what is a better medcine with least side effects for bipolar mood disorder?

Answer 1

It depends. What might be a good medicine for you might be bad for someone else, and vice versa. Ask your doctor, he/she will help you way more than anyone on here. It might take a little trial-and-error to find the best person for you. Everyone's different.

Good luck though! I'm glad you are seeking help rather than ignoring the problem like many other people I know!!

Answer 2

there is no accurate or reliable way to self diagnose for this disorder.. see a psychiatrist or mental health professional..
and different things work for different people at different times for different reasons.. so what works best for some may not work at all for you.. and the opposite may be true as well.
I am bipolar and after trying many different combinations of prescription medicines.. i have found that a combination of Seroquel (300 Mg.) and Lamictal (400 Mg.) taken half in the morning and half about 10 hours later is what has finally stabilized my cycles.. the highs are not as high and the lows are not as low..
I also take Ativan in very small doses on an 'as needed' basis to drag me back down from really intense manic spells. But, like I said.. this is what works for me.. you may be different.. bipolar disorder is different for just about everyone that has it.. basic symptoms are the same.. some have a partially psychotic manic side (like me) but most do not. Some have severe suicidal depression (I don't) It's all relative to the individual. Your doctor will never prescribe anything unless they believe the potential for improvement outweighs the negative side effects..
and I suggest going over everything with a knowledgable and fully accredited pharmacist.
They will take the time to explain all the potential interactions with you. In my personal experience I have found that doctors and psychiatrists in a hospital setting are typically too busy to go over things in great detail, and that is what registered pharmacists are trained and paid to do. :)
Get a second and third opinion for everything and keep notes on what works and what doesn't .. to avoid the potential for a different doctor to try the same treatment that didn't work before.. be patient with it.. there is light at the end of the tunnel :)
Best of luck to ya :)

Answer 3

First you want to make sure you have a diagnosis of bipolar, by a Dr. such as one who works with these disorders, and make sure you get good care, everyone deserves that and not to just have pills thrown at them! Bipolar is extremely hard to deal with if you have it, and you want to make sure you have the right medication. The favorite and most effective medication still on the market is Lithium. It has been out for years and I believe has a generic by now, and has been clinically used with well needed counseling to help deal with this disorder. This is one of the "silent hells" alot! of people deal with, you would be amazed at the percentage of people that are diagnosed with bipolar every year, let alone the people that live with it and don't get help. Lithium has side effects, as do alot of meds. The best person to ask I have found out over the years, is of course you Dr. but more so your pharmacist. You don't even have to be on the med and you can stop and ask a pharmacist and they are a wealth of information. Right on the spot, they have helped me alot. Also bring it up on line, you will find alot of info, but Lithium is usually always their drug of choice. Good luck to you.

Answer 4

Hey! Check this out. Back in 1987, I was diagnosed BP and went through a detailed month of in hospital hit and miss on meds. They tried this, they tried that. then, for me, they came up with the master med plan. Depakote, Effexor xr, Klonipin, and a vitamin shot. I was actually good to go for a few years until I moved from Ohio to Indiana. Then this young buck of a Dr. decided he wanted to "change" my meds. Well, let me tell you this, I don't remember much after the change. I went through hell for years because this Dr. thought he knew better. Now I struggle with this condition without medication. I do know that I need to go to the Dr. again, but the meds I was taking kept me sane. The depakote does make you gain weight, but I stayed active to try to balance the effect. alas, What works for one person will not be the same for another. Our body chemistry is very sensitive. .01mg of anything can be completely different for you than it will be for me. So, you have to let yourself become a guinea pig for a short time so they can find the right combination that works best. Keep charging forward, there is life after diagnosis!

Answer 5

It's tough, because everybody has a different chemical reaction. Sometimes people have to change meds because their body gets 'immune' to it over a period. Try a search on google: Bipolar, medication, low side effects
Zoloft was successful for a friend, but then her chemistry is different from yours. You have to try them out...dont be under too much stress or pressure when you do, because it may make life more complicated. And then see what works best for you. Good luck. It's a fine balance...especially when weight gain and sleepiness are side effects.

Answer 6

Depakote is usually the first choice, but it varies for everybody. That's why it's important to be seeing a good psychiatrist. Psychiatry is an art not a science. If all the answers were cut and dried, clerks, not shrinks could prescribe the medications.

Answer 7

My grandson takes seroquel and depakote. He's gained some weight with the seroquel but he is so much better than he was without the meds.

Answer 8

I've found regular meditation works for me instead of drugs.

Answer 9

General Goals of Therapy

Bipolar is a recurrent disease and its course is unpredictable. The major goals of treatment, then, are the following:
To treat and reduce acute episodes of mania or depression when they occur.


To reduce the frequency of episodes.


To avoid cycling from one phase to another.


To help the patient function as effectively as possible between episodes.
First, the physician will try to determine conditions that might have precipitated the attack and identify any accompanying medical or emotional problems that might interfere with or complicate treatment.
Challenges of Bipolar Treatment

The treatments for bipolar disorder, while very effective, pose some specific challenges that the patient must be aware of:
Because the mood variations in bipolar disorder are not predictable, it is sometimes difficult to tell if a patient is responding to treatment or simply coming out of a phase naturally.


A bipolar disorder patient is not always reliable in reporting the state of the illness to the physician.


The patient is likely to need more than one medication during the course of the disease; at some point all have at least some distressing side effects. Noncompliance is common.


Patients often have more than one disorder and need different drugs (which may interact with each other) for each disorder. For example, children with bipolar disorder have a higher risk for attention deficit-hyperactivity disorder, which is treated with stimulants that can complicate treatment plans.


Family members who have not been educated about the disorder may undermine the treatment regimens.


Treatment strategies for children and the very elderly have not been intensively studied and have not been clearly defined.


Treatments may be costly.
Specific Treatment Choices

The following are the treatment options for most patients with bipolar disorder, depending on the bipolar disorder phase or episode. Patients should understand that, even with aggressive therapy, either mania or depression recurs in almost three-quarters of patients.

Mood-Stabilizing Drugs. Mood stabilizing drugs are the mainstay medications for bipolar disorder. They are defined as drugs that are effective for acute episodes of mania and depression and that can be used for maintenance. The currently available standard mood stabilizers are lithium and valproate. Both drugs stimulate the release of the neurotransmitter glutamate, although they appear to work through different mechanisms.
Lithium is the best drug for people with pure mania characterized by euphoria and pure depression.


Valproate is the drug of choice for many patients with mania, rapid-cycling, and mixed states, and for patients who are also substance abusers.


Lamotrigine, an antiseizure agent, is proving to be an effective mood-stabilizer for bipolar disorder patients and is more effective for depressive episodes than is lithium.


Other drugs that have mood stabilizing properties include some agents known as atypical antipsychotics (e.g., risperidone and olanzapine) and other anti-seizure agents (e.g., carbamazepine and topiramate.)
Other Drugs. Depending on the phase or the treatment success of the mood stabilizers, other agents are often used, including anti-psychotic agents, particularly atypical drugs and novel anti-seizure drugs. Additional drugs, such as antidepressants and antianxiety drugs, and experimental treatments are used as necessary.

Electroconvulsive Therapy. Electroconvulsive therapy may be administered in certain patients for acute episodes or for maintenance.

Non-Medical Treatments. In addition to medical treatments, psychologic therapies and sleep management are also extremely critical components of bipolar disorder treatments to reduce bipolar disorder symptoms and to help the patient manage and even prevent relapse.
Treatment Guidelines for Acute Manic Episodes

Step 1. Determination of Hospitalization and Elimination of Triggers. The first step in treating an acute manic episode is to rule out any life-threatening conditions and discontinue therapy with antidepressants or other mood elevators. Patients often require hospitalization at the onset of acute mania. The need for hospitalization depends on a number of factors, including the following:
Whether the patient is at risk for suicide or for harming others.


The availability of social and emotional support at home.
In any case, physicians must often try different agents to control a manic episode, usually adding them one at a time to the regimen if the current drugs are not effective.

Step 2. Control of Acute Symptoms with a Mood Stabilizer. Initiating a mood stabilizing drug is always critical:
Valproate is now usually preferred for most manic episodes.


Lithium or carbamazepine is another option.


Olanzapine (Zyprexa), known as an atypical agent, has recently been approved for manic episodes. In a direct comparison with valproate, 49% of patients experienced improvement compared to 38% for valproate. Olanzapine has not been studied for very long, however, and it may have more side effects than valproate, particularly weight gain.
Some experts recommend a combined program of valproate and lithium as first-line treatment for manic episodes in bipolar disorder patients. It may take several weeks for a mood stabilizer to be effective and other agents may be needed.

Step 3. Addition of Other Agents to Reduce Acute Symptoms and to Achieve Stable Remission. Other treatments may be added to speed up recovery, treat any psychosis, and achieve remission. They include any of the following:
Antipsychotic (also called neuroleptic) drugs, such as haloperidol (Haldol). Neuroleptics can cause severe side effects, particularly those known as extrapyramidal effects, which disrupt motor control and are similar to symptoms of Parkinson's disease.


Alternative antipsychotics, known as atypical drugs, are now proving to be very effective. Other atypicals include clozapine (Clozaril), risperidone (Risperidal), and quetiapine (Seroquel).


Antianxiety drugs, known as benzodiazepines, usually clonazepam (Klonopin) or lorazepam (Ativan) may be a good choice, particularly if the patient is experiencing severe mania.


Electroconvulsive therapy helps patients who do not respond to medication, and they may be life-saving in elderly patients with severe late-onset mania.
Step 4. Termination of Drug Treatments. Drugs may be stopped under the following circumstances:
Side effects are intolerable.


The patient does not respond to the maximum dose.


The patient improves and recovery is sustained. In such cases, the neuroleptic or benzodiazepine drug is slowly withdrawn and only the mood-stabilizing drug is continued.
Step 5. Continuation of Mood Stabilizers. Mood stabilizers are typically continued for about eight weeks, unless the patient shows signs of shifting to another mood state. If the patient remains stable at that time, the physician may decide to continue maintenance treatment or to gradually withdraw medications.
Treatment Guidelines for Depressive Episodes

Depressive episodes pose a particular challenge. They are a significant cause of suffering and yet the use of standard antidepressants poses a significant risk for triggering mania. (It appears to be lower with some newer antidepressants.) Some experts recommend the following approach for treating depressive episodes, particularly for patients with bipolar disorder type I:
Use mood stabilizers as the first-line treatment. (About half of all bipolar disorder patients with depressive episodes will respond to this treatment.) Lithium and valproate are the standard mood stabilizers, but evidence suggests that lamotrigine, another anti-seizure agent, may be a beneficial mood stabilizer for depression episodes.


If improvement does not occur within two to four weeks, then an antidepressant drug may be added. The first choices are either unique antidepressants, such as bupropion (Wellbutrin) or venlafaxine (Effexor), or a selective serotonin reuptake inhibitor (SSRI), such as paroxetine (Paxil) or sertraline (Zoloft). In one study only 12% of those taking these antidepressants switched to mania during treatment, with the risk being highest in those with 20 or more previous manic episodes. Even in rapid cyclers, the switch-rate was relatively low when patients also took mood stabilizers.


Patients whose depression does not respond to these agents may try other antidepressants, particularly monoamine oxidase inhibitors, such as tranylcypromine (Parnate), or venlafaxine (Effexor), a newer "designer" antidepressant. (Electroconvulsive therapy is another option for depression that does not respond to less intense approaches.)


Any patients on antidepressants who develop symptoms of hypomania should stop taking them, since this is often a sign of impending mania. All antidepressants should be tapered after the mood has been stabilized for a month.
Of some concern was a study reporting a paradoxical response in which manic symptoms developed in some patients when they discontinued antidepressant therapy, even though they were also receiving mood stabilizers.

Other drugs sometimes used for depressive episodes include the following:
Severely depressed and delusional patients may require an antipsychotic medication.


Small studies indicate that a subgroup of patients may respond to thyrotropin-releasing hormone, a substance that regulates thyroid hormones.
[For more information, see What Are the Major Drugs Used for Bipolar Disorder, below.]
Treatment Guidelines for Mixed Episodes and Rapid Cycling

At one time, patients with rapid cycling were treated with a single drug, but now treatment typically involves the use of three or four drugs. There are different approaches:
Mixed states and rapid cycling tend to be more resistant to lithium, and so valproate in combination with other agents is a reasonable choice. One approach uses valproate first, followed by carbamazepine, and then a combination of carbamazepine and lithium.


The newer antiepileptic drug lamotrigine is proving to be effective for rapid cyclers, particularly those who have severe depression. In one small 2000 study, lithium was effective in less than half of the patients, while 86% of patients who took lamotrigine experienced fewer than four episodes in a year.


Atypical drugs, such as clozapine, may also be useful in some patients.


One biologic mechanism involved with rapid cycling is an excessive influx of calcium into brain cells. Cardiovascular drugs called calcium channel blockers, such as nimodipine, are proving to be beneficial. Nimodipine has been shown to reduce hypomania and is particularly effective when added to carbamazepine.


In some cases, using levothyroxine, which is a synthetic derivative of T4 (thyroxine), a thyroid hormone, has helped stabilize rapid-cycling patients. Because of possible problems with long-term use of thyroid hormone, however, other agents should be tried first.


Electroconvulsive therapy can be useful in emergency situations.
In addition, other measures should be taken:
Patients should avoid anti-anxiety drugs, alcohol, caffeine, and stimulants. Rapid cycling between manic and depressive poles has been treated with antidepressants, but experts now believe they should also be avoided or used with caution.


Patients should also avoid exposure to bright light.


All efforts should be made to help the patient sleep normally.
Treatment Guidelines for Maintenance

Drugs Used During Maintenance. Relapse occurs in most patients after treatment of acute attacks, and patients who are at high risk for recurring episodes should consider lifelong maintenance therapy, generally using mood stabilizing agents.
Lithium is the standard mood stabilizer.


The anti-epileptic agent valproate is another option. Valproate is more effective for patients who have had multiple manic episodes.


Carbamazepine, another anti-epileptic agent, is a third alternative.


The atypical drugs, clozapine (Clozaril), olanzapine (Zyprexa), and risperidone (Risperidal) are proving to be useful, particularly in combination with mood stabilizers.
A 2000 study reported that valproate posed a better outlook than lithium, although the study was limited. In another 2000 study, there were no significant differences in effectiveness between the agents. But there were some differences in side effects:
Valproate caused greater weight gain than placebo and more sleepiness, infection, and ringing in the ear than lithium.


Urinary frequency was greater with lithium.
Nevertheless, two 2000 studies found no differences in drop-out rates between the two agents. Lithium is certainly the best and longest studied mood stabilizer. So, for purposes of this report, the guidelines for maintenance treatment use lithium as its basis:
The earlier lithium is started in the disease process the more effective it is. Studies are showing that patients on long-term lithium therapy have survival rates comparable to the general population, but those who permanently drop out of therapy have significantly lower survival rates. In one study, patients who stopped taking it increased their risk of suicide in the first year 20 fold.


Lithium is still effective for patients who discontinue and then restart treatment again later on. In such cases, however, there may be a greater need for drug combinations. In addition, patients who stop and start again may be at higher risk for hospitalization than those who use the drug continuously.


For those who want to stop, a gradual discontinuation (over 15 to 30 days) may help to delay recurrence. Stopping it quickly poses a high risk for suicide and relapse.
Electroconvulsive Therapy. Some studies are finding that maintenance electroconvulsive (ECT) therapy may be helpful for those who do not respond to medications. In one study of bipolar disorder patients, those who had intractable recurrent episodes were maintained on monthly ECT treatments for more than a year and a half. Without ECT, those patients spent an average of almost half a year in the hospital, suffering at least three episodes annually. After ECT treatment, all the rapid cyclers achieved full or partial remission.