After remission from an acute episode of mania or depression, people with bipolar disorder are at an especially high risk of relapse for about six months. So, continuation and maintenance of (ongoing) therapy is often recommended as treatment.
Anyone who’s experienced two or more episodes is generally considered to have bipolar disorder, a chronic condition, where the goal focuses not only on treating current symptoms but also preventing future episodes. This should include maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase (either a manic or depressive episode), drug therapy is continued indefinitely — sometimes at lower doses.
It’s important to remember this: Even if you’ve been without bipolar symptoms for several months, don’t stop taking your medications. Your doctor may lower your doses, but stopping medications puts you at risk for bipolar symptoms to come back.
The most successful strategy is to keep taking the medication that helped control the acute episode.
FDA-approved medications for maintenance therapy for bipolar disorder include options such as:
- Aripiprazole (Abilify)
- Lamotrigine (Lamictal)
- Lithium
- Olanzapine (Zyprexa)
- Olanzapine and samidorphan (Lybalvi)
- Risperidon consta (Consta)
- Quetiapine (Seroquel)
- Ziprasidone (Geodon)
These medications can differ in their ability to prevent manic versus depressive episodes, as well as in their side effects. However, many other drugs used to treat manic episodes are also used for maintenance treatment.
These drugs include:
A combination of these drugs may also be used.
Lamotrigine (Lamictal) for Bipolar Disorder
Lamictal is approved by the FDA for the maintenance treatment of adults with bipolar disorder. It can help delay bouts of depression, mania, hypomania (a milder form of mania), and mixed episodes in those being treated with standard therapy. It’s especially effective in the prevention of bipolar depression. It was the first FDA-approved therapy since lithium for maintenance in bipolar disorder.
Lamictal is considered a mood-stabilizing anticonvulsant and is most commonly prescribed to prevent or control seizures in the treatment of epilepsy. Recent studies have shown it may possess antidepressant effects in bipolar disorder.
Lamictal side effects
Lamictal comes in several types of tablets, such as chewable or orally disintegrating. It adds to the effects of other central nervous system suppressants such as alcohol — and to those found in many antihistamines, cold medications, pain medications, and muscle relaxants. Check with your doctor before taking any of these.
About 3 out of every 1,000 people taking Lamictal will develop a rash. Sometimes, the rash can prove serious or even fatal. If a rash develops, you should consult your doctor immediately. They may tell you to stop the drug right away.
Common side effects of Lamictal include:
Sometimes, medication errors happen when filling lamotrigine prescriptions because other drugs have similar names, like labetalol, Lamisil, lamivudine, Lomotil, and Ludiomil. To avoid confusion, make sure the drug name is clearly written on your prescription.
Lithium for Bipolar Disorder
Lithium (brand names include Eskalith or Lithobid) is the most widely used and studied medication for treating bipolar disorder. It’s been used for more than 50 years and helps reduce the severity and frequency of manic states. It may also help ease depression.
People with bipolar disorder may take lifelong lithium as maintenance therapy to prevent relapses. Stopping taking lithium significantly increases one’s chances of experiencing a recurrence of a bipolar episode.
Studies show that lithium can significantly reduce the risk of suicide among people with bipolar disorder. It also helps prevent future manic episodes.
Lithium is a simple salt that acts on a person's central nervous system. Doctors don’t know exactly how lithium works to stabilize mood. But it helps people with bipolar disorder feel more in control over their emotions and cope better with the problems of daily life.
When lithium is used as part of maintenance therapy for bipolar disorder, your doctor will want to take regular blood tests during your treatment because it can affect kidney and thyroid function. Blood tests will also help your doctor monitor the level of lithium in your blood. Your doctor will also probably suggest you drink 8-10 glasses of water or fluid a day during treatment and use a normal amount of salt in your food. Both salt and fluid can affect the levels of lithium in your blood, so it's important to consume enough every day.
Lithium side effects
About 75% of people who take lithium for bipolar disorder have some side effects, although they may be minor. Sometimes, changing the dose can ease side effects. Never change your dose or drug schedule on your own. If you’re having problems, talk to your doctor about your options.
Common side effects of lithium include:
- Weight gain
- Impaired memory
- Poor concentration
- Confusion
- Mental slowness
- Hand tremor
- Sedation or lethargy
- Impaired coordination
- Nausea, vomiting, or diarrhea
- Hair loss
- Acne
- Excessive thirst and dry mouth
- Excessive urination
- Decreased thyroid function (which can be treated with thyroid hormone)
Particularly bothersome tremors can be treated with additional medication.
There are a few serious risks to consider. Lithium may weaken bones in children. The drug has also been linked to a specific birth defect in heart valve formation occurring in 1 in 1,000 to 1 in 2,000 people and should be administered with caution to pregnant women. Also, in a very few people, long-term lithium treatment can interfere with kidney function.
