11Medication therapy

Medication Treatment
Though bipolar illness is classified as a mental illness, its causes are quite physical in nature. As mentioned previously, evidence from psychiatric and neurological research strongly suggests that bipolar disorders are biologically based in the nervous, endocrine, and perhaps immune systems. The primary means of treating these disorders, medication, is correspondingly physical in nature and functions by directly manipulating brain and body chemistries. Talk therapies are not generally appropriate as primary means of treatment for bipolar disorders, although they can be quite helpful and even essential as adjunctive treatments.
Often two types of medications, antidepressants and mood stabilizers, are required for treating bipolar disorders. Antidepressants help the patient to come back "up" and out of depressive states, while mood stabilizers help to keep patients' moods even and centered as much as possible. There are also a few medications that have anti-manic properties that are used on occasion. Bipolar patients treated with antidepressants alone have a heightened risk of swinging into mania. Patients treated with mood stabilizers alone often end up spending more time in dangerous depressive states than is necessary.
Doctors confronted with a new case of depression can never be sure whether they are dealing with regular unipolar depression, or bipolar depression, as all depressions basically take similar forms. It would be easy for doctors to appropriately diagnose patients if they came in during period of mania, but of course, patients just don't do this typically, as they feel good during periods of mania. A doctor may start a given patient on a course of antidepressants, only to find that the patient becomes manic or hypomanic as a result. In such cases, the doctor must adjust and add medications so as to quickly and appropriately respond to the new, more complex bipolar symptom picture.
The list of drugs used to treat bipolar is extensive due to the complex and variable nature of the disorder and the complexities of individual reactions to medications (some of which have serious side effects). We describe and discuss the major medications used for treating bipolar disorders in the following sections.