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Microsoft word - intro to medication leaflet january 2012.doc
Medications for Bipolar – a short description and resource guide
Always seek medical advice from your doctor when making decisions about your medication. This leaflet is for information only.
There is a range of different drugs used to treat bipolar. The medications used will depend on the nature and degree of your symptoms and the phase of the illness you are in. Bipolar is also associated with other problems such as sleep disturbance that may require additional medication. Drug treatment is the cornerstone of treating bipolar, but there are many other aspects to keeping well. Medications commonly used are:
Drugs for mood stabilisation or mood maintenance
Complementary treatments and food supplements
Scientific evidence on how effective individual or a combination of medications illustrate the impact for individuals varies significantly. People can respond differently to the same drug and an individual’s response to a drug can change over time. There are a variety of side effects and different people will experience these in different ways. There are also new drugs being developed for bipolar all the time.
Be Safe. Never change your medication without speaking with your doctor first.
1. Medications for mood stabilisation or mood maintenance
The following are used as mood stabilisers or for mood maintenance. Each acts in a different way in the brain to prevent your mood becoming unstable. They may also act to improve your mood if depressed or calm you down if high.
How do they work?
Their exact mechanism is not known and they probably work in
different ways. They may have a common action to change the level of mood changing
chemicals and boost levels of a “brain fertiliser hormone” called Brain Derived Neurotrophic
Factor (BDNF). This is boosted particularly in critical areas of the brain responsible for mood
regulation, or an area known as the limbic system and prefrontal cortex.
Many of the mood stabilisers require some kind of regular blood
monitoring to check the drug’s plasma level. Lithium can affect organs such as the kidney,
thyroid and liver. Regular blood tests can monitor this.
When you start on a mood stabiliser or antipsychotic you may have tests
before and then at regular intervals afterwards. Olanzapine and quetiapine can cause
changes in your metabolism leading to weight gain, diabetes or raised cholesterol. Initially
your weight gain, blood pressure and blood will be tested every three months for the first
year and then each year thereafter. It is important that these tests are done to detect
changes early and treat them.
2. Medications used when high (hypomania/mania)
Antipsychotics are the most commonly used drug to treat a high. These
drugs are divided into groups based on their side effects. No drug has a more tolerable side
effect, but rather they have different side effects. Newer drugs are equally effective in
treating bipolar but all have different side effects that are not necessarily less troublesome
than older ones. Psychiatrists use the wider range of antipsychotics available to suit
individual patients. Antipsychotics have been shown to act as mood stabilisers in some
cases. Some of the mood stabilisers are effective in treating a high if given at higher doses.
The following is a list of common antipsychotics that your psychiatrist may use:
Other anti-manic drugs that are not antipsychotics include clonazepam, lorazepam, lithium and valproate.
Other drugs may also be used as anti-manic drugs, but there is less evidence
for their effectiveness. These include topiramate, lamotrigine, levetiracetam, oxcarbazepine,
ritanserin, ziprasidone and gabapentin.
How do drugs work?
The exact mechanism is not known. They have a sedative effect on
the brain and alter the balance of a brain chemical called dopamine which is known to be
abnormal in mania and psychosis.
3. Medications used for bipolar depression
The following drugs are established treatments for bipolar depression:
There are many groups and types of antidepressants, too many to list in completeness here. Those commonly prescribed today are the SSRIs (selective serotonin reuptake inhibitors) and include fluoxetine, paroxetine and citalopram. They work by altering the balance of the brain chemical serotonin in parts of the brain.
Antidepressants alone without a mood stabiliser are avoided in bipolar depression as there is a risk of inducing a hypomania or rapid cycling. Other treatments, but with less scientific evidence for effectiveness in bipolar depression, include valproate, carbamazepine, aripiprazole and gabapentin.
Treatment resistant bipolar depression
This can be disabling and your doctor will have to weigh the risk of inducing a high or rapid cycling in you if using multiple treatments. Your doctor may, by combining drugs, boost their effectiveness. Combinations your doctor may investigate include multiple mood stabilisers, two antidepressants or lithium plus lamotrigine.
In severe cases electroconvulsive therapy (ECT) may be necessary. The law governing the use of ECT is very strict in the UK and it is used infrequently.
4. Medications used for associated conditions
From time to time people with bipolar suffer from sleep difficulties.
Managing your sleep by keeping regular patterns and habits will aid good sleep. This is
essential in keeping your moods stable. Avoiding stimulants like coffee in the afternoon and
evening is a good example. If you are struggling to sleep it may be wise to take a sleeping
tablet with your doctor’s agreement as when you have bipolar you can become more
sensitive to sleep loss. Your doctor may be cautious about giving you too many sleeping
tablets too often as they can become addictive. When stopping them you may have difficulty
sleeping for a night or two and have vivid dreams. The most commonly used sleeping
tablets are zolpidem and zopiclone.
Anxiety problems with bipolar are common. Generalised anxiety,
panic attacks and social anxiety are all more common in bipolar than in those without the
illness. Anxiety problems are more likely just before, during or after a period of instability of
mood. Most of the drugs used to treat bipolar may help anxiety. However some of the side
effects may make it worse or may seem like anxiety. For example some antipsychotics can
induce a restlessness called akathisia (Greek for “can’t sit still”). It is important to report your
symptoms in detail to your doctor so he/she may provide the right treatment. There are
many psychological and other non-drug treatments for anxiety. Common used drugs include
antidepressants, beta-blockers, valproate and gabapentin.
How do they work?
They have a varied mechanism but benzodiazepines act like a key on
large receptors on the surface of brain cells causing the cells to be less likely to activate,
therefore mildly sedating them.
5. Complementary treatments and food supplements
Medication is the cornerstone of treating bipolar, but there are many other aspects to keeping well including diet, physical exercise and complementary therapies. At Bipolar UK we run intensive three-day self-management training programmes that have been developed on the key principle that individuals with bipolar can become experts in their own mental health. If you look after yourself, you are better equipped to understand bipolar and monitor variations in your mood swings.
- As the national bipolar charity, we produce and publish a range of leaflets and
information sheets. For more specific information on medications please NHS direct:
http://www.nhsdirect.nhs.uk or the sites below. We also provide a pathway of services
across the country for individuals with bipolar their carers and loved ones. In the first
instance look at our website www.bipolaruk.org.uk or call 0207 931 6480.
UK Psychiatric Pharmacy Group
– This site offers a group of frequently asked questions
about medications, please see www.choiceandmedication.org.uk.
The Royal College of Psychiatrists
– This site offers a range of detailed information
leaflets for a variety of mental health issues. Please see http://www.rcpsych.ac.uk.
The Institute of Psychiatry, King’s College
– This site carries a comprehensive list of
medications and their side effects plus helpful videos. Please see:
We hope you find this information sheet useful. Please do not hesitate to contact your doctor or mental health professional for specialist advice.
Bipolar UK is the national bipolar charity. For further information about our work and our services, please look at our website www.bipolaruk.org.uk or contact us on 0207 931 6480.
Bipolar UK, 11 Belgrave Road, London SW1V 1RB.
Charity No: 293340, Company No: 1955570
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