Free Medical Articles

Antimanic medications are commonly used to treat a mental illness called bipolar disorder. Bipolar disorder (manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression). Cycles may be predominantly manic or depressive with normal mood between cycles. The episodes usually last several days to several weeks, if they are untreated. Some people switch back and forth between depression and mania, and some will have mostly repeated manic episodes. Mood swings sometimes follow each other very closely, or they may be separated by months or years. These "highs" and "lows" can vary in both intensity and severity.

When someone is in a manic "high," that person may be overactive, extremely talkative and have a tremendous amount of energy. People with bipolar disorder switch quickly from one topic to another as if their thoughts cannot get out fast enough. Attention span is often short and these individuals can easily be distracted. Sometimes, a patient who is "high" becomes irritable or angry and has false or inflated ideas about their importance in the world, or feels elated, full of grand schemes ranging from business deals to romantic sprees. Often, poor judgment shows in these ventures. Mania, if untreated, may worsen to a psychotic state.

People with bipolar disorder who have dramatic manic episodes and relatively mild depression may be described as having bipolar disorder type 1. Those who have more severe depressions and more mild manic episodes may be classed as type 2.

Almost always, mania is followed by a period of depression which shows in a "low" mood, lack of energy, changes in eating and sleeping patterns, feelings of hopelessness, helplessness, sadness, worthlessness and guilt, and sometimes thoughts of suicide. Some individuals with bipolar disorder have a difficult time functioning well in day-to-day life during both manic and depressive episodes. While many bipolar disorder patients do well between episodes, some are chronically ill. For most bipolar disorder patients, medication is the only solution to control their symptoms, allowing them to enjoy and participate in a full and normal life. Lithium, anticonvulsant medications and antipsychotic medications are the main types of drugs used to treat bipolar disorder.

The PDR lists medications with an indication for treating mania. These include:

Lithium carbonate

• Eskalith® capsules
• Eskalith CR® tablets
• Lithobid® slow-release tablets

Divalproex sodium

• Depakote®

Olanzapine

• Zyprexa® tablets
• Zyprexa® ZYDIS orally disintegrating tablets

The anticonvulsant lamotrigine (Lamictal®) was approved in 2003 to treat people with bipolar.

Several anticonvulsant medications, which do not have a formal indication for mania, also have been used for the treatment of acute mania or as mood stabilizers to help prevent relapse in bipolar disorder patients. These anticonvulsants have included carbamazepine (Tegretol®), oxcarbazepine (Trileptal®), gabapentin (Neurontin®), and topiramate (Topamax®). While olanzapine does have a formal antimanic indication, other antipsychotic medications commonly have been used to treat acutely manic patients and sometimes on a chronic basis. Some benzodiazepine medications also may be prescribed for acute manic and occasionally on a chronic basis.

Lithium

The medication used most often to combat a manic "high" is lithium. It is unusual to find mania without a subsequent or preceding period of depression. Lithium evens out mood swings in both directions. Someone may have one episode of bipolar disorder and never have another, or be free of illness for several years. However, for those who have more than one episode, continuing (maintenance) treatment on lithium is usually recommended.

Someone may have one episode of bipolar disorder and never have another or be free of illness for several years. However, for those who have more than one episode, continuous treatment on lithium usually is recommended.

Lithium diminishes severe manic symptoms in about five to 14 days, but it may take anywhere from days to several months until the condition is fully controlled. Anti-psychotic medications are sometimes used in the first several days of treatment to control manic symptoms until the lithium begins to work. Then, antidepressants may be needed along with lithium during the depressive phase. Brand names include Carbolith®, Cibalith-S®, Duralith®, Eskalith®, Lithane®, Lithizine®, Lithobid®, Lithonate®, and Lithotabs®.

Response to treatment with lithium varies from person to person, and it cannot be determined beforehand who will or will not respond to treatment.

Side effects

A lithium level must be checked periodically to be certain how much medication is in the body. This may be checked frequently when the medication is started but eventually may be checked every few months if there are no signs of an excessive amount in the body. If too little is taken, lithium is not effective. If too much is taken, side effects may occur. The range between an effective dose and a toxic one is small. How much lithium an individual needs may vary over time, depending on the severity of the illness, body chemistry and the person's physical condition.

Side effects with lithium can include:

• Drowsiness, weakness, fatigue
• Nausea, vomiting
• Persistent hand tremor
• Increased thirst and urination due to kidney changes
• Weight gain
• Dizziness, confusion
• Memory problems
• Headaches
• Double vision or blurred vision
• Anxiety
• Slurred speech
• Irregular heart beat

Considerations with lithium

Because of possible complications, lithium either may not be recommended or may be given with caution when a person has existing thyroid, kidney, or heart disorders, epilepsy, or brain damage. Thyroid function monitoring is part of treatment with lithium due to the possibility of the thyroid gland becoming underactive (hypothyroidism) or enlarged (goiter). In order to restore normal thyroid function, a thyroid hormone pill may be needed along with lithium.

Women of childbearing age should be aware that lithium increases the risk of congenital malformations in newborns. Special caution should be taken during the first three months of pregnancy.

Many different factors, including dangerous interactions with other medications, affect lithium levels. An unusual amount of exercise, fever, vomiting, diarrhea or a switch to a low-salt diet can cause body changes that interfere with lithium levels. Also, some diuretic substances, or anything that removes water from the body, can increase the level of lithium and can cause toxicity. Other diuretics, like coffee and tea, can lower the level of lithium and interfere with treatment.

A serious lithium overdose can be life-threatening. But, with regular monitoring, lithium is a safe and effective drug that enables many people, who otherwise would suffer from incapacitating mood swings, to lead normal lives.

Anticonvulsants

Not all patients with symptoms of mania benefit from lithium. Some respond best to anticonvulsant medications, drugs that are usually used to treat epilepsy. Carbamazepine (Tegretol®) is the anticonvulsant that has been most widely used for individuals with bipolar disorder who rapidly change from mania to depression and back again over the course of hours or days, rather than months.

The anticonvulsant divalproex sodium can be as effective as lithium in controlling manic symptoms.

Divalproex occasionally causes side effects such as:

• Stomach distress
• Headache
• Double vision
• Dizziness
• Anxiety
• Confusion

Because divalproex can cause liver problems, blood tests to assess liver function are recommended before starting medication and at frequent intervals, particularly during the first six months of treatment.

Lamotrigine (Lamictal®) was approved recently as a maintenance therapy along with standard medications. And it has been effective in delaying disordered mood episodes (depression and mania). A rare but serious side effect is a rash that may require hospitalization. For this reason, people taking lamotrigine are advised to contact their doctor and discontinue the medication if any unexplained rash occurs. The dose is increased very gradually to reduce the risk of this type of rash.

Antidepressants

Occasionally, patients with bipolar disorder are prescribed antidepressants during depressive episodes. However, antidepressants are less likely to be used for extended periods in bipolar disorder patients because these drugs can increase the risk of a switch to a manic episode.

For  more  information:  Please  consult  your  physician  on  your  next  visit.