How Do Bipolar Disorder Agents Work?

Bipolar disorder agents are mood-stabilizing medications that are prescribed to manage both manic and depressive moods of bipolar disorder, and schizophrenia. Some bipolar disorder agents have anticonvulsant properties and are also used to treat neurological conditions such as epilepsy and trigeminal neuralgia.

Bipolar disorder is characterized by periods of mania, an extremely euphoric and excited mood, alternating with depression. Bipolar disorder agents are effective for both inhibiting mania and improving depression symptoms. Bipolar disorder agents work by regulating the chemical balance and activity, and electrical activity in the brain.

Bipolar disorder agents have effects on several neurotransmitters involved in mood regulation such as dopamine, serotonin, norepinephrine, glutamate and gamma aminobutyric acid (GABA), which are chemicals that neurons release to send signals to each other and stimulate activity.

Bipolar disorder agents balance the levels of neurotransmitters and also alter the way receptors on nerve cells (neurons) receive and transmit signals. Receptors are protein molecules on neuronal surfaces that initiate intracellular action when stimulated by a neurotransmitter.

Bipolar disorder agents regulate the brain’s chemical balance and activity in many different ways such as:

• Reducing the activity of dopamine and glutamate, which are excitatory neurotransmitters.
• Enhancing the activity of GABA, an inhibitory neurotransmitter.
• Modulating intracellular signaling by second messenger systems which translate the signals to action within the cell.
• Increasing the levels and activity of serotonin and norepinephrine.
• Partial agonist activity on D2 and D3 dopamine receptors which are excitatory, and 5-HT1A serotonin receptors which are inhibitory. Partial agonists enhance or block receptor activity depending on the neurotransmitter concentration levels.
• Blocking 5-HT2A serotonin receptors which are excitatory.
• Stimulating H1 histamine receptors in the central nervous system, which produces sedation and a calming effect.

In addition, some bipolar disorder agents control involuntary muscle contractions and pain from abnormal electrical activity in the brain. These bipolar disorder medications prevent abnormal electrical impulses by stabilizing the sodium channels in neurons and reducing their electrical conductivity.

Bipolar disorder agents may be administered as oral tablets, capsules, solutions or suspensions to treat the following conditions:

FDA-approved:

• Bipolar I disorder (mania, depression or mixed)
• Bipolar I disorder maintenance
• Agitation associated with schizophrenia and bipolar I mania
• Schizophrenia
• Epilepsy
• Trigeminal neuralgia

Off-label uses:

• Restless legs syndrome
• Postherpetic neuralgia

Orphan designation:

• Huntington's disease (an inherited degenerative brain disorder)

Side effects of bipolar disorder agents may include the following:

• Polyuria (excessive urination)
• Polydipsia (excessive thirst)
• Xerostomia (dry mouth)
• Hand tremor
• Confusion
• Decreased memory
• Insomnia
• Headache
• Muscle weakness
• Changes in ECG
• Tachycardia (rapid heartbeat)
• Hypertension (high blood pressure)
• Myocardial infarction (heart attack)
• Congestive heart failure (CHF)
• Aggravation of hypertension/hypotension
• Aggravation of coronary artery disease
• Atrioventricular block
• Arrhythmia (irregular heartbeat)
• Syncope (fainting) and collapse
• Ischemic stroke
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain
• Dyspepsia (indigestion)
• Gastroesophageal reflux disease (GERD)
• Gastritis
• Anorexia (loss of appetite)
• Hyperreflexia (overactive reflexes)
• Muscle twitch
• Vertigo
• Dizziness
• Somnolence (drowsiness)
• Anxiety
• Agitation
• Talkativeness
• Depression with agitation
• Suicide ideation and attempt
• Extrapyramidal symptoms, which are drug-induced movement disorders such as:
  • Akathisia
  • Dystonia
  • Dyskinesia
  • Akinesia
  • Muscle stiffness
  • Parkinsonism
  • Tardive dyskinesia
  • Neuroleptic malignant syndrome (rare, life-threatening reaction)
• Ataxia (impaired coordination, balance and speech)
• Goiter
• Hypothyroidism
• Lethargy
• Seizures
• Coma
• Acute lithium toxicity
• Peripheral neuritis (damage to peripheral nerves)
• Paresthesia (abnormal skin sensations)
• Hyperacusis (sensitivity to sounds)
• Tinnitus (ringing in ears)
• Speech disorder
• Drying and thinning of hair
• Alopecia (hair loss)
• Hypersensitivity skin reactions such as:
  • Acne
  • Loss of sensation on the skin
  • Chronic folliculitis
  • Xerosis cutis (abnormally dry skin)
  • Psoriasis onset or exacerbation
  • Generalized pruritus (itching) with or without rash
  • Skin ulcers
  • Urticaria (hives)
  • Itchy red rashes
  • Changes in skin pigmentation
  • Purpura (discoloration from bleeding under the skin)
  • Angioedema (swelling in the tissue under the skin or mucous membranes)
  • Photosensitivity reactions
  • Erythema multiforme (round lesions like bullseye)
  • Erythematous nodosum (painful bumps under the skin)
  • Exfoliative dermatitis (redness and peeling of the skin)
  • Generalized exanthematous pustulosis (pustular eruptions)
  • Onychomadesis (separation of the nail from the nail bed)
  • Drug rash with eosinophilia and systemic symptoms (DRESS)
  • Stevens-Johnson syndrome (a rare medical emergency with flu-like symptoms and a painful rash)
  • Toxic epidermal necrolysis (a severe skin condition with widespread redness, skin cell death and exfoliation which can lead to sepsis)
• Aggravation of disseminated lupus erythematosus (an autoimmune disorder)
• Hyperhidrosis (excessive sweating)
• Toothache
• Blurred vision
• Punctate (marked by tiny holes or dots) cortical lens opacities
• Transient diplopia (double vision)
• Visual hallucinations
• Nystagmus (involuntary eye movement)
• Increased intraocular pressure
• Conjunctivitis (inflammation of the conjunctiva, the membrane over the whites of the eye and inner surface of eyelids)
• Cough
• Pain in extremities
• Fever
• Fatigue
• Musculoskeletal stiffness
• Back pain
• Arthralgia (joint pain)
• Rhabdomyolysis (breakdown of skeletal muscle cells)
• Blood disorders such as:
  • Increase or decrease in levels of leukocytes
  • Agranulocytosis (low granulocytes, immune cells with granules)
  • Aplastic anemia (anemia due to reduced red cell production)
  • Pancytopenia (decrease in all types of blood cells)
  • Eosinophilia (high level of eosinophils, a type of immune cell)
  • Thrombocytopenia (decrease in platelet count)
  • Porphyria (a disorder that causes buildup of porphyrin, a chemical that helps hemoglobin carry oxygen)
• Bone marrow depression
• Vasculitis (inflammation of blood vessels)
• Thrombophlebitis (inflammation of veins with blood clot)
• Thromboembolism (obstruction of a blood vessel by a blood clot)
• Adenopathy (swelling of glands)
• Lymphadenopathy (swelling of lymph nodes)
• Increased appetite
• Increase in weight
• Increase in creatinine phosphokinase (CPK) levels
• Increase in liver enzymes
• Hepatitis (inflammation of the liver)
• Jaundice
• Liver failure
• Hepatosplenomegaly (enlargement of liver and spleen)
• Pancreatitis (inflammation of the pancreas)
• Nasopharyngitis (inflammation of throat and nasal passage)
• Throat pain
• Dyspnea (shortness of breath)
• Pneumonia/pneumonitis (lung inflammation)
• Urinary tract infections
• Pollakiuria (frequent daytime urination)
• Urinary frequency
• Urinary retention
• Dysuria (painful urination)
• Azotemia (increased blood urea nitrogen [BUN] and creatinine)
• Renal failure
• Hyponatremia (reduced sodium levels in the blood)
• Reduced calcium in the blood leading to osteoporosis
• Hypogammaglobulinemia (immune system disorder that prevents antibody production)
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH, a disorder which causes water retention)
• Impotence

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of bipolar disorder drugs include:

• carbamazepine
• Carbamazepine Chewtabs
• Carbatrol
• cariprazine
• Epitol
• Equetro
• lithium
• Lithobid
• Tegretol
• Tegretol XR
• Teril
• Vraylar