Bipolar Disorders

Bipolar Disorder, also referred to as Manic Depressive Illness, presents classically with mania. This is typically an elevated mood with grandiosity and at times, with psychotic or paranoid symptoms; typically with a dramatically reduced need for sleep. That situation typically alternates with depression. There may be normal periods of time between depressive and the manic episodes. Another variant is one in which there is a period of high irritability and particular problems with anger that may alternate with normal times and with depression. These conditions are best treated with mood stabilizing agents. The most effective treatment is the prevention of the episode. The episodes per se can be difficult to treat. Lithium is the oldest mood-stablizing drug. Some people have no side effects with Lithium; some will have increased thirst, loose stools or weight gain and mild tremor. Rarely, people may have a more pronounced tremor that may be reason to discontinue the medication. It is usual to measure thyroid function at the beginning of Lithium treatment because Lithium treatment may well produce hypothyroidism that is easily treatable with the addition of thyroid replacement medication. More rarely, people may lose urinary concentrating capacity. Creatine is also measured to monitor kidney function which may be affected by Lithium.

Tegretol, Trileptal, and Depakote are anticonvulsants which have been used to produce mood stability. All three of these agents may at times be associated with appetite stimulation for a small percentage of people. With Depakote, some people experience nausea or gastrointestinal upset and very rarely there are associated liver problems. With Tegretol, rarely there may be a depression of white blood count and so, if a person were to experience persistent infection or one that did not respond to conventional treatment, checking for white blood count would definitely be in order. It is appropriate that one’s primary care physician be informed about the use of these medications. With both Tegretol and Depakote, for women of childbearing age, it is advised that they take 4 mg. of folate since it might have a protective effect were they to become pregnant. These agents are associated with an increased rate of birth defects and specifically Neural Tube Defect. Folate produces a relative lowering of that risk. I also advise the use of vitamins with selenium and zinc to reduce the likelihood of hair breakage.

Lamictal became available in 1995. It has a relatively low profile of side effects, but does have an incidence of one in three thousand of producing a potentially lethal skin rash called Stevens Johnson Syndrome or exfoliative dermatitis.

Second generation anti-psychotic agents, Abilify and Zyprexa have been approved for the treatment of mania and maintenance in Bipolar Illness. Geodon is approved for the treatment of mania. Zyprexa may produce weight gain. Abilify and Geodon may produce restlessness or agitation. Newer agents include Saphris, Latuda and Vraylar.

In general, with Bipolar Illness, it is advised not to use anti-depressants as they may well destabilize a person’s mood. For some people with Bipolar Illness who have a predominant picture of significant depression, it may be worth the associated risks of using an anti-depressant medication.

Some books that might be helpful are The Unquiet Mind by Kay Jamison Ph.D.; and Mood Swings by Ronald Fieve, M.D.