Information in this post is NOT medical advice; it’s provided for educational purposes only. Please consult with a doctor and/or a mental health professional for any medication changes.
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Not really sure where this list came from, but I have a lot to add! Pharmacy background (not a doctor) here (in the US so YMMV) and Bipolar 2 with anxiety features and ADHD. I am only speaking from my educational background and this is most certainly not medical advice.
Typically these days AEDs are first line along with antipsychotics if the patient is distressed. Personally I take Lamictal and used to keep an emergency stash of antipsychotics but I don’t metabolize them well. Lithium seems to be a last resort kind of thing because of the small therapeutic range. It’s hard to ensure continuous blood level monitoring, but from what I hear from other pts is good things.
Drugs affecting serotonin should be used with extreme caution. These primarily include SSRIs SNRIs but also some drugs you might not expect. Trazodone indicated for sleep, buspirone indicated for anxiety, Zolfran indicated for nausea are a few on the top off my head but is not an exhaustive list. The fastest I have ever achieved hypomania was buspirone in about 2 weeks. In comparison it took about 4 months for Zoloft.
Benzodiazepines are the black sheep in pharmaceuticals in my opinion. The therapeutic range is huge so the odds of overdose are near 0. Primarily for anxiety, some of these drugs have a very mild mood stabilization effect. They also help reduce excess movement tardive diskenesia from long term antipsychotic use. Personally, I have never had to increase my dose and have been on a regular low dose schedule for about 4 years, but they can be addictive.
Beta blockers- Propranolol is unique in that it’s not selective as to which beta receptors it affects. Long story short, can prevent adrenaline rushes and in turn prevent anxiety attacks.
Stimulants are typically not advised but I’m sure a lot of people on here have comorbid adhd and can understand the value. Data on this is a bit polarized (pun intended). My opinion that is purely anecdotal to my experiences trying to find the right treatment is that providers only seem to care about preventing mania and rarely seem concerned about all the other facets of mental health once the BD is slapped on my chart. I’m lucky after 15 years to have found a provider who treats me as a whole person and sees that if I cannot manage my hyperactivity and regulate my emotions, then I say or do things impulsively that end up growing into larger mood episodes.
Sorry for editorializing this so much. I find chemistry fascinating
Thank you for such an insightful comment! Lots of great info here.
Drugs affecting serotonin should be used with extreme caution. These primarily include SSRIs SNRIs but also some drugs you might not expect.
Definitely agree. I may add a link to some antidepressant research in this post for educational purposes.
My opinion that is purely anecdotal to my experiences trying to find the right treatment is that providers only seem to care about preventing mania and rarely seem concerned about all the other facets of mental health once the BD is slapped on my chart.
I feel this so much. I'm so lucky to have my psychiatrist who sees me holistically. I also have ADHD and take dextroamphetamine. My life changed in an instant when I started on stimulants, I actually could function. They have not triggered any manic episodes; I'm also on lamotrigine, and it keeps me pretty stable.
If you would like to lookup your medications, here is the NLM website. Just type in the drug, select any form (tablet, capsule, etc) and look for package insert information.
I recently did this with lamictal as I’ve been on it since 2016 and found it to have a new black box warning about heart issues that I wish had been known before I had said heart issues.
Good list, I'd also like to add Asenapine (saphris). It's an atypical antipsychotic. I had a lot of trouble finding a med that worked well without having terrible side effects. I started this about two years ago and in combination with my lithium, it's been a godsend, I've never felt more even-mooded for this long a duration ever before.
Thank you so much, I added it to the list. I feel like the new atypical antipsychotics are great, for me it was Vraylar (cariprazine) that helped a ton along with lamotrigine.
They've definitely come a long way with medicinal treatment for bipolar, even just in the last 20 years. When i was first diagnosed the meds helped level out the bipolar symptoms, but basically made me a zombie; now the meds successfully even me out, but I'm still functional.
While finding out your dose did you ever get songs playing in your head absolutely non stop? Around 125-150 I seriously had my own personal radio station going on 24/7. I then looked on Reddit and it is supposedly a thing
I’m at 100mg now curious if 200mg can make things even better for me. I hear different stories of people staying at 100 and others saying 200 is the best therapeutic level. 100mg has calmed my anger outbursts so much.