Introduction to Bipolar Medications

During depression, clients have low mood, low energy, & motivation & high risk for suicide. During mania, they experience high energy, hyperactivity, elevated mood, and violent aggression. 

While the exact cause of bipolar disorder is unknown, it’s thought to be a combination of genetic, environmental, and psychological factors. Manic episodes can last anywhere from a few days to several months, and depressive episodes can last as long as a year.

The symptoms of bipolar disorder can vary from person to person but generally include:

• Excessive energy
• Irritability or anger
• Reduced need for sleep
• Unrealistic optimism about personal abilities or achievements
• Grandiose beliefs about one’s abilities or importance (thinking that one is a celebrity or can perform miracles)
• Racing thoughts or rapid speech pattern

Medications to treat Bipolar disorder include anxiolytics, antidepressants, and mood stabilizers (also called anti-manic medications). These medications can work by stabilizing mood, preventing depressive and manic episodes, reducing anxiety and stress, and managing depression. They can be used alone or in combination with other medications.

Anxiolytics for Mania

Anxiolytics can be used to treat mania (manic episodes) in bipolar disorder. Manic episodes are characterized by euphoria, racing thoughts, grandiosity (thinking you’re better than everyone else), and hyperactivity. 

The treatment of mania in bipolar disorder is a complex process. Anxiolytics help calm anxiety and reduce stress, and can be used alone or as part of a treatment plan for mania.

Benzodiazepines and barbiturates are common types of anxiolytics used for treating mania in bipolar disorder because they have sedative effects. Bipolar clients need to take these medications every day for at least six weeks before they start working properly.

Benzodiazepines

Benzodiazepines typically end in “-lam” or “-pam,” which include:

• Alprazolam
• Midazolam
• Temazepam
• Clonazepam

Indication: Reducing anxiety and seizures.

Mechanism of Action: Increases gamma-aminobutyric acid (GABA).

Side effects: Low and slow vitals and brain activity.

Barbiturates

Phenobarbital

Indication: Treating anxiety and seizures. 

Mechanism of Action: Suppressing the central nervous system and decreasing anxiety.

Side effects: 

• Dizziness
• Blurred vision
• Nausea
• Vomiting
• Constipation
• Loss of appetite

Buspirone

Indication: Increasing serotonin activity in the brain. 

Mechanism of action: Relieving symptoms of anxiety and depression.

Side effects: 

• Drowsiness
• Dizziness
• Headache
• Nausea

Antidepressants

Antidepressants are a common treatment for bipolar disorder, and there are several types including: SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), TCAs (tricyclic antidepressants), and MAOIs (monoamine oxidase inhibitors).

Antidepressants help relieve symptoms of depression by increasing neurotransmitters in the brain that contribute to feelings of well-being and happiness. They work by increasing the amount of serotonin and norepinephrine that is released in the brain. 

Nurses must be competent in all medication administration. Four key points to remember when educating and administering antidepressant medications are:

1. Antidepressants can increase suicidal thoughts in the first few weeks of treatment. Teaching clients with new prescriptions and their families to monitor new thoughts of suicide, unusual behavior, or worsening depression.
2. When clients stop using antidepressants, remember slow onset and slow taper off – never stop them abruptly.
3. Never mix St John’s Wort with Antidepressants.
4. All psychotropic drugs cause weight changes and decrease blood pressure.

SSRI Drugs 

Selective serotonin reuptake inhibitors (SSRIs) can balance the mood swings of clients with bipolar disorder by regulating the neurotransmitters in their brain. These neurotransmitters are responsible for moods and can cause depression or mania episodes.

SSRIs are often prescribed as an alternative to other types of bipolar medication because they generally have fewer side effects than most other types of antidepressants, and don’t interact with alcohol like tricyclics or MAOIs.

SSRI drug list:

• Sertraline
• Citalopram
• Escitalopram
• Paroxetine
• Fluoxetine

SNRI Drugs

Selective serotonin and norepinephrine reuptake inhibitors (SNRIs) are a newer class of antidepressants, and are less likely to cause side effects like weight gain, sedation, and sexual dysfunction. SNRIs work by increasing the amount of these neurotransmitters in the brain. 

SNRI drug list:

• Desvenlafaxine
• Duloxetine

TCA Drugs

Tricyclic antidepressants (TCAs) are a type of medication used to treat bipolar depression. They block the reuptake of serotonin and norepinephrine – meaning that instead of natural brain chemicals being used up by synapses, they stay in clients’ bodies longer, making them feel less depressed.

TCAs are particularly useful when clients are experiencing rapid cycling (swinging between mania and depression quickly) or mixed states (experiencing both mania and depression at once).

TCA drug list:

• Amitriptyline
• Amoxapine
• Desipramine 
• Doxepin
• Imipramine
• Nortriptyline 
• Protriptyline
• Trimipramine

MAOI Drugs 

Monoamine oxidase inhibitors (MAOIs) are commonly prescribed to treat bipolar disorder. These medications work by preventing the breakdown of certain neurotransmitters in the brain. The neurotransmitters involved are norepinephrine, serotonin, and dopamine — the same ones that are believed to be involved in many cases of bipolar disorder.

By blocking the breakdown of these neurotransmitters, clients’ moods can stabilize and prevent depressive episodes from occurring often.

MAOI drug list:

• Phenelzine
• Selegiline
• Isocarboxazid

Mood Stabilizers for Bipolar

Mood stabilizers are a class of drugs used to treat the symptoms of bipolar disorder. They work by stabilizing mood and reducing the risk of suicide, and are typically prescribed to clients having difficulty controlling their moods through other methods.

Carbamazepine, Valproic acid, and Lithium are the most common mood stabilizers. All three are used to treat mania and depression. However, carbamazepine is prescribed to treat seizures and trigeminal neuralgia, while valproic acid is prescribed to treat manic episodes of schizophrenia.

Carbamazepine

Carbamazepine is a mood stabilizer used to treat bipolar disorder, and is also used as an anticonvulsant and analgesic to treat epilepsy. It’s effective for both epilepsy and bipolar by blocking sodium channels reduces neuronal excitability, while increasing dopamine levels help stabilize moods.

Two main mechanisms of action make it effective: 

1. Increasing dopamine, which can help with mania.
2. Blocking voltage-gated sodium channels and potassium channels, which can help with depression.

Valproic Acid

Valproic acid is a medication that helps to treat and prevent bipolar manic episodes. It works by increasing the amount of GABA in the brain. GABA is a neurotransmitter that helps inhibit neurons from firing, which can reduce anxiety and help promote sleep.

Valproic acid also increases levels of serotonin in the brain, which can help improve mood and reduce symptoms of depression

Lithium

Lithium is a mood stabilizer that helps to keep these swings from happening as often or with such intensity. It affects how certain chemicals in the brain work together — specifically, it affects the balance of two neurotransmitters: serotonin and norepinephrine.

Bipolar Medications Toxic Signs

Nurses need to be aware of the signs and symptoms of lithium toxicity, such as:

• Sweating
• Nausea
• Dizziness or confusion
• Hallucinations
• Increased blood pressure
• Dyskinesia (involuntary movement)
• Decreased platelet count
• Increased (or decreased) white blood cell count
• Fever
• Heart arrhythmias 
• Liver enzyme elevation

Nursing Interventions for Bipolar Medications

Assess

• The client’s mood and any changes from the normal.
• The client’s ability to perform tasks that require mental alertness (such as driving a car or working with machinery).

Monitor

• Clients’ mood, behavior, and side effects of medications.

Perform

• Medication adjustments with changing side effects or mood changes.

Encourage

• The client exercises at least twenty minutes per day.
• Not skipping taking medications.
• Consistent routines with respect to meals, exercise, and sleep.
• Keep a journal of moods and activities, including dosage changes and side effects of medication.

Bipolar Medications Conclusion

Bipolar is a mood disorder defined by cycles of depression and mania. Clients with depressive episodes have low mood, little motivation, and a higher risk of committing suicide. During mania, they exhibit violent aggression, higher energy, hyperactivity, and an elevated mood.

Bipolar medications are used to treat symptoms of the disease in conjunction with psychotherapy, including mood stabilizers, anxiolytics, and antidepressants. They function by regulating clients’ moods and averting manic and depressed crises.

Anxiolytics also assist clients in controlling their mood swings by easing anxiety and stress symptoms. Antidepressants can be used alone or in conjunction with other drugs to treat the depression symptoms of bipolar disorder. Mood stabilizers aid in regulating mood changes and guard against recurrent manic episodes. 

Sources

https://www.verywellmind.com/anxiety-medications-380539 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213896/ 

https://www.healthline.com/health/bipolar-disorder/antidepressants 

https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/diagnosis-treatment/drc-20355961