The Latest in Treatments for Bipolar Disorder

By Jane Farrell

You—or a loved one—feel depressed. Then very excited, or even “hyper.” Then depressed again. These ups and downs can be a sign of bipolar disorder, a brain disorder.

Though there is no cure for this disorder, medications approved by the U.S. Food and Drug Administration can treat symptoms and help you feel better.

Symptoms

Bipolar disorder can be present even if symptoms do not appear extreme. There is more than one type of bipolar disorder: bipolar I disorder and bipolar II disorder.

Bipolar I disorder (also known as manic-depressive illness) causes unusual shifts in mood, energy, activity levels, and the lack of ability to do everyday tasks. Symptoms include periods of depression alternating with periods of energized behavior (called “mania” or “manic episodes”).

In the second type of this disorder, called bipolar II disorder, a person with a less severe manic episode (called “hypomania”) may be productive and may not feel like anything is wrong. But this hypomania can then switch to major depressive episodes. So diagnosis is important.

Symptoms of depression include:

Feeling very sad or hopeless

Not having energy

Feeling like you can’t enjoy anything

Thinking about death or suicide

Symptoms of mania include:

An elevated or irritable mood

Increased activity and restlessness

Racing thoughts or talking fast

A decreased need for sleep

“People experiencing mania also can engage in impulsive behavior such as buying sprees and other risky behaviors,” says Mitchell Mathis, M.D., director of the Division of Psychiatry Products at the FDA. “This behavior is unusual for the person and can be dangerous.”

What to Do if You Suspect Bipolar Disorder

If you suspect you have a bipolar disorder, you should be evaluated by a mental health professional.

If you or a loved one has unstable mood symptoms, don’t ignore them. Talk with a doctor or other licensed mental health professional to get help.

“A doctor can complete a medical history, physical exam, and laboratory exam to rule out physical conditions that may cause similar symptoms. If symptoms are not caused by other illnesses, the doctor may then provide a referral to a mental health professional,” Mathis says.

Bipolar Disorder Treatments

“Today, people with bipolar disorder have more FDA-approved treatment options,” Mathis says.

Medications to treat bipolar disorder include: mood stabilizers, which help balance certain brain chemicals to prevent mania, hypomania, or depressive episodes; and antipsychotic drugs, which include relatively newer drugs called “atypical antipsychotics.”

“Atypical antipsychotics are often used as the first-line treatment in severely manic patients because they work quickly and are, in several ways, safer than the older antipsychotic drugs,” Mathis explains.

That said, medications may have side effects. For instance, side effects of mood stabilizers can include nausea, trembling, and increased thirst. And side effects of antipsychotic medications can include sleepiness, dizziness, and feeling restless.

In addition, if you take atypical antipsychotics, your doctor should regularly monitor your weight, blood sugar, and blood cholesterol, Mathis notes, because these medications can cause problems like weight gain and increased cholesterol.

Treatment for Bipolar Disorder Is Different from Treatment for Depression

With depression (also called “major depressive disorder” or “unipolar depression”), people feel low. But remember bipolar disorder includes lows and highs.

Although patients with depression can be treated with antidepressants, note that antidepressants in bipolar patients can cause manic episodes.

“If you experience manic symptoms, tell your health care provider so that you receive the correct diagnosis and medication,” Mathis says.

Considerations for Pregnant Women

The FDA ensures that approved medications are safe and effective when prescribed according to the labeling. However, the FDA has little information about pregnant women who use antipsychotic drugs because research studies for these medications generally do not include these women.

If you’re being treated for bipolar disorder and are pregnant, planning to become pregnant, or breastfeeding, work with your doctor to consider the risks and benefits of medication.

If you take medication while pregnant, you may be able to help other pregnant women and doctors find out more about the safety of that medication by joining a pregnancy registry. These registries collect data on safety issues during pregnancy. The FDA does not run registries.

The Bottom Line—and What to Do if You’re in Crisis

Everyone responds to treatment differently, so you may need to try several treatments before you find one that’s best for you. But treatment can help. If you’re ever in crisis or thinking about suicide, immediately tell someone who can help. You can call your doctor, go to a hospital emergency room, or even call the toll-free National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This line is open 24 hours a day, 7 days a week and all calls are confidential.

This article appears on the FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.