Bipolar Blog

Mood stabilizers are usually effective in treating acute mania. Treating bipolar depression, however, is often more challenging for two reasons:

1. Antidepressants tend to be less effective in treating bipolar depression than in treating unipolar depression, especially in people who have the Bipolar I diagnosis (characterized by severe episodes of depression alternating with manic episodes).
2. Antidepressants carry some risk of unmasking mania in people who are prone to it, especially people who have the Bipolar I diagnosis.

Because depression is often the “pole” of bipolar that causes the most misery and carries the highest risk for suicide, it’s essential that we have a safe and effective way to treat it. Unfortunately, no single solution is safe and effective for everyone. In this post, we explore four options:

1. An antidepressant alone
2. A mood stabilizer alone
3. A mood stabilizer with an antidepressant
4. Non-medication therapies

Treating Bipolar Depression with an Antidepressant Alone

When someone visits the doctor reporting depression and has no history of elevated mood or family history of bipolar, the doctor usually prescribes an antidepressant alone. If you carry a bipolar diagnosis other than Bipolar I – in other words, you’ve experience depression but never had a manic or mixed (depression and mania) episode – treating your depression with an antidepressant may be a reasonable approach.

Discuss this option with your doctor, and be sure to address the possibility of manic switching – triggering a manic episode when treating depression. Ask your doctor to describe any symptoms of manic switching you should be aware of. This way, if you start to cycle into mania, you’ll be more sensitive to the warning signs. (Have a close friend or family member help you watch for the warning signs, because you may not recognize them yourself.)

Treating Both Poles with a Mood Stabilizer

Ideally, a mood stabilizer does exactly what its name implies; it stabilizes your moods so you feel good – neither manic nor depressed. And in a subset of people with bipolar disorder, this treatment works perfectly. A few mood stabilizers have proven more effective than others in treating both mania and depression:

1. Lithium: Lithium prevents both poles of the disorder from appearing, and people can manage well as long as they take their medication. (Unfortunately, lithium doesn’t work or keep working for everyone.)
2. Lamictal: Lamictal is another mood stabilizer that often has a good antidepressant effect. It is an anticonvulsant (used primarily to treat seizures) that has been approved for the treatment of bipolar disorder – specifically to prevent recurrence of mood cycles.
3. Seroquel: The atypical agent quetiapine (Seroquel) has recently been approved for the treatment of bipolar depression, and therefore it could treat both poles of bipolar disorder in some people.

Note: The antimanic agent divalproic acid (Depakote or Depakene) has not been shown to have an antidepressant effect.

Combining an Antidepressant with a Mood Stabilizer

Doctors often prescribe a mood stabilizer in combination with an antidepressant for one of the following reasons:

1. The mood stabilizer alone is ineffective in treating the depression.
2. You’re in a high-risk group for experiencing a manic switch on an antidepressant alone, so the doctor wants to reduce the risk by adding a mood stabilizer.
3. Antidepressants alone seem to be ineffective in treating your depression.

One of the few medications that contains both an antimanic and an antidepressant in a single pill is Symbyax, which combines the antidepressant fluoxetine (Prozac) with olanzapine (Zyprexa) in one capsule. This medication has FDA approval to treat bipolar depression.

Without the benefit of a combination pill, doctors often combine antidepressants with atypical mood stabilizers such as risperidone (Risperdal) and Aripiprazole (Abilify).

The jury is still out on how effective these mood stabilizer + antidepressant treatments really are. You’ll need to work closely with your doctor to develop a treatment plan that’s effective for you.

Exploring Non-Pharmaceutical Options

Beyond all of the medication managing and adjusting, non-medication treatments are just as essential to the management of all types of bipolar disorder. Recent large studies have shown significant improvement in quality of life and function with the addition of some type of structured and intensive psychosocial interventions – such as Cognitive Behavioral Therapy (CBT), Interpersonal Rhythm Therapy (IRT), or family-focused therapy.

Don’t get lost in the maze of medication treatments to the exclusion of these and other forms of treatment.

This is Part I of our three-part series on the challenges of treating bipolar depression. In Parts II and III, we will be answering two often-asked questions: “Is my antidepressant making me manic?” and “How effective are antidepressants in treating bipolar depression?” Stay tuned.

Whether you’ve been recently diagnosed with bipolar disorder or have been dealing with it for a long time, it’s likely that nobody has taken the time to sit you down and explain what you can and should be doing to help yourself. We’ve put together this Top 10 list to bring you up to speed on bipolar self-help strategies that really work: (more…)

Whenever you have a change in medications or therapies, your moods will improve, worsen, or stay about the same. Documenting how you feel can be a valuable tool in helping you team up with your doctor and therapist to obtain the right combination of medications and therapy. Use the following form to record the most recent change in your treatment plan and in how you feel since the change. (Or download the form as a Word Document.) (more…)

The standard approach to treating bipolar disorder calls for a combination of medication and psychotherapy—a mood stabilizer for the mania, an anti-depressant to treat the depressive side, and psychotherapy to deal with the stressors and triggers that often push the disorder through the protective barrier of medications.

There are, however, some alternative and complementary treatments available that may help when the standard treatments are ineffective or cause intolerable side effects. When used in place of standard medications and therapies, these are known as “alternative.” When used along with standard medications and therapies, they are called “complementary” or “adjunctive.” (more…)

When you begin seeing a psychiatrist (or any physician who manages your bipolar medication), you may begin to feel like a guinea pig. Your doctor tries one medication after another to see which one works and which one doesn’t, which one produces the least annoying side effects, and which medications seem to get along best with one another when you’re taking multiple medications. You may begin to wonder whether you are the first person on the planet who’s been diagnosed with bipolar disorder. Shouldn’t the medical community know by now what works and what doesn’t?! (more…)

On Sunday September 30, the CBS news program 60 Minutes aired a report entitled “Who Killed Rebecca Riley.” The piece explores the tragic death of four-year old Rebecca Riley due to an overdose of psychiatric medications. In the story, Katie Couric explains how Rebecca had been diagnosed with bipolar disorder at the age of three years and how she had been prescribed several medications to treat her behavioral symptoms. Rebecca’s mother is now in jail, accused of murdering Rebecca by regularly giving her too much of the medication Clonidine, which was one of the medications prescribed for Rebecca by the child psychiatrist. The prosecutors allege that Rebecca’s parents used this medication excessively to keep Rebecca quiet and subdued. Rebecca’s mother states that she gave Rebecca only the prescribed amount of Clonidine. (more…)

On September 3, 2007, Associated Press Science Writer Malcom Ritter published an insightful article called “Scientists Test New Bipolar Remedies,” about scientists who are “casting a wide net to find better treatments for the crushing depression and uncontrolled manias of bipolar disorder.”

The article sheds light on various treatments/medications that hold out some promise for those with bipolar disorder, many of which have been discovered almost completely by accident, including the following: (more…)

Science Daily just reported in an article titled “‘Wake-Up Pill’ Under Study To Treat Patients With Bipolar Disorder” that a “preliminary study of 85 patients with bipolar disorder shows that a drug used to treat patients with sleep disorders might also control the depressive symptoms associated with bipolar disorder.” The study first appeared in the August 2007 edition of the American Journal of Psychiatry. (more…)

When you have other illnesses, you’re usually well aware that you are not feeling well, and you seek some form of medical treatment. When you’re manic or depressed, however, you may not realize what’s going on and may actually do your best to avoid treatment. That’s why it’s so important to have a solid bipolar disorder treatment team in place—to care for you when you’re not able to care for yourself and help you stay on course.

In this article, we cover the basics of building a strong and effective bipolar treatment team. (more…)

About a year into our bipolar journey, I received a referral from a colleague of mine… actually my agent at the time. My agent knew of a doctor at a local university who specialized in bipolar disorder. After going through three or four doctors and seeing very little progress, the “specialist” seemed like the best option. We felt as though we were getting the rock star of psychiatry. We searched the Internet, and this guy’s name was on at least a half dozen journal articles!

(more…)