228 CHAPTER 6
(psychological factors) meant that she didn’t do as good a job as she could have
done in protecting herself from overwork (social factor), making her more vulner-
able to a mood episode.Treating Bipolar Disorders
As with depressive disorders, treatment for bipolar disorders can directly target any
of the three types of factors—neurological, psychological, and social. Keep in mind,
though, that the effects of any successful treatment extend to all the types of factors.
Jamison describes the subtle ways that feedback loops operated on her disorder and
treatment:
My temperament, moods, and illness clearly, and deeply, affected the relationships
I had with others and the fabric of my work. But my moods were themselves power-
fully shaped by the same relationships and work. The challenge was in learning to
understand the complexity of this mutual beholdenness and in learning to distinguish
the roles of lithium, will, and insight in getting well and in leading a meaningful life. It
was the task and gift of psychotherapy.
(1995, p. 88)Targeting Neurological Factors: Medication
People diagnosed with a bipolar disorder usually take some type of mood stabilizer—a
medication that minimizes mood swings—for the rest of their lives. (The term mood
stabilizer is sometimes used more broadly to include medications that decrease im-
pulsive behavior and violent aggression.) Mood stabilizers can reduce recurrences
of both manic and depressive episodes (Arana & Rosenbaum, 2000). The oldest
mood stabilizer is lithium;technically the medication is called lithium carbonate, a
type of salt. Jamison describes her response to the drug: “I took [lithium] faithfully
and found that life was a much stabler and more predictable place than I had ever
reckoned. My moods were still intense and my temperament rather quick to the
boil, but I could make plans with far more certainty and the periods of absolute
blackness were fewer and less extreme” (1995, p. 153). Lithium apparently affects
several different neurotransmitters (Jope, 1999; Lenox & Hahn, 2000) and thereby
alters the inner workings of neurons (Friedrich, 2005). Too high a dose of lithium
can produce severe side effects, including coordination problems, vomiting, muscu-
lar weakness, blurred vision, and ringing in the ears; thus, patients must have their
blood levels of lithium checked regularly to ensure that they are taking an appropri-
ate dosage (Arana & Rosenbaum, 2000).
However, up to half of patients taking lithium either cannot tolerate the side
effects or do not show signifi cant improvement, especially patients who have
mixed episodes or rapid cycling (Burgess et al., 2001; Keck & McElroy, 2003;
Montgomery et al., 2001; Soares, 2000). In such cases, other mood stabilizers
may be effective in preventing extreme mood shifts, especially recurring manic
episodes. These include antiepileptic medications (also called anticonvulsants)
such as divalproex (Depakote), carbamazepine (Tegretol), lamotrigine(Lamictal),
andgabapentin (Neurontin).
Some people with bipolar disorders stop taking mood stabilizers, not neces-
sarily because of the common side effects (such as thirst, frequent urination, and
diarrhea), but because the medication does what it’s supposed to do—evens out
their moods (Arana & Rosenbaum, 2000; Rosa et al., 2007). Some of these people
report that they miss aspects of their manic episodes and feel that the medication
blunts their emotions.
Mood stabilizers aren’t the only medications given for bipolar disorders. Patients
with a bipolar disorder may be given antidepressant medication for depression, but
such medications can induce mania and so should be taken along with a mood
stabilizer; in addition, patients with a bipolar disorder who take antidepressantMood stabilizer
A category of medication that minimizes
mood swings.
Lithium
The oldest mood stabilizer; it is administered
as a salt.