John Markowitz, MD, a psychiatrist at the New York State Psychiatric Institute and clinical professor of psychiatry at Weill Medical College of Cornell University in New York City, adds: "One episode of mania, you're on a mood stabilizer for life. Mania with severe depression can have catastrophic consequences."
But the drugs themselves are no easy solution for people suffering from bipolar disorder, says Laurel Lemke, 54, of Lakewood, Wash., who says she experienced "cognitive dulling" on lithium, so much so that switched to another medication when she wanted to try to go to graduate school. "You have to weigh the downside of the drugs against having a life in an institution," she says.
Once you're taking a mood stabilizer, you may not need an antidepressant, which can trigger manic phases.
Results of the multicenter Systemic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study support the notion that antidepressants like Prozac may not be appropriate for bipolar patients.
In this rigorously controlled study, people with bipolar disorder were treated for up to 26 weeks with either a mood stabilizer paired with an antidepressant or a mood stabilizer plus a placebo. Of the 179 subjects, 42 (or 23.5%) who were taking a mood stabilizer plus an antidepressant had a durable recovery. Of the 187 subjects taking a mood stabilizer plus a placebo that looked like the antidepressant, 51 (or 27.3%) had a durable recovery.