Ideally, bipolar is treated by a combination of different med-ications, talking therapies, natural treatments and lifestyle choices. No one treatment, therapy, or lifestyle choice on its own is likely to get the job done. A number of them working as complements to each other ensures your best chance of success.

Tell me about medications treatment.

Medications treatment involves three classes of drugs antidepressants for depression and mood stabilizers and antipsychotics for mania. In addition, some patients may take a benzodiazepine to help calm them down. Patients are typically prescribed a combination of drugs referred to as a cocktail. The American Psychiatric Association in its bipolar treatment guideline lists remission as the goal of medications treatment, meaning virtually no symptoms and a return to full functioning. Unfortunately, we may have to settle for less, given the imperfect nature of these medications, but what we are clearly entitled to is a best effort from our psychiatrist. Equally as important, side effects that interfere with our ability to think and function should not be regarded as an acceptable trade-off for reducing our symptoms.

Tell me about antidepressants.

What you need to know about antidepressants from a bipolar perspective is there is divided opinion in psychiatry concerning the safety of bipolar patients on antidepressants. This is because an antidepressant without a concomitant antimania med is almost certain to switch a patient into mania. Some authorities contend that even with an antimania drug, the danger is there. Accordingly, the American Psychiatric Association in its bipolar guidelines issued in 2002 does not recommend an antidepressant-antimania combination as a first option, and another guideline recommends tapering and discontinuing soon after remission is achieved.

On the other hand, there is a body of opinion that feels the risk is overstated. One study found that those who stayed on their antidepressants fared better over 12 months than those who quit on them before six months. But the same study also found that antidepressants did not work for the large majority of those in the study.

There are two mood stabilizers with antidepressant properties, lithium and Lamictal. In addition, Eli Lilly has submitted a Zyprexa-Prozac combination to the FDA for treating bipolar depression.

Tell me about mood stabilizers.

Mood stabilizers keep mania in check, though we are not sure precisely how they function in the brain. Lithium, which is a common salt, was discovered as a treatment for bipolar by accident. The other mood stabilizers - Depakote (valproic acid), Tegretol (carbamazepine), Trileptal (oxcarbazepine), Neurontin (gabapentin), Topamax (topiramate) and Lamictal (lamotrigine) - first came on the market as antiseizure medications. Because we don’t know exactly how they work and what we should be targeting, it comes as no surprise that their clinical benefit leaves much to be desired, with burdensome side effects ranging from dry mouth to weight gain to tremors to sedation to skin rash. A lot of these effects go away as the body adjusts to the medication. Because of the side effects, noncompliance is common. What one needs to keep in mind is as imperfect as these meds are, they offer one a fighting chance at recovery, as well as a welcome alternative to what would have been a lifetime of institutionalization a generation ago.

Tell me about antipsychotics.

Antipsychotics are yet another antimania medication that first came on the market to treat another illness, in this case schizophrenia. The drugs work by binding to dopamine receptors in the brain, preventing overstimulation from the neurotransmitter dopamine. The older antipsychotics bind tightly to these receptors, resulting in considerable side effects, including sexual dysfunction, increased lactation (which can result in loss of menses in women and lower testosterone in men), dulled cognition, sedation, and involuntary facial and muscular spasms. One of these, Haldol, is still in common use.

The newer "atypical" antipsychotics bind more loosely to the dopamine receptors, resulting in less risk of these side effects, though they still remain fairly common. Nevertheless, the APA and other guidelines recommend the atypicals as a first option for treating mania, often in combination with a mood stabilizer. The atypicals include Clozaril (clozapine), Zyprexa (olanzapine), Risperdal (risperidone), Seroquel (quetiapine), Geodon (ziprasidone), and Abilify (aripiprazole). Abilify, the newest, is thought to have the best side effects profile.

What do I do about sexual dysfunction?

Viagra may help, for women as well as men.

What about the other side effects?

There are meds to treat tremors and spasms, and wakefulness agents to handle sedation. Sometimes simply lowering the dose may solve the problem, or changing to a different med. Please let your psychiatrist know of any side effects, so the two of you can work on a solution. Also keep in mind that good lifestyle choices can reduce side effects.