Mood stabilizers, described below, are highly effective in stabilizing and maintaining a remission of manic symptoms.
Lithium was first regularly used in the United States to manage bipolar disorder in 1970. People who have previously taken lithium or who are experiencing an euphoric (as opposed to an anxious or unhappy) mania respond best to lithium. It takes about 10 to 14 days for the drug to start to take effect; it can take three weeks for manic symptoms to fully subside and six weeks for depressive symptoms to lessen. Roughly 50 percent of people who initially try lithium improve. Another 50 to 40 percent improve with the addition of another medication or trying another mood stabilizer.
At first, doctors may check a patient’s blood levels of lithium twice a week; during continuation treatment, monitoring may occur less often, perhaps every two weeks. For stable patients on lithium maintenance, blood levels may be checked every six to twelve months. Because lithium is handled primarily by the kidneys, a renal function test (a blood test) is also recommended at least once a year. Because lithium may also affect the thyroid gland, its function should be checked once or twice a year. Women appear to be at greater risk for lithium-induced thyroid problems. In addition to the above mentioned blood tests, an annual electrocardiogram (ECG) is also recommended for patients 35 years old and older to check heart rhythm.
Valproate has been approved by the U.S. Food and Drug Administration (FDA) for the acute treatment of mania since 1995. Patients who respond best to the drug include rapid cyclers those with a history of depression mixed with mania, and those with a history of head trauma, mental retardation or substance abuse. It takes about seven to 14 days for the drug to start working, and most psychiatrists wait three weeks before adjusting the dosage.