There have been major advancements in treatments for both depression and bipolar
disorder (or manic depression) in the past twenty years. Before your mental health
care professional prescribes medication for you, he or she should make sure that
your condition is not associated with any other medical problems. Once your doctor
decides that you are a good candidate for a medication regimen, they should explain
how the medication will work and the possible side effects you may encounter.
This is the time to inquire about the medications that your doctor is prescribing
-- don't be afraid to ask questions about your treatment.
Usually, if you are diagnosed with depression, your doctor will prescribe a
serotonin reuptake inhibitor (SRI). Today, most people are familiar with the most
popular of this family of the "designer" drugs -- Prozac (its chemical
name is fluoxetine). Prozac has been heralded as an "emotional Band-Aid"
and cure-all for depression, but you might also be treated with Zoloft, Effexor,
Paxilor, Wellbutrin, or Serzone. The problem with some of these drugs is that
when they are used to combat depression in the case of a bipolar patient, it can
induce mania and rapid cycling. For me, taking Prozac fueled my mania and put
me into very dangerous situations. For the most severe cases of depression, MAOIs
(monoamine oxidase inhibitors) are used -- these are the strongest antidepressants
available. Finally, you should be aware that your medication may have side effects
including drowsiness, weight gain, dry mouth and constipation. These medications
may also interfere with your sex drive.
Luckily most bipolar patients respond well to lithium, and need only to take
this one medication to control their illness. For the others who have no success
with lithium, there are other mood stabilizing medications, primarily Depakote
(its chemical name is divalproex sodium), which is used to control mania (it is
also used for seizures). In conjunction with lithium, it usually stabilizes the
bipolar patient. Other medications that can be used in conjunction with lithium
are Neurontin, Tegretol, Klonopin and Lamictal.
Bipolar patients who require anti-psychotic medication can also be treated
with Risperdal, Zyprexa, Haldol or Seroquel. With some of these medications there
are several risks:
* Tardive Dyskinesia (TD) may appear with use after extended periods
on the older anti-psychotics. The patient has uncontrollable movements and spasms
of the tongue, head, neck and even limbs.
* Parkinsonian Syndrome may occur and the patient may experience hand
tremors and muscle stiffness in the face and rigidity in the arms and legs. There
are medications to counter this side effect including Cogentin, Symmetrel and
* Akathisia is a symptom that causes the patient to be edgy and irritable
and it stems from the anti-psychotic. It can be treated with propranolol (which
is also used for tremors) or Valium.
It is important to remember that drug therapy may be complicated by alcohol
or substance abuse and the patient must closely monitor his habits and avoid self-medicating.
There are those patients, both unipolar and bipolar, who do not respond to
any type or combination of medication. Sometimes they spend years experimenting
with all kinds of medication, searching for the "cocktail" that will
cure them. Ultimately, their situation gets so severe (sometimes they even become
suicidal) that they are forced to opt for the last resort -- electroshock therapy.
It is interesting to note that some doctors choose ECT over a medication regimen
because they believe it is quicker and more effective.
Finally, pharmaceuticals alone are not enough. Psychotherapy, in addition to
a well monitored regimen of medication, helps the patient to understand his or
her illness and learn to live a fulfilling life with a mental illness.