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, depressive episodes can rob biploars of their enjoyment of life and present the danger of suicidal behavior (APA 2000).
Drug Therapies Used in the Treatment of Bipolar Disorder
Mood Stabilizers – Lithium
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).
Mood Stabilizers – Anticonvulsants
In the 1980s and 1990s anticonvulsants 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 anticonvulsants require specific blood levels of the drugs and regular monitoring of physiologic functioning (McElroy & Keck 1995).
Mood Stabilizers – Atypical Antipsychotics
Newer atypical antipsychotic 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. The original research appeared in the April issue of the New England Journal of Medicine (Sachs).