Medications for Depression and Bipolar Disorder

There are many safe, effective medications that may be prescribed to relieve symptoms of a mood disorder. While doctors do know something about the average effects of medication (how any medication works for most people), you are an individual and your reaction may not be the same as someone else’s. You and your doctor will need to work together to find the right medication or combination of medications for you. This process may take some time, so don’t lose hope. Many people need to try several medications before they find the best one(s).

Your health care provider (HCP) might prescribe one or more medications to treat your symptoms. These may include:

• Mood stabilizers
  This category of medications includes lithium as well as several medications that were originally developed to treat seizures or epilepsy (called anticonvulsants). Several of these medications are approved as safe and effective for treatment of bipolar disorder. Some others are commonly used, even if they are not officially approved. These medications help even out highs and lows.  Mood stabilizer medications work slowly - it usually takes 2-4 weeks to see if one of these medications will  help. These medications are sometimes used to treat more severe depression in people who do not have bipolar disorder.

• Antidepressants
  These medications help lift the symptoms of depression. There are several different classes and types of antidepressants to choose from. It is believed that certain brain chemicals, called neurotransmitters, are associated with depression. These brain chemicals include serotonin, norepinephrine, and dopamine. Most antidepressants relieve depression symptoms by working on these neurotransmitters. Each class of antidepressant affects neurotransmitters in slightly different ways.

• Antipsychotics
  These medications are called antipsychotics because they were first used to treat schizophrenia, but they are now often used to treat bipolar disorder. These medications can reduce symptoms of mania, and some are also effective at reducing depression. Even if you are not hallucinating or having delusions, these medications can help slow racing thoughts to a manageable speed.

• Chart of Medication Choices for Treatment of Unipolar Depression
  
• Chart of Medication Choices for Treatment of Other Depression or Bipolar Depression
  
• Chart of Medication Choices for Treatment of Mania

Even if a medication is not officially approved for a specific condition or diagnosis, it can still be helpful. But, your doctor should tell you when they prescribe a medication that isn’t officially approved. Doctors call this off label prescribing.

It can take several weeks for medications to fully work, so it’s important not to get discouraged and give up too soon. You might feel some side effects of your medication before you feel the benefits. Be sure to talk to your doctor about when you might expect to feel the benefits from a new medication. You’ll be much more successful finding the right medication plan if you keep a daily record of your mood symptoms, medications, sleep patterns, and other things that seem to affect your mood.
DBSA offers a printed personal calendar, which allows you to record changes in your mood level, symptoms, stressful life events, the medications that you take, and any side effects that you experience. Print or download the calendar at DBSAlliance.org/pdfs/calendarforweb.pdf. DBSA also offers a web and phone-based app called DBSA Wellness Tracker to help you track your well-being, moods, symptoms, medications, physical health, and more. Visit DBSAlliance.org/Tracker for more information.

Questions to Ask your HCP about Your Medication or Treatment 

Play an active role in finding your treatment and managing your condition. No one knows better than you do how you are feeling and how your symptoms or the events in your life are affecting you. Never be afraid to get a second opinion if you don't feel your treatment is working as well as it should.

• How does this treatment work in my brain? What chemicals or processes does it work on?
• When will I start to feel some improvement? What symptoms should this treatment relieve?
• Is this the usual treatment for my condition? If not, how did you choose it?
• How will this treatment affect the treatments I'm receiving for other illnesses?
• How can I reach you in an emergency?
• What's the name of my medication and how will it help me?
• What dosage(s) of medication do I need to take, what time(s) of day should I take them, and what should I do if I forget to take my medication?
• If my medication needs to be stopped for any reason, how should I go about it? (Never stop taking your medication without first talking to your doctor.)
• Is there a generic form of my medication available? Would it be right for me?
• How often will I need to see a doctor and how long will appointments take?
• How do I change my dosage, if this is to be done before my next visit?
• Is psychotherapy recommended as part of my treatment? What type?
• What are the possible side effects of my medication(s)? What should I do if I experience a troublesome side effect?
• Is there anything I can do to improve my response to treatment, such as changing my diet, physical activity, or sleep patterns
• What alternatives exist if my current medication isn't helpful? What will my next step be?
• What are the risks associated with my treatment and how can I recognize problems when they occur?
• What are the risks involved if I am pregnant, plan to become pregnant, or am nursing?

Learn more about effectively communicating with your doctor.

Medication Side Effects

Many of the medications that affect the brain may also affect other systems of the body, and cause side effects such as dry mouth, constipation, sleepiness, blurred vision, weight gain, weight loss, dizziness, or sexual problems. Some side effects lessen or go away within days or weeks, while others can be long term.

Don’t be discouraged by side effects; there are often ways to reduce or get rid of them. It may help to change the time you take your medications to help with sleepiness or sleeplessness, or take it with food to help with nausea. Sometimes another medication can be prescribed to block an unwanted side effect, or your dosage can be adjusted to reduce the side effect to a tolerable level. Other times, your medication must be changed. Tell your doctor about any side effects that you experience. The decision to change or add medication must be made by you and your doctor together. You should never stop taking your medication or change your dosage without talking to your doctor first.
Contact your doctor or a hospital emergency room right away if your side effects cause you to become very ill with symptoms such as fever, rash, jaundice (yellow skin or eyes), breathing problems, heart problems (skipped beats or racing), or other severe changes that concern you. This includes changes in your thoughts, such as hearing voices, seeing things, or having thoughts of death or suicide.

Be sure your doctor knows about all the medications you are taking for a mood disorder and any other health conditions you have. This includes over-the-counter or natural/herbal supplements. Even natural treatments may interact with your medications and change the way they work.

Keep track of your side effects and talk about them with your doctor. He or she may suggest adding a new medication, adjusting your dosage, or changing your medication. Don’t stop taking your medication, change your dosage, or add any kind of medication or supplements without first speaking to your doctor.

DBSA provides two tools to help track medications and/or side effects. This includes the DBSA Wellness Tracker and a downloadable medication side effects form.

Medication while Pregnant or Nursing

Try to discuss pregnancy ahead of time with your doctor if you are planning on becoming pregnant. If you become pregnant, inform your doctor immediately. You and your doctor should discuss your health in detail and make medication decisions based on your need for medication compared to the risk the medication may pose to your baby’s health. Some medications used to treat mood disorders are known to cause birth defects, and those should be avoided. Some are not known to cause birth defects, and taking them during pregnancy may be appropriate for some women. The greatest risk for most medication is during the first three months of pregnancy, but some medications may also be harmful to a fetus during the later stages of pregnancy. Medications may also be present in breast milk, so your doctor may advise you to stop breastfeeding if you take medication.

Medication and Older Adults

With older adults, mood disorder symptoms can sometimes be mistaken for normal signs of aging. These symptoms are not a normal part of growing older. Treatment can be very helpful for older adults, and they should be given a thorough physical examination if they have symptoms of a mood disorder. It’s also important for older adults to be aware of possible medication interactions or medication side effects if they are taking several medications for different health conditions.

Medication and Children

Many mood disorder medications used for adults are prescribed for children. If your child has a mood disorder, make sure he or she is being treated by a doctor who has experience treating mood disorders in children. Much has been written about the use of certain types of depression medication in children and adolescents and the possibility of increased risk of suicide. Families and physicians must make informed decisions that compare benefits and risks of all treatment options. Treatment involves more than taking a medication. Talk therapy can be helpful in assisting children in learning coping and effective communication skills. In addition, many wellness strategies used for adults can help children as well such as relaxation exercises, artistic expression, or journaling. Parents, in partnership with their child, must monitor the child’s moods and behaviors and develop a close working relationship with their child’s health care providers that includes regular follow-up appointments.

What if I don’t feel better?

If you don’t feel better right away, remember that it is isn’t your fault and you haven’t failed. Never be afraid to get a second opinion if you don’t feel your treatment is working as well as it should. Here are some reasons the medication you are taking may be not be giving you the results you need.

• Not enough time
  Often a medication may not appear to work, when the reality is that it may not have had enough time to take effect. Most medications for mood disorders must be taken for a few weeks before you begin to see results. The length of time will vary by medication, taking between 2 and eight weeks before the full effect is felt. So, though it may not be easy, give your medication time to start working. Whenever your doctor prescribes a new medication or changes the dose of an old medication, be sure to ask when you should judge whether it’s helping.

• Dosage too low
  With most medications used to treat mood disorders, the actual amount reaching the brain can be very different from one person to the next. A medication must reach the brain to be effective, so if your dose is too low and not enough reaches your brain, you might incorrectly assume the medication doesn’t work, when you just need your doctor to adjust your dosage.

• Different type (class) of medication needed
  Your doctor may need to prescribe a different type of medication, or add one or more different types of medication to what you are currently taking. While different medications may be equally effective on average, everyone may respond differently.

• Not taking medications as prescribed
  A medication may have poor results if it is not taken as prescribed. Even if you start to feel better, keep taking your medication so you can keep feeling better. If you often forget to take your medications, consider using an alarm to remind you or keeping track of what you have taken using a pillbox with one or more compartments for each day. It may also be helpful for you to keep a written checklist of medications and times taken, or to take your medication at the same time as a specified event - a meal, a television show, bedtime, or the start or end of a work day.

Medication Interactions

Medications used to treat other illnesses may interfere with the medication you are taking for a mood disorder - either increasing or decreasing the amount in your system. This can prevent the medication from being effective or cause more side effects. Be sure that all your doctors and your pharmacist know all the medications that you are taking so they can check for any interactions.

Other Medical Conditions

Other medical conditions can sometimes cause symptoms like depression or agitation. Make sure that your medical doctors know about your mental health treatment and that your mental health providers know about your medical treatment.

Substance Use

Alcohol or recreational drug use may interfere with the treatment of a mood disorder. The combination of alcohol or drugs with your medication(s) may lead to serious or dangerous side effects. It can also be difficult to benefit from talk therapy if you are under the influence. If you are having trouble stopping drinking or using, you may want to consider seeking help from a 12-step recovery program or treatment center.

There are medications that can be used in the treatment of a substance abuse disorder. Per SAMHSA, the FDA has approved several different medications to treat opioid addiction and alcohol dependence. Learn more on SAMHSA’s website.

Anxiety

Medications used to treat a mood disorder may also help manage anxiety. Per the National Institute of Mental Health (NIMH) there are additional medication classes: benzodiazepine, beta blockers, and a drug called buspirone, that can help with anxiety symptoms such as panic attacks or extreme feelings of worry or fear. NIMH notes that benzodiazepine and beta blockers are short term medications that help manage the physical effects of anxiety, while buspirone may be used for long term symptom management.

Need help paying for your medications? Learn about Patient Assistance Programs.