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Mental Illness Guide: Care, Support, and Education
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Understanding Bipolar Disorder - Medications


Mood-stabilizing medications, like lithium, can bring an acute episode of mania to a halt and can also prevent future episodes from occurring. After the first episode of bipolar disorder, it is likely that another episode will follow in a year or two or three, but taking a medication like lithium can cut the risk of reoccurrence in half or better. Taking a mood stabilizing medication also greatly decreases the risk of dying by suicide. You should consider the benefits of medication for both acute and preventative treatment.

Acute and preventative treatment

The medications you may take in the acute phase of treatment may be different from those used during the maintenance or prevention phase.

Acute treatment is designed to bring you down from a manic high or up out of a depressive phase. The acute phase of treatment may last just a few weeks or months. The medicines you take during this phase are likely to be a combination of mood stabilizers and antipsychotic medications.

The maintenance phase, on the other hand, could go on for years, and may only require that you take a mood stabilizer. You may be feeling just fine and thinking you can stop using the medication, but remember that the medication you take in the healthy, maintenance phase could well be protecting you from suffering episodes of mania or depression.

Sometimes, maintenance medications may not completely prevent episodes of illness, but they can reduce the intensity of symptoms to such an extent that you can tolerate the milder symptoms and keep working or going to school. This is a lot better than having a full-blown episode and ending up in the hospital and losing your job and your friends and other important connections to the world around you.

How long do I have to take medication?

After the first severe episode of bipolar disorder, especially a manic episode, it can be hard to decide whether you should take maintenance medications. The remission between the first and second episode could last for years or not. No-one can predict. The things to talk with your doctor about are:

  1. How severe was the first episode? How badly did it mess up my life? How important is it to prevent that from happening again?

  2. Have I been getting episodes of depression mild, moderate or severe before the episode of mania, that might be prevented or decreased in intensity if I were to take medication?

  3. How much do I dislike taking medication every day?

  4. Do I get any significant side effects from the medications?

When the illness is more advanced when the frequency and severity of episodes is more apparent the decision about whether or not to take preventative medication gets a lot clearer. Bipolar disorder does not get milder as it advances. In fact, each episode of illness makes it more likely that you will experience another one sooner rather than later. Taking maintenance medication will make it much likelier that you will put off the next episode and have a milder, more benign course of illness.The depressive episode may be free of psychotic symptoms but, when delusions are present, they often focus on death, disease, or guilt about some imagined offence, and hallucinations are likely to be critical or abusive in nature.