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Medication Management for Bipolar Disorder

Treatment for bipolar disorder is best guided by a medical doctor specializing in diagnosing and treating mental health conditions, like a licensed psychiatrist. As bipolar disorder is a life-long condition, treatment is aimed at managing symptoms. The primary treatments for bipolar disorder includes medications and psychological counseling (psychotherapy) to help control the symptoms.

The Role of Medication

A number of medications are used in the treatment of bipolar disorder and are chosen based on the patient’s particular symptoms and goals. During the initial assessment, we can start to build a treatment plan based off the patient’s symptoms. Medications can include mood stabilizers, antipsychotics, antidepressants, antidepressant-antipsychotics or anti-anxiety medications. Mood stabilizers are needed to control manic and hypomanic episodes; this category of medication includes lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).

Antipsychotics are used to treat symptoms of depression or mania if they persist in spite of other treatments. Adding an antipsychotic medication can help improve symptoms alone or in conjunction with a mood stabilizer. A psychiatrist may prescribe olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris), depending on the need.

Antidepressants are used to treat a wide array of mental disorders, but can be particularly effective in managing depressive episodes that come with bipolar disorder. Because antidepressants have the ability to trigger and manic episode, they are typically prescribed with a mood stabilizer. 

For anti-anxiety medications, benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis. They are highly effective at promoting a relaxed feeling and reducing muscular tension that comes with anxiety. Benzodiazepines may be prescribed in conjunction with another class of medication for long-term management as well as covering short-term needs, like panic attacks. When used long-term, benzodiazepines may require a higher dosage to remain effective and can lead to dependence on the drug. 

Finding the right medication or combination of medications can take some time– if one doesn’t work, there are several others to try. This process requires patience from both patient and doctor as some medications can take weeks or month to take full effect. Medications are changed one at a time to allow the doctor to identify which medications are relieving symptoms and which are not. Medications may also need to be adjusted as symptoms change. 

 

Part of the challenge of medication and why medication management is important is determining the specific dose and timing of medication for each individual. There are no consistent relationships between height, age and clinical response to a medication. Trial often is the best determining factor to finding the most beneficial dosage. Typically, patients will start with a lower dose, increasing dosage in three to seven day intervals until clinical benefits are achieved. 

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