Manic-depressive illness (Bipolar I) is well-covered on other websites. I just have two things to add:
Lithium is the first-line medication for Bipolar I
About 30% of people living with Bipolar I get a great response to lithium. Often they are able to live life without interference from manic or depressive episodes.
Recent Bipolar I treatment guidelines suggest lithium as the number one option. Here are two reasons:
- lithium does not cause as much weight gain as the antipsychotics or valproate (some, yes, but not that much, and with less disturbance of glucose/insulin metabolism)
- most people taking lithium don’t feel it*; people taking antipsychotics do: sluggish, slowed down, can’t think quickly or creatively
*Side effects, perhaps, like thirst and frequent urination; but thinking is generally clear and crisp. Not as sharp and fast as when hypomanic or manic. Creativity, same: not as stunning as when hypomanic or manic, but still there. Most of my artistic patients liked life far better on lithium, got more done, felt more effective, than when cycling up and down. They certainly didn’t want to stop it.
Unfortunately, about 1 person in 10 or so feels “blah, dull, flat” on lithium. That’s my estimate from over 20 years of specializing in complex mood disorder. For those people this effect could happen at even 150 mg of lithium and just got worse as the dose went up, and never got better. If that happened, I’d suggest we just give up on lithium, because no one wants to live like that when there are alternatives.
Don’t forget valproate/divalproex
Valproate causes weight gain too, more than lithium. But not more than some antipsychotics (especially olanzapine, but also including risperidone and aripiprazole). But like lithium, at routine doses it does not slow or cloud thinking.
Yes, I know there are some new medications out there that can serve as “mood stabilizers”: preventing manic episodes, and some of them preventing and treating depressions as well.
I’m getting old, and too far away from actually treating patients myself. So I do not have direct experience with the newer stuff. But I have lots of experience with using divalproex as an “add-on” when lithium alone was not sufficient. For example, there seems to be a weight gain threshold around 750-1000 mg/day: once you go above that, weight gain affects almost everyone. So sometimes the trick was to lower lithium just a bit to get rid of its side effect (like frequent urination) and make up the difference with 500-750mg of divalproex. No side effects, good symptom control. Bingo.