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.
SSRIs may not help
The statistical analysis confirmed what a quick look at the numbers suggests: The antidepressant didn't add anything to the benefits of the mood stabilizer. In fact, the people taking only a mood stabilizer plus placebo did a little better than the people who took an antidepressant plus a mood stabilizer.
Mary, a middle-aged woman living in Massachusetts who has bipolar disorder, says that the mood stabilizer Lamictal keeps her from spinning off into manic episodes. A low dose of Zoloft keeps depression at bay, and she takes a benzodiazepine tranquilizer occasionally. But Mary faces a big pitfall: "I do periodically miss my old life, with its creative, productive highs. I have thoughts like, 'How can I get back there?'"
Sometimes she convinces herself that she can go off her meds, and that strategy has landed her in the hospital several times because she felt strong suicidal impulses. The last time she went off her medications, in early 2007, she slid into a crisis so fast "that even I didn't see it coming," she says. "I went running to the hospital because I felt that I might kill myself. I can't do that to my family."