Most people experience a range of moods throughout the day based on interactions with their surroundings. A smile from a loved one can brighten your day. A traffic jam can sour it. Emotions, and the ability to control them, are an essential part of our lives. In people with bipolar disorder, their mood can swing wildly and uncontrollably between depression and mania. These swings can severely handicap a person’s life, affecting personal relationships, work, and even their own well-being.

Bipolar disorder is a serious brain illness that affects around four percent of people in the United States: almost two million people. Because it affects brain function, bipolar disorder disrupts a person’s behavior. The effects differ from person to person, but the main symptom is mood swings. During depression, a person will feel hopelessness, loss of appetite, general lack of interest in activities, and suicidal thoughts. During manic periods, a person will completely shift and feel optimistic, speak quickly, become overly joyful – even aggressive, have an increased sex drive, and make irrational decisions.

Though anyone can be affected by bipolar disorder, it commonly occurs to people between the ages of 18 and 35.

Medications for Bipolar Disorder

There is no true cure for bipolar disorder, but treatment is available to steady mood swings and regulate symptoms. There are several medications that treat symptoms of bipolar disorder. They are mood stabilizers, antipsychotics, and antidepressants. A doctor and a psychologist can work with a patient to determine which treatment is right for them. Most medications must be taken even after symptoms have subsided.

Mood stabilizers

Mood stabilizers tend to be the first line of defense against bipolar disorder. The purpose of this medication is to regulate both types of mood swings. The first mood stabilizer developed was lithium, which is still considered highly effective at preventing both manic and depressive episodes. Lithium works by interrupting dopamine receptors in the brain; excess dopamine can lead to mood swings. Side effects of lithium include weight gain, uncontrollable tremor, and nausea. In the long-term, lithium can affect the thyroid and kidneys.

The remaining mood stabilizers are anticonvulsants. Lithium generally takes up to 10 days to become effective, so often an anticonvulsant is prescribed in the interim because it works faster. They can be prescribed if lithium is found to be ineffective. Originally, anticonvulsants were used to treat seizures until it was discovered they were also affecting mood. The reason for this is still unclear, but it is known that anticonvulsants reduce excitement in the brain.

The anticonvulsants valproic acid and divalproex are considered as effective as lithium in controlling manic episodes, and lamotrigine is used for those who rapidly cycle between mood swings and depressive episodes. Side effects include fluctuations in weight, tremors, and feeling tired.

Antipsychotics

If mood stabilizers are ineffective, a person will be prescribed antipsychotics. They treat symptoms of mania by blocking different types of neurotransmitters, especially the dopamine receptors. This directly affects the transmission of information between individual brain cells. Antipsychotics can be combined with other medications to be more effective. Antipsychotics used for bipolar are known as “atypical,” as opposed to typical antipsychotics, which are considered an older medication. Atypical antipsychotics include olanzapine, arpiprazole, quetiapine, and risperidone. Olanzipine is given with antidepressant medication to control mania. Arpiprazole also treats mania, but can be administered as an injection to act quickly on sudden manic onset.

Side effects for most antipsychotics include weight gain, sexual dysfunction, drowsiness, and blurred vision. Long-term use can lead to metabolic syndrome, which is excess fat in the abdomen that leads to insulin resistance, high blood sugar and blood pressure, and inflated cholesterol.

Antidepressants

Antidepressants are administered to people with bipolar disorder carefully, as they can actually increase mood swings and trigger manic episodes. They are generally given alongside mood stabilizers to prevent mood swings. Antidepressants work like most other bipolar medication, by affecting specific neurotransmitters associated with mood and emotion. Types of antidepressants used for bipolar disorder include fluoxetine, paroxetine, sertraline, and bupropion.

Side effects of antidepressants can include a triggering of manic or depressive episodes, difficulty sleeping, headache, nausea, and sexual dysfunction. In some cases, depression can actually deepen, and a person will experience suicidal thoughts. It is important to monitor the effects of antidepressants when taken for bipolar disorder.

Electroconvulsive Therapy

When medication and psychotherapy fail a patient with bipolar disorder, there is an additional procedure available known as electroconvulsive therapy. In electroconvulsive therapy a machine sends currents of electricity to the brain, inducing a seizure that lasts between 30 and 90 seconds. The electric shock is believed to change the brain chemistry, therefore improving a person’s mood. The patient is given a muscle relaxant and no pain is felt during the procedure. This is repeated two to three times a week for several weeks.

Electroconvulsive therapy is generally attempted after medications have failed, but has proven to be effective against depressive and manic episodes. Risks include confusion and memory loss following the procedure, nausea, headache, and muscle pains.

Emergency Treatments

There are times when bipolar disorder is overwhelming and can interfere with a person’s daily life. Manic or depressive episodes can be life threatening to a person with bipolar disorder or to those around them. For these occasions, there are emergency treatments available.

Hospitalization can place a person in a safe environment, where psychiatric treatment can be administered without outside influences. Emergency treatments are temporary measures taken only while a patient is struggling to get symptoms under control.