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Author: Dr Simon SurguladzeConsultant Psychiatrist

Medications such as Lithium or antidepressants can be used to effectively manage the symptoms of Bipolar disorders.

Expert knowledge is needed to make sure that the right medication is chosen for your Bipolar symptoms and to ensure the dosage levels are right for you. We can help.


Medications for acute manic or mixed episodes

Most patients with mania will require treatment with an antipsychotic and / or Valproate because they quickly reduce the symptoms of mania.

Antipsychotic drugs can also be effectively used to deal with delusions or hallucinations which can be experienced in severe manic states.

The following antipsychotics are licensed in the UK for treatment of manic states. Your clinician may try you on one and move you to another if it does not seem to work for you.

  • Aripiprazole
  • Haloperidol
  • Olanzapine
  • Quetiapine
  • Risperidone

30%
of those with Bipolar will have a suicide attempt


Medications for acute depressive episodes

It is known that depression in Bipolar disorder is particularly difficult to treat. Suicide is a key risk across the life span for Bipolar patients, especially when patients are experiencing depression episodes.

Antidepressant ‘monotherapy’ (using antidepressants alone) is not recommended for some patients because of the increased risk of a switch to manic episode. We know that antidepressants appear less likely to induce mania when combined with Lithium, Valproate or an antipsychotic.
Dr Surguladze


Mood stabilisers and long term treatment

Long-term agents are often called ‘mood stabilizers. An ideal mood stabilizer would prevent relapse to either pole of the illness – manic and depressive.

Medications like Lithium, Valporate and antipsychotics are known as mood stabilisers.

When a patient has been taking Bipolar treatment for several years and remains well, they are strongly advised to continue indefinitely, because the risks of relapse remain high2. Bipolar episodes can recur so finding a long term solution, that a patient can adhere to, is key for improving their quality of life.

2 Goodwin, GM et al (2009)


Lithium and side effects

What is Lithium?

Lithium is effective against both manic and depressive relapse, although it is more effective in preventing mania. Long-term treatment in general, and Lithium specifically, is associated with a reduced risk of suicide in Bipolar patients.

Unbelievably helpful – I’d go as far as to say life changing. Someone actually cared enough to listen to what was going on in my head and give me a reason for it.

Charlotte, Norfolk

Side Effects of Lithium

Although Lithium is highly effective, it isn’t without its issues and side effects can occur. If you experience unpleasant or severe side effects, always consult medical opinion as quickly as possible, before changing your dose.

10% of people taking Lithium will experience:

  • Stomach upset
  • Fatigue
  • Metallic taste in mouth
  • Increased thirst and urination
  • Weight change
  • Tremor

Less than 1% of people taking Lithium will experience:

  • Blurred vision
  • Skin rashes
  • Hypothyroidism
  • Kidney problems
  • Fits or seizures (seek emergency help immediately)

Taking Lithium for Bipolar affective disorder

If you are prescribed Lithium for Bipolar your consultant will advise you on the dosage you should take. It is thought 40% of people prescribed the drug do not take it as prescribed and this can have a large impact on the efficacy of the drug as well as the side effects.

You will be closely monitored to check that the drug is working and to review the impact on your body and mental health. It is vitally important that you discuss any changes to the dosage of your drug with your consultant before making changes.

Lithium is not advised for those with certain physical health conditions e.g. Addison’s disease, cardiac rhythm disorder and hypothyroidism, therefore you will be advised to undergo thorough medical investigations before Lithium could be considered. These tests can be done privately or may be available through your GP.

You will need regular blood tests while you are taking Lithium. Once you are on a steady dose, you should
have a blood test every 3 months to check your Lithium blood or plasma levels. Every six months you should
also have a test on your thyroid and kidney to make sure they are not being damaged by the Lithium.

Lithium raises levels of feel good chemicals in the brain, such as serotonin, which help alleviate depression. Lithium affects the way that brain cells communicate with each other, in particular the messages involved in cell resilience and regeneration. It increases the level of certain proteins in the brain and one in particular called Brain Derived Neurotrophic Factor (BDNF), which helps repair damaged areas which impacts on the symptoms of Bipolar.
MD, PhD, DSc

Consultant Psychiatrist
London

Dr Surguladze is a psychiatrist with over 30 years of clinical and academic experience in various areas of mental health.

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