mania
or long-term treatment of bipolar disorder. Side-effects
of anticonvulsants include drowsiness, nausea, dizziness,
allergic rash and lack of energy. Anticonvulsants
can be associated with liver or blood problems,
so these need to be monitored during treatment.
Some interfere with the effectiveness of the oral
contraceptive pill, so discuss this with a doctor.
Blood levels of anticonvulsants should be checked
every few months once they stabilise. In general,
pregnant women should not take these medications.
Antidepressants are used to treat the depressive
phase of bipolar disorder, just as they are used
for treating other types of depression. However,
in bipolar disorder, antidepressants can sometimes
cause a sudden switch from depression into mania.
When antidepressants are used in bipolar depression
they are usually combined with a mood stabiliser,
but careful supervision is needed. One anticonvulsant,
lamotrigine (Lamictal) has been found to be useful
in treating bipolar depression, and for some people
it can be used in place of an antidepressant.
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