Approved by the FDA in 1970, Lithium has traditionally been the first line of treatment for mania. More recent studies have also confirmed lithium's effectiveness for treating depression. Kay Redfield Jamison, author of An Unquiet Mind and a leading authority on bipolar disorder, believes lithium is underprescribed because it is inexpensive. Read More - Lithium: The First Mood Stabilizer
The use of anticonvulsants in the treatment of mania was introduced when their therapeutic value was noted through improved mood stability of those with epilepsy. Initially they were used for those who were resistant to Lithium treatment. They are now an important alternative both as a monotherapy and as an adjunctive to other medications. Page 2 lists the primary anticonvulsants used for bipolar disorder.
Calcium Channel Blockers
This class of drugs (of which Verapamil, Diltiazem, Nifedipine and Nimodipine are examples) is only used to a very minor degree in managing the symptoms of mania associated with bipolar disorder. Their efficacy is limited.
Acute episodes of mania present psychosis in as many as two-thirds of those with this disorder. Thus, this class of meds is used to a great extent. They are also often used to decrease symptoms of mania until mood stabilizers such as those listed above can take full effect. In some cases, these may be used for long-term maintenance of stability. Important antipsychotics are listed on page 3.
The Benzodiazepines are central nervous system (CNS) depressants. They are used to produce sedation, induce sleep, relieve anxiety and muscle spasms, and to prevent seizures. For bipolar disorder, they are used to gain rapid control of manic symptoms so that mood stabilizers have time to take effect. They may also be used to help restore a normal sleep schedule. The most common medications in this class include alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), and Clonazepam (Klonopin). Read more about benzodiazepines.