Replies to '08/01 Extreme Highs and Lows'

Talk with your doctor about the best treatment plan for you. Treatment options include: 

The following medications may be used to treat bipolar disorder (many patients are treated with a combination of two or more of these medications):  

• Lithium – a mood stabilizer, often used as initial treatment (helps prevent manic and depressive episodes from returning)
• Valproate (Depakote), carbamazepine (Tegretol), lamotrigine, topiramate, gabapentin (zonisamide, felbarnate) – anti-seizure medications, also used as mood stabilizers instead or in combination with lithium
• Benzodiazepines – clonazepam (Klonopin) or lorazepam (Ativan) can be used to treat agitation or insomnia
• Zolpidem (Ambien) – used to treat insomnia
• Antidepressants – serotonin reuptake inhibitors or bupropion (Wellbutrin) can be used to treat depression
• Antipsychotic medications – used if patient exhibits psychotic behavior at extremes of mood; “classic” anti-psychotic medications [e.g., haloperidol (Haldol) are not often used because of risks of tardive dyskinesia (uncontrollable movements); “atypical” antipsychotic medications [e.g., risperidone (Risperdal) are more effective with less risk of tardive dyskinesia

Treatment may need to be continued for prolonged periods or indefinitely, depending on the pattern of the illness, to prevent significant mood swings. 

Psychotherapy may include:  

• Cognitive-behavioral therapy
• Counseling
• Family therapy
• Interpersonal therapy

Electroconvulsive therapy may be effective for both mania and depression when medications fail.  

There are no guidelines for preventing bipolar disorder. 

Child and Adolescent Bipolar Foundation
http://www.bpkids.org 

Depression and Bipolar Support Alliance
http://www.dbsalliance.org/ 

Belmaker R. Medical progress: bipolar disorder. N Eng J Med. 2004;351:476-486.  

Bipolar disorder. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/publicat/bipolar.cfm. Accessed November 10, 2005.  

Last reviewed November 2005 by Janet H. Greenhut, MD, MPH  

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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.