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Clinician’s Corner: Bipolar Disorder

Bipolar disorder: People who live with bipolar disorder experience periods of great excitement, overactivity, delusions, and euphoria (mania) and other periods of feeling sad and hopeless (depression).

Mood stabilizers (lithium, valproate,carbamazepine, lamotrigine) are the cornerstone of the drug therapy of bipolar disorder. Antipsychotics, alone or in combination with mood stabilizers, are also commonly used.

Mood swings OR bipolar disorder? Patients with mood swings experience fluctuations in mood are caused by a situation, person, or events in their lives. While the moods of people with bipolar disorder can be affected by situational variables, people with bipolar disorder also frequently become manic or depressed for no apparent reason.

Duration: Bipolar patients experience an elevated or irritable mood for at least four consecutive days. A patient with bipolar may have depressive episodes that last for at least two weeks at a time.


In addition to preventing relapse in patients with bipolar disorder, maintenance Drug therapy may be associated with reduced rates of violent behavior. A national registry study identified 494 convictions for violent crime (eg, assault, robbery, or threats/intimidation) in 11,918 patients with bipolar disorder and examined the time periods when patients were or were not prescribed mood stabilizers (eg, lithium, valproate, lamotrigine, or carbamazepine) or antipsychotics.

The rate of violent behavior when mood stabilizers were prescribed was 60 percent less, compared with times when mood stabilizers were not prescribed. In addition, prescription of antipsychotics was associated with a 50 percent decrease in interpersonal violence.


History: The first recorded use of lithium for the treatment of mania, based in part on the urate/lithium connection, was 1871. Use of lithium carbonate to prevent depression came in 1886. In 1948 an Australian psychiatrist started using lithium after he treated guinea pigs and noticed they became more docile.  It wasn’t until 1970 the FDA approved lithium, under the trade names of Lithonate® and Eskalith® for the treatment of mania.

Common use: Lithium is effective for prevention of both manic and depressive episodes. Lithium also reduces the risk of suicide, perhaps by reducing agitation and impulsivity.

  • Considered drug of choice for maintenance treatment of bipolar disorder.
  • Considered drug of choice specially to PREVENT manic episodes
  • Using lithium reduces the risk of relapse by approximately 30 percent.

Adverse effects:  fine hand tremor, frequent urination, mild thirst, nausea, hair loss & metallic taste.


  • Draw lithium blood levels 12 hours after last dose.
  • Check lithium blood levels: 5-7 days after initiation & any change in dosage.
  • Maintenance: every 1-2 months.    In stable patients 6-12 months.
  • Monitor more frequently if dehydration, or diuretic use, diarrhea or vomiting.
  • Check thyroid and kidney function before starting lithium and every 6-12 months.
  • Hypothyroidism can occur and contribute to bipolar fluctuations.

Your Thompson Pharmacist is a great resource for information for mental health disorders.  We can help you select over-the-counter medicines for a variety of ailments that are safe with your mental health drugs.  It’s our job to help you get the most from your therapy. Go Ahead and ASK… at Thompson Pharmacy it’s ALL for YOU!