Mania & Medication Choices
Various medications may be used in the treatment of hypomania or mania and a number of factors will be taken into consideration before one of more of these is prescribed. The severity and duration of symptoms is influential; whether other illnesses are being treated, the effectiveness or otherwise of previous treatments and of course, the financial costs all have to be factored in.
Not only do different drugs have different effects, but people react to them in very different ways. Because of this, the best therapeutic effect from medication rests on the relationship a patient is able to form with their doctor. This may involve a little trial and error and quite a lot of time.
In the case of mania or hypomania, lithium is the best known and most widely used form of medication. Its properties enable it to be effective during acute episodes as well as being used for longer-term maintenance. There are other effective forms of medication such as carbamazepine and valproate (divalproex) and a range of atypical antipsychotics like risperidone, clozapine, olanzapine and aripiprazole.
Just one of the problems facing a diagnostician is mixed state bipolar where depression is more obvious than mania. Misdiagnosis of depression is quite possible and the net result of prescribing antidepressants alone can cause hypomania or mania, mixed phases and rapid cycling. Because of this antidepressants are not advised in mixed states even when depression is the most marked symptom. This is why medicine in combination is frequently used as an alternative to antidepressants.
The term ‘mood stabilizer' is frequently used to describe the pharmacological effects of certain medication. During many conversations with people who take these drugs I realize the term can be loaded. For some, mood stabilization suggests long periods away from the extremes of mood they dislike. For others, mood stabilization is seen as little more than an agent of behavioral control, intended for the benefit of others. However, medication can only really be thought of as a mood stabilizer if its actions don't contribute to rapid cycling or an opposite mood episode. Mood stabilizers don't remove the cause of mood swings they simply help to regulate them.
Lithium is a simple naturally occurring salt known to be effective in people with classic symptoms of mania or hypomania. In most people therapeutic levels of lithium can take quite a while to become established and it's important to ensure blood levels don't tip over. For this reason period blood tests are taken. As a medication it is prescribed either as lithium carbonate (Camcolit, Liskonum, Priadel) or lithium citrate (Li-liquid, Priadel liquid).
Alternatives to lithium are also used according to symptoms. For example, lithium is not the first choice for rapid cycling bipolar, so sodium valproate or semi-sodium (Depakote) may be used as an alternative.
Managing the symptoms of mania is something that gets easier over time. Evidence seems to point to the fact that people who are able to respond to the warning signs have fewer relapses and enjoy better functioning in their working lives and relationships (Lam, 2001).