Bipolar4LifeSupport

From fatty snacks to morning cups of joe, these foods may trigger mood swings in people with bipolar disorder.

Your morning coffee and doughnut could trigger a manic episode.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium.

Thursday, May 12, 2016

Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found.

Patients taking lithium had lower rates of self-harm and unintentional injury compared to those taking other bipolar drugs, such as valproate (Depacon, Depakote), olanzapine (Zyprexa) or quetiapine (Seroquel), said lead researcher Joseph Hayes. He is a fellow of psychiatry at University College London.

“This is important because people with bipolar disorder are 15 times more likely to die by suicide and six times more likely to die by accidental injury than the general population,” Hayes explained.

People taking one of the alternative mood stabilizers were 40 percent more likely to harm themselves compared to patients on lithium, Hayes and his colleagues found.

And people on valproate or quetiapine were 32 percent to 34 percent more likely to fall victim to unintentional injury, most likely while experiencing a manic episode, the researchers said.

“Lithium still is the gold standard for the treatment of bipolar. We really haven’t had a medication that surpasses lithium, as far as we know,” said Dr. Raphael Braga. He is physician-in-charge of the Center for Treatment and Research of Bipolar Disorder at Zucker Hillside Hospital in Glen Oaks, N.Y., and was not involved with the study.

RELATED: Why Bipolar Disorder Is Often Misdiagnosed

Hayes noted that lithium has been used for more than half a century to treat bipolar disorder, but it’s still not clear how the drug stabilizes a person’s mood.

Bipolar disorder, which used to be called manic depression, is characterized by extreme mood swings ranging from emotional highs to depressive lows.

The researchers undertook their study following evidence reviews and studies that suggested lithium might be better than newer medications at preventing suicide and self-harm.

These studies have contended that lithium achieves these results by reducing symptoms such as depression, aggression, risk-taking and impulsive behavior, according to background notes in the study.

Lithium can be hard on the body, the study authors said, increasing a person’s risk of kidney and thyroid disease, but even that may have a positive side in bipolar patients. Because patients must be closely monitored for side effects, they are in more frequent contact with doctors who can pick up on emotional problems that lead to suicide, the researchers contend.

To compare lithium against newer medications, Hayes and his colleagues collected medical data on nearly 6,700 people diagnosed as bipolar and prescribed only one of the drugs — lithium, valproate, olanzapine or quetiapine.

The investigators found that people on lithium were less likely to harm themselves, either intentionally or by accident.

The suicide rate was lower in the lithium group, but too few suicides occurred to allow accurate risk estimates, the study authors said.

The findings were published online May 11 in the journal JAMA Psychiatry.

Lithium can cause kidney disease and hypothyroidism (underactive thyroid gland), Braga and Hayes said.

Doctors need to carefully weigh benefits versus harm when prescribing lithium to people with kidney or thyroid problems, and “if these are severe, it should be avoided,” Hayes said. “Lithium [also] needs to be reviewed on an individual patient basis before pregnancy.”

Braga said psychiatrists often require patients taking lithium to undergo lab tests every three to six months, to make sure their kidney function hasn’t been compromised.

Even with this, lithium is much cheaper than the other medications in the study, Braga said. Hayes noted a 2008 study that found lithium was nearly $500 cheaper per month compared with olanzapine.

“Lithium is a great drug,” Braga said. “It’s definitely a drug every clinician should think about when prescribing for bipolar disorder.”

For most people with bipolar disorder, strict adherence to medications is necessary to help keep episodes to a minimum.

If you have bipolar disorder, you may be wondering what the future will bring. Will your bipolar symptoms get worse or can this disorder go away? What happens if you stop taking your medications or seeing your psychiatrist?

Bipolar Disorder: Treatment Over Time

“Having bipolar disorder is very different than having a blood pressure problem ordiabetes,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says that unlike other illnesses, in which patients accept the fact that they need to take medicine to control their disease, people with bipolar disorder often refuse to take their medications — an issue called treatment compliance. These patients often have trouble perceiving that they have a problem, even during a bipolar episode (a condition known as anosognosia, and therefore don’t believe they need treatment.

Avoiding treatment, however, is the worst thing you can do with bipolar disorder. Why? Because bipolar disorder tends to get worse if it’s not treated. So to improve your prognosis — your future with this condition — you need to follow your doctor’s prescribed treatments.

Bipolar Disorder: The Timeline

Bipolar symptoms usually appear during the late adolescent years, but they can emerge at any time from early childhood to your 50s. For a very few people diagnosed with bipolar disorder, symptoms will improve with medication to the point that medications will no longer be necessary.

But most people won’t be that lucky, since it is typical for manic and depressive episodes to recur later on.

“If you have a single episode of mania, the chances that you are going to have another one over your lifetime is virtually 100 percent,” says Sachs.

And there is a good chance that your manic and depressive episodes will become more frequent and severe over time. According to Sachs, most people can also expect more depressive episodes and fewer manic ones. “You will have fewer highs and more depression,” he says. Your illness may even progress to what is called rapid-cycling bipolar disorder, which is when you have four or more episodes a year.

And, Sach adds, “If you’ve had several [bipolar] episodes, there is probably a 60 to 80 percent chance that you will have one episode every year if untreated.” But with treatment, you can probably cut your risk of having an episode by half.

Bipolar Disorder: Remission

Most people who have bipolar disorder will have normal moods in between their manic and depressive episodes. However, in almost every case, bipolar disorder is a lifelong illness requiring treatment.

While there is no cure for bipolar disorder, there is every reason to believe that with proper treatment, you will get better. Proper treatment means taking all your medications and attending therapy sessions as recommended by your doctor. It is important to take the bipolar medications even between episodes of depression or mania. Consistency in taking the medications can stabilize your mood swings.

By learning to recognize the early signs of a manic or depressive episode, you will be empowered to take control of your bipolar disorder and deal with your symptoms before they become a full-blown episode.