Defining and Treating Bipolar Disorder

What is bipolar disorder?

Originally referred to as “manic depression,” bipolar disorder is a very serious mental illness that can be devastating to the lives of people who suffer from it. Thankfully, we now have several pharmaceutical options to treat bipolar. The National Institute of Mental Health has an overview of the condition. People with bipolar have to live between two extremes of mood: severe depression and “mania,” which is a type of heightened mood that causes erratic behavior, poor judgment, and, in some cases, psychosis. In recent decades, the psychiatric community has embraced the diagnosis of “bipolar II.” People with this latter diagnosis suffer from similar disabling depressive episodes as what is now known as “bipolar I,” but instead of mania, people with bipolar II experience something called “hypomania.” While both forms of mania share certain symptoms (e.g., decreased need for sleep, agitation, racing thoughts), hypomania is significantly less severe and by definition cannot involve a psychotic break. The Mayo Clinic is a reliable resource for information on this topic. You and your provider will work together to determine if you have bipolar disorder and, if so, which type.

Lithium

Unlike the wide swath of potentially successful pharmaceutical treatments for major depression, there is one particular drug that has had a singularly monumental and enduring impact on the symptoms of bipolar disorder: lithium. Lithium is not a drug per se, because it is composed of only one elementary particle, Li. One can imagine the impact that an effective treatment had on patients who had been living like a pinball flung violently from vertiginous, dangerously unstable highs to suicidal depression. Lithium has a long history, but it first began to take hold in the United States in 1949 and was approved by the Food and Drug Administration in 1970. One of lithium’s most helpful properties is its ability to prevent episodes of mania, rather than merely chemically restraining a patient in the throes of such mania. The sheer wonder that a salt, an indivisibly small and naturally occurring particle, can have such an immensely positive impact on people suffering from a terrible, and often fatal, disease cannot be overstated. One excellent, entertaining, and well informed discussion of lithium is from the August 22, 2015 episode of “Radiolab.” Lithium is not without its disadvantages: bloodwork is required a few times per year to make sure the lithium level is within a therapeutic range but not so high as to risk lithium toxicity and to monitor kidney function, which can be impacted by lithium therapy.

Lamotrigine

Unlike lithium, lamotrigine is not an elementary particle (few medicines in any field are), but an anticonvulsant originally used to treat epilepsy. In the 2000s, it was discovered that lamotrigine was very effective in preventing both the manic and depressive poles of bipolar disorder. At this time, lamotrigine is considered potent and safe enough to be used as a first-line therapy for bipolar disorder. Once lamotrigine therapy is established, it has relatively few side effects and is generally well tolerated. It is important to note that it can take up to six weeks for lamotrigine to start working. This is partially related to the fact that your provider will have to start at a very low dose and increase it slowly, because there is a small risk of developing Stevens-Johnson Syndrome. Stevens-Johnson is a rare but potentially life threatening dermatological reaction (a very bad rash) making it essential to move slowly when introducing lamotrigine therapy.

Other medicines