People with bipolar disorder usually need to take a combination of several different types of medicines.
Conventional (typical) antipsychotics such as haloperidol, cloropromazine and perphenazine are often used to treat acute mania. However, concerns have been raised about the long-term safety of these medicines.
The newer ‘atypical’ antipsychotics such as clozapine, quetiapine, olanzapine and risperidone are effective in the treatment of mania and depression and have fewer side-effects than typical antipsychotics. Atypical antipsychotics may be prescribed in combination with lithium, valproate or carbamezapine for the treatment of acute mania or may be given on their own if patients do not respond to, or cannot tolerate lithium, valproate or carbamezapine.
The side-effects of atypical antipsychotics vary between the different medicines and your doctor will choose the one that is most suitable for you.
Mood Stabilizers: Lithium, valproate and carbamezapine
Lithium, valproate and carbamezapine are used to improve symptoms during acute manic or depressive, hypomanic and mixed episodes or prevent them from occurring.
Lithium has for many years been considered the “gold standard” for the treatment of bipolar disorder. Lithium effectively treats both manic and depressive episodes. It typically takes 1-2 weeks for lithium to work. Common side-effects of lithium include blurred vision, dry mouth, fine hand tremor, frequent urination, nausea and vomiting.
Valproate is more effective than lithium in treating rapid-cycling bipolar disorder. Common side-effects include dizziness, drowsiness, tremor and nausea.
Carbamezapine effectively controls mania and depression in bipolar disorder. Common side effects include dizziness, drowsiness, nausea, vomiting and rash.
Lithium, valproate and carbamezapine all require regular blood tests to monitor safety.
Antidepressants are normally given in combination with lithium, valproate or carbamezapine or during a depressive episode associated with bipolar I disorder. Amfebutamone (bupropion), selective serotonin reuptake inhibitors, monoamine oxidase inhibitors and tricyclic antidepressants are all commonly used. It typically takes several weeks before the patient experiences any benefit from antidepressants. Once the symptoms of the depressive episode have stopped and the patient has been stable for a period of time, the dose should be tapered down over several weeks and finally stopped altogether.
Benzodiazepines, such as clonazepam or lorazepam, may be used to treat insomnia and agitation. Because of problems with dependence, benzodiazepines are recommended for short-term use only.