When might I need medicines for bipolar disorder?

Bipolar disorder is a serious, chronic (ongoing) mental health condition that involves having extreme mood changes.

If you have bipolar disorder, you can have episodes of both:

• depressed mood
• mania — feeling very euphoric or high

This is why the condition used to be called 'manic depression'.

Bipolar disorder can be treated with a combination of medicines and psychotherapy. Each person with bipolar disorder should have an individual treatment plan.

Medicines are a key part of the immediate and long-term treatment of bipolar disorder.

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). For help and support, call Lifeline on 13 11 14.

How do medicines for bipolar disorder work?

Medicines for bipolar disorder work by adjusting an imbalance in the chemicals in your brain. Medicines can help to:

• treat episodes of depression
• treat episodes of mania (or hypomania)
• reduce the chance of these episodes from happening again

Most medicines for bipolar disorder come as a tablet that you take every day. If you are having an episode of sudden, severe mania, you may need an injection.

What types of medicine might I be prescribed for bipolar disorder?

You and your doctor will need to work together to find out which medicines are best for you. Sometimes the first one that you try isn't quite right.

Many people will need a combination of medicines. It's important to talk to your doctor and work with them to find the right medicine to help with your symptoms.

Some of the types of medicines that your doctor could prescribe are:

• mood stabilisers
• anticonvulsants
• antipsychotics
• antidepressants

Mood stabilisers

Mood stabilisers are medicines that treat or prevent mania by reducing mood swings. They include:

• lithium, which is commonly used as a long-term treatment
• anticonvulsant medicines, such as sodium valproate, carbamazepine and lamotrigine

Antipsychotic medicines

You may need an antipsychotic medicine if you have symptoms such as:

• hallucinations (hearing or seeing things that are not there)
• delusions
• extreme agitation

Antipsychotic medicines include:

• aripiprazole
• quetiapine
• olanzapine
• risperidone
• asenapine
• haloperidol

Your doctor might suggest an antipsychotic medicine in the short term to treat an episode of mania. Some people with bipolar disorder take an antipsychotic medicine long term.

Antidepressant medicines

Antidepressants can be used to treat episodes of depression. You will most likely need to take a mood stabiliser as well.

Don't stop your medicines or adjust doses without talking to your doctor.

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How long will I need to take medicines for bipolar disorder?

Bipolar disorder is a chronic condition. Most people continue treatment for years.

Always take medicines for bipolar disorder as prescribed. Talk to your doctor before:

• changing your dose
• stopping a medicine
• starting a medicine

Sudden changes to your medicines and doses can cause serious side effects and increase your chance of relapse (getting worse again). It's also important to tell your doctor about any other medicines you take, including over-the-counter and herbal medicines.

Some other medicines can interact with the medicines you take for bipolar disorder.

What are the possible side effects of medicines used for bipolar disorder?

Medicines used to treat bipolar disorder can cause side effects in some people. Side effects can be serious, but often they are not.

Talk to your doctor or pharmacist about side effects to look out for with your new medicine.

Lithium

Side effects of lithium can include:

• tremor
• weight gain
• drowsiness
• thyroid problems
• nausea, abdominal pain or diarrhoea
• muscle weakness
• memory problems

Some of these side effects may improve as your body gets used to the medicine.

Lithium can be very effective for control of bipolar disorder. But the amount of lithium can slowly build up in your body. If the level of lithium in your body gets too high, it can eventually cause harm to your:

• thyroid gland
• kidneys
• central nervous system

If you are taking lithium, you will need regular blood tests to make sure the dose is right for you (see below).

Anticonvulsant mood stabilisers

These mood stabilisers, such as valproate, can cause side effects including:

• drowsiness
• weight gain
• dizziness
• tremor
• diarrhoea
• nausea

These medicines can also cause liver problems.

Antipsychotic medicines

Side effects of antipsychotic medicines can include:

• drowsiness
• weight gain, type 2 diabetes or increased cholesterol
• dry mouth
• problems with sexual function
• constipation
• blurred vision

Antidepressants

Antidepressants can cause side effects in some people. These may include:

• nausea
• weight gain
• tiredness or agitation
• dry mouth
• sexual problems

The side effects will depend on the type of antidepressant you have been prescribed. Ask your doctor or pharmacist about the medicine you are taking.

What is lithium toxicity?

If you have too much lithium in your body, it can be toxic.

Your doctor will refer you for regular blood tests to make sure your lithium levels aren't too low or too high.

Contact your doctor immediately if you are taking lithium and you have new symptoms, including:

• nausea, vomiting or diarrhoea
• increased thirst
• often needing to urinate (do a wee)
• difficulty concentrating
• unsteadiness

Tell your doctor straight away or go to the nearest hospital emergency department if you notice any signs of lithium toxicity.

To reduce your chance of getting lithium toxicity you can:

• keep your salt and caffeine intake at about the same level each day — sudden changes can affect your lithium levels
• avoid drinking alcohol
• drink 8 to 10 glasses of water a day

Your doctor and pharmacist can tell you about medicines that you should avoid when taking lithium.

When should I see my doctor?

You should see your doctor if you are still having symptoms despite treatment. You should also see your doctor if you have any side effects. Your medicines may need to be adjusted or changed.

For most people, the benefits of treatment outweigh the downside of taking medicines for bipolar disorder. But don't be shy about asking your doctor any questions that you have about these medicines.

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Are there any alternatives to taking medicines for bipolar disorder?

Several treatments are usually used in combination to treat bipolar disorder. These include medicines and psychotherapy.

Other things that can help you manage bipolar disorder include:

• doing regular exercise
• maintaining a stable sleep schedule
• eating a healthy diet
• asking for support from your family and friends
• contacting a bipolar disorder support group

But these should not replace the treatments your doctor has prescribed for you. They should be used in combination.

If your condition is severe, you may need electroconvulsive therapy (ECT).

Resources and support

Talk to your doctor, pharmacist or other health practitioner if you have questions about your medicines.

You can find out more about your medicine by reading the Consumer Medicine Information (CMI) that comes with it.

Call 1300 MEDICINE (1300 633 424) to speak with a pharmacist who can answer your questions about medicines.

Visit SANE Australia for information and support for people with mental health conditions or call 1800 187 263.

Visit Lifeline Australia or call 13 11 14 for crisis support, 24 hours a day.

Read the personal stories of other Australians living with mental health conditions at the Black Dog Institute.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.