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.
Should you consider lithium orotate over plain lithium?
Valproate or Valproic Acid (Depakote)
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.
Carbamazepine is not officially approved by the FDA for use in bipolar disorder, but its use in this disorder is extensively studied and published in medical literature. Between 44 and 63 percent of patients respond well to carbamazepine, depending on the study design and type of patient. The highest response rates, exceeding 75 percent, were in patients taking carbamazepine and lithium. Patients who respond best to the drug include those who have early-onset bipolar disorder (i.e., before age 25), rapid cyclers, and patients lacking a history of mood disorder. It takes seven to 14 days for the medication to start working; if there is no response in three weeks, the doctor can assume that the drug is not suitable for that patient. This drug is used less frequently due to the risk of possible drug interactions and the fact that its effects wear off with time.
Gabapentin is used for treatment of seizures and is not approved for treatment of mania. However, uncontrolled studies have shown positive results when gabapentin is added to standard treatment (e.g., for patients who are not responding well to lithium). Research using gabapentin alone has been disappointing, although it does show a good response for less severe forms of bipolar disorder. Adult patients with chronic painful conditions respond best to the drug. Studies indicate that it may not be a good choice for children with a history of tantrums or hyperactivity.
Lamictal is used to treat seizure conditions such as epilepsy. It has not been approved for treating major depression, although some case reports have indicated it may be effective in treating bipolar disorder. There is ongoing research examining its use in treating bipolar disorder.