How is bipolar disorder treated?
Mood stabilizers are the most common treatments. The most common of these is Lithium, which was first approved in the 1970’s. It is not known exactly how lithium works, but it seems to be very effective at both preventing mania and preventing depressive episodes. It probably acts on neurons in the brain (since these symptoms are neuronal), but it’s not clear how or where exactly. Other mood stabilizers include anticonvulsants (used to prevent seizures in epilepsy) that were also found to stabilize mood. For instance, valproic acid may work better than lithium for some people.
Lithium also seems to change brain structure. It increased gray matter volume in limbic and related areas in patients with bipolar disorder as compared to other treatments (see image; Germana et al., 2010). These areas are involved in emotional regulation, and so it suggests that lithium may help cause structural changes in these areas that lead to the mood stabilizing effects.
Antipsychotics can also be used along with other medications to decrease some of the symptoms of bipolar disorder. These include olanzapine (which helps with severe depressive episodes), risperidone, and clozapine, among others.
Antidepressants can also be added to decrease depressive symptoms (such as the SSRIs, or selective serotonin reuptake inhibitors). However, these are never (or should never) be given alone to people with bipolar disorder as this can cause the person to swing from depressive episodes into mania. Therefore, antidepressants are usually given in conjunction with mood stabilizers, such as lithium. It’s not clear whether mood stabilizers + antidepressants is all that effective though, as a study conducted by NIMH found it no more effective at treating bipolar disorder than the mood stabilizer and placebo (sugar pill). For more information on that study, see here.
The next post will talk about EH’s experiences with treatment.