Although there is as yet no known cure, bipolar disorder can often be kept under better control by the use of medication. For more information on medication options and possible combinations refer to the Royal Australian and New Zealand College of Psychiatrists’ treatment guide for bipolar disorder (RANZCP 2005).

Two of the medications that people with bipolar disorder are most likely to be on are profiled in this section.

 

Lithium Carbonate (Lithicarb, Priadel) This medication has shown benefits such as:        • control episodes of mania        • act as an antidepressant        • when taken over a period it tends to even out or          dampen down mood swings and so actually helps to          prevent the illness from recurring (acts as a prophylactic) The benefits of taking lithium are cumulative, i.e. the benefits increase with time, and may not develop until after the first six months to one year. Lithium treatment may not completely abolish episodes of the illness but episodes will usually be less severe and/or less frequent. A person who has had two or three episodes of illness may decide to take lithium on a longer-term basis.

 

Blood testing
The level of lithium in the body takes 5–10 days to level out and lithium levels of approximately 0.6-1.0 mmol/L for maintenance are now generally recommended. Lower levels are generally less effective than the higher levels. To determine the lithium level a blood sample is drawn periodically and tested for lithium concentration. This blood sample should be taken exactly 12 hours after the lithium is taken. The daily dosage will be determined by this blood level, i.e. if the blood level is too low the doctor may advise an increase in dosage.

People with bipolar disorder are normally routinely screened by their doctor at two to three monthly intervals to check lithium levels. Kidney damage is possible if levels get too high. Low thyroid levels may occur and can be treated. Therefore periodic blood tests for renal and thyroid function are necessary. Check with your doctor.

Lithium levels may be affected by sweating due to increased physical activity or hot weather. It is therefore important to drink lots of water when taking lithium. To overcome thirst associated with lithium use, drink water in preference to high kilojoule drinks which may contribute to weight gain.

Possible side effects of lithium
Thirst, weight gain, worsening of skin rashes and acne are among possible adverse effects. Some people also develop a tremor (shake). Cognitive effects such as slower thinking or intellectual functioning, decreased memory and concentration, and lessened enthusiasm may also occur. Many people with bipolar disorder may find the cognitive side effects and changes in appearance (skin and weight) very difficult to live with.

Signs of toxicity
Dehydration can precipitate toxicity. Avoid dehydration by drinking water and by having a low-salt diet. Nausea and tremor are the first signs of toxicity. If these symptoms occur, drink plenty of water and seek medical advice if they persist.

If the lithium level does get high due to overdosing, dehydration or because you stop excreting it due to illness, a number of unpleasant symptoms may occur and you should contact your doctor. These include: weakness, sleepiness, shakes and twitches, stomach cramps, feeling sick, and in more serious cases a drunken walk, slurred speech, loss of appetite and vomiting. Should any of these symptoms develop while you are taking this medication, call your doctor immediately. They will want you to have a laboratory test done promptly to find out the concentration of lithium in your blood. If the level is not dangerous, these feelings may disappear after a short time. If you cannot reach your doctor, stop the medication until you do.

While taking lithium, diuretics (water pills) should be avoided as they raise the blood level of lithium. Any other medication (traditional or alternative) should not be taken without consulting your doctor first. If you are on a low salt diet, you should also let your doctor know. It is also recommended you discuss with your doctor any medical conditions that you may have, particularly those affecting heart or kidney function, or the thyroid gland.

Lithium should not usually be taken in the first three months of pregnancy. Breastfeeding while taking lithium is possible though not always recommended because lithium is passed to the baby through breast milk. It is important to review your particular options and circumstances with your doctor.

Many people take lithium safely for many years. The secret of success appears to be good communication between doctor and patient. Be sure to ask your doctor if you have any questions relating to this treatment. Be sure that at least one other member of your family or a significant other knows the purpose and plan of treatment.

It is important to note that stopping lithium suddenly may cause mania. If someone with bipolar disorder is intending to stop taking lithium they should discuss with their doctor the best way to gradually decrease their medication.

 

Sodium Valproate (Epilim)
This medication is being used more often now in New Zealand and other countries in the treatment of bipolar disorder. It was approved in the United States in May 1995 for the treatment of manic episodes.

When prescribing sodium valproate the doctor will take a number of factors into consideration, including the person’s medical history and other medications. As with other mood stabilisers, ongoing treatment is often recommended with doses typically ranging anywhere from 500 to 2000mg per day but sometimes higher doses will be prescribed. Response to sodium valproate has been seen in patients after as little as five days of treatment. Other individuals may take up to several weeks to see maximum effects from the medication. Sometimes additional medications may be prescribed temporarily until the sodium valproate takes effect.

Sodium valproate can interact with any other medications and common over-the-counter medications such as aspirin. Therefore it is very important to let your doctor and pharmacist know about all medications (traditional or alternative) that you are currently taking. Sodium valproate is not addictive.

Possible side effects of sodium valproate
Some of the common side effects include nausea, indigestion, mild abdominal cramps, sleepiness, dizziness, rash, weight gain, sedation, trembling hands, brittleness of hair and some hair loss. Potentially serious side effects to be aware of include unusual bleeding or bruising, dark urine or pale stools, yellowing of the skin or eyes, severe upper abdominal pain or confusion. Signs of overdose include severe dizziness, severe drowsiness, severe trembling, irregular, slow or shallow breathing, and coma. Sodium valproate may increase the risk of birth defects and is not recommended for women who are in the first trimester of pregnancy or who are planning to become pregnant. Before conception, prospective parents should consult their physicians about sodium valproate and pregnancy. Breastfeeding is often not recommended as it is passed on to the baby through breast milk, so it is important to review your particular options and circumstances with your doctor.


Other medications
Apart from mood stabilisers (lithium, carbemazepine, sodium valproate) which act to prevent mood swings as well as dampening them down, a number of other drugs can be of benefit to people with bipolar disorder. They generally fall into two main groups – those for treating mania and those for depression.


PLEASE NOTE:
THE DRUG INFORMATION ON THE FOLLOWING PAGES IS A GUIDE ONLY. IT IS NOT INTENDED TO PROVIDE DETAILED INFORMATION ON ALL DRUGS. IT IS NOT INTENDED TO BE A SUBSTITUTE FOR MEDICAL ADVICE.