An estimated 5.7 million American adults have bipolar disorder, which is a mental illness characterized by dramatic changes or shifts in mood, energy and intensity. Since there is no cure for bipolar disorder, the chronic illness requires lifelong treatment and monitoring. Prescription medicines used to treat bipolar disorder range from traditional mood stabilizers like Lithium and Depakote to newer antipsychotics like Abilify and Zyprexa; all of these drugs have serious side effects. Behavior changes -– like maintaining sleep hygiene and keeping anxiety in check — can also help people manage this illness.
This is the second part of a two-part interview on the Diagnosis and Treatment of Bipolar Disorder with psychiatrist Candida Fink, MD (pictured), one of the leading experts in Bipolar Disorder. Part I focused on the diagnosing of the illness and included a list of Fast Facts about bipolar disorder. Dr. Fink is the co-author of The Ups and Downs of Raising a Bipolar Child (with Judith Lederman, Simon and Schuster, 2003) and Bipolar Disorder for Dummies (with Joe Kraynak, John Wiley & Sons, 2015). Based in New Rochelle, NY, Dr. Fink specializes in child and adolescent psychiatry, with expertise in developmental disabilities, ADHD, pediatric anxiety and mental health issues in school settings. You can read her blogs on bipolar disorder at www.finkshrink.com.
Suelain Moy: What are some of the treatment options for people with bipolar disorder?
Dr. Candida Fink: Part of the long-term treatment is to help people try to build in systems with themselves and the people around them to flag early symptoms before they’re completely sucked into a manic episode, so that they can take action before they’re so far into it that they lose insight. Try to stay ahead of the game, track their moods, track their sleep, track their energy, and hopefully be willing to allow their loved ones and friends to be part of that. To try to catch it sooner rather than later because once you enter a full-blown episode, it’s very hard to control.
SM: What’s the hardest aspect about treating bipolar disorder?
Dr. Candida Fink: The unwillingness to accept treatment is far and away the most difficult aspect of treating bipolar disorder. Some of the things individuals struggle with most intensively is that they just don’t feel like there’s anything wrong, and they’re unwilling to go for care. In the meantime, lives are falling apart and being destroyed.
SM: Which medications are most commonly prescribed for the treatment of bipolar disorder and what are their side effects?
Dr. Candida Fink: Lithium is one of the oldest medications for bipolar disorder. It does a number of things. I call it the “Swiss Army Knife” of psychiatry medications. It reduces mania. If someone is actively in a manic episode, lithium will often help to reduce that. It also has some anti-depressant effects so usually not alone — but in some cases alone — it will actually relieve depressive symptoms. It helps on both ends of the polarity. It is helpful in preventing or reducing the frequency of dramatic mood shifts. And it has a very specific anti-suicide effect that is not well-explained, but it reduces frequency of successful suicide. It definitely decreases the rate of completed suicide and we don’t really know why. It has a lot of uses. It is one of the core medications for people with bipolar disorder and they’re going to take it their whole life. It’s not such an easy medication to take. It often causes some weight gain. It can cause acne, especially in younger people. It can cause tremor. Long-term, it can impair thyroid function. You can’t go on lithium for a long time without needing thyroid replacement medication. And kidney function can be impaired and that should be monitored over the years.
And then kidney toxicity is another side effect of lithium. Because it’s cleared in the kidneys, you can get a kidney problem after being on it for many years. It can make you nauseous, give you a headache and it can make you tired but not everybody has all of these side effects and certainly for many people, it’s a lifesaver. The other thing about lithium is that it has a very narrow window between a blood level that is therapeutic and helpful, and a blood level that is toxic. There’s not much room between getting to helpful and getting to dangerous, so we do monitor blood level closely. Toxicity can be deadly. That has to be monitored regularly. It can cause fatal cardiac events. So we check levels all the time. Levels are affected by people’s hydration status. So especially in the hot months, we have to make sure people stay hydrated because if you get dehydrated, your blood level of lithium can go up very high.
If someone is out in the sun or working out, or it’s just a hot day and they’re not rehydrating enough, then the concentration of lithium goes up in the blood and that can become dangerous.
With the older, first-generation antipsychotics, the biggest problem was a permanent disorder called tardive dyskinesia, a movement disorder that can cause involuntary movement. The older antipsychotics had that as a big side effect. This side effect is less common in the newer ones but it does still happen.
SM: I can imagine if someone is an actress or something, they might not want to take lithium because of the weight gain or the tremors.
Dr. Candida Fink: Years ago, I treated a young woman who was a pianist but the tremors from the lithium were just unbearable. She couldn’t remain in her profession and stay on lithium. It’s hard.
Suelain Moy is a journalist and author, who lives in New York City. Her articles and interviews have been published in national magazines and websites including Parenting, American Baby, Good Housekeeping, KidsHealth.org, BabyZone.com, Kaboose.com, Parents.com, and Parenting.com. She is a graduate of Yale University.