Lithium: The first mood stabilizer for bipolar disorder. Mood stabilizers are medications that help control the highs and lows of bipolar disorder. They are the cornerstone of treatment, both for mania and depression. Lithium is the oldest and most well-known mood stabilizer and is highly effective for treating mania.
Divalproex: Also known as valproate or valproic acid, divalproex is the anticonvulsant with the most uses in bipolar disorder — this is discussed more below.
The most effective treatment for bipolar disorder is a combination of medication and psychotherapy. Most people take more than one drug, like a mood-stabilizing drug and an antipsychotic or antidepressant.
In December 2021, the FDA approved Caplyta (lumateperone) to treat depressive episodes in bipolar 1 or 2 disorder in adults. It can be taken by itself or combined with lithium or valproate (Depakote). Caplyta is an oral capsule that you take once a day with or without food.
Lithium is considered the gold standard treatment for bipolar disorder (BD). Current clinical guidelines and scientific evidence support its use as a first-line treatment in BD.
Lamotrigine. Lamotrigine (Lamictal) may be the most effective mood stabilizer for depression in bipolar disorder, but is not as helpful for mania. The starting dose of lamotrigine should be very low and increased very slowly over four weeks or more.
Bipolar I disorder is the most severe form of the illness. Bipolar II disorder is characterized by predominantly depressive episodes accompanied by occasional hypomanic episodes. Hypomanic episodes are milder than manic episodes but can still impair functioning.
For second-line options, data show that lithium once again is the superior initial monotherapy. Data also support valproate, quetiapine, and lamotrigine as second-line options for monotherapy, especially for patients who fail or have contraindications to lithium therapy.
The most widely used mood stabilizing drug is lithium. The clinical effects of lithium were discovered in the 1940s, and it has since become a widely used medication. The clinical properties of other mood stabilizers (carbamazepine, valproic acid) were discovered in the 1970s and 1980s.
Drugs with a definite propensity to cause manic symptoms include levodopa, corticosteroids and anabolic-androgenic steroids. Antidepressants of the tricyclic and monoamine oxidase inhibitor classes can induce mania in patients with pre-existing bipolar affective disorder.
ABILIFY MAINTENA is the first and only FDA-approved once-monthly* maintenance treatment for bipolar I in adults. It is an injection that is prescribed by your healthcare provider. Some adults with bipolar I may take a pill to manage their condition.
It's usually prescribed for at least 6 months. If you're prescribed lithium, stick to the prescribed dose and do not stop taking it suddenly unless told to by your doctor.
Long-term lithium treatment is more effective than second-generation antipsychotics. For the majority of patients, the side effect profile of lithium carries less risk than the use of second generation antipsychotic medications.
Although there is no official classification for end stage bipolar disorder, mild structural changes in the brain that lead to cognitive dysfunction can severely reduce someone's quality of life, especially toward the end of life.
Brain Changes
Research shows bipolar disorder may damage the brain over time. Experts think it's because you slowly lose amino acids. They help build the proteins that make up the insulation around your neurons.
No one knows exactly what causes bipolar disorder. Research suggests that a combination of factors could increase your chance of developing it. This includes physical, environmental and social conditions.
Mood stabilizers such as lithium (Lithobid) are usually part of the mix. Lithium can help treat symptoms of bipolar disorder.
The main current alternative treatments in manic episodes which fail to respond to lithium alone are neuroleptics, carbamazepine and electroconvulsive therapy (ECT-ither singly or in combination, with or without lithium.
Adults who experience severe bipolar disorder will likely have to remain medicated their whole life. However, it's common for people to go off course with their medications or even stop them entirely.
Bipolar disorder is generally a chronic, lifelong condition. While it is your choice whether or not to use medication, not doing so could lead to severe complications and significant risks to your health and wellbeing.
In those instances, if one can consistently utilize healthy lifestyle management and good self-care, then it may be possible to maintain mood stability without medication.
The Brain and Bipolar Disorder
Norepinephrine and serotonin have been consistently linked to psychiatric mood disorders such as depression and bipolar disorder. Nerve pathways within areas of the brain that regulate pleasure and emotional reward are regulated by dopamine.