ANTIPSYCHOTIC MEDICATIONS

Also known as major tranquilizers, antipsychotics are used to treat psychosis and mood instability. It often takes two weeks or longer for them to take effect. The two main types of antipsychotic medications are known as the traditional or “typical” medications (also known as neuroleptics) and the newer "atypical" medications.

Special precautions: Because of the risk of major side effects, use of these medications should be monitored by a physician. Have regular checkups. If you detect any unexpected effects, contact your doctor or go to the Emergency Room. In rare cases, these medications can cause Neuroleptic Malignant Syndrome, which can be fatal. Signs include severe rigidity, high fever, rapid heartbeat, confusion and difficulty in breathing. Immediate medical help is required.

MOOD STABILIZERS

This group of medications are drugs for mania, associated with Bipolar Disorder and Schizoaffective Disorder – Bipolar Type. In addition, these medications are used to treat impulsivity and certain features of personality disorders. Antipyschotic medications are often used for mood stabilization and the atypical antipsychotics are considered by some experts to be safe enough to use as first-line treatments for mood stabilization.

Lithium is the oldest and best-studied mood stabilizer. It is effective for the majority of patients but less effective in those who cycle rapidly. Typically, the effects of lithium take 5-14 days to work.

Special precautions: Because there is some risk of lithium poisoning, which can be fatal, blood lithium levels must be monitored. Have regular blood tests, drink plenty of fluids and monitor salt intake, as instructed. Know the signs of lithium poisoning. These include loss of appetite, vomiting, diarrhea, trembling, slurred speech, unsteadiness end seizures. If you detect any unexpected effects, immediately contact your doctor or go to the emergency room. Early possible side effects of lithium: nausea, cramps, diarrhea, hand tremors, thirst and feeling tired or dazed. Later possible side effects include hand tremors, extreme thirst, frequent urination and weight gain. Lithium can cause kidney and thyroid problems.

Carbamazepine (Tegretol) and Valproate (Depakote) have been used extensively for mania. Both are effective in patients who cycle rapidly. Tegretol also has an antidepressant effect. Possible side effects of Tegretol include lethargy, confusion, movement disorders and lowering of the white blood cell count. Because Tegretol affects the liver enzymes that metabolizes many medications, it is important to get frequent blood tests with this medication.

Possible side effects of Depakote include fatigue, stomach upset, liver function problems and blood clotting changes.

Zyprexa also has an FDA indication for the treatment of mania. See the section on antipsychotic medications for further details about Zyprexa.

Several newer medications show promise in the treatment of mania. Lamotrigene (Lamictal) shows promise in the treatment of Bipolar depression and in the prevention of depressive episodes in Bipolar patients. Lamictal can cause a rash. Although this is usually benign, Lamictal can also cause a rare deadly skin condition so it is important to tell your doctor and go to an emergency room if you develop a rash soon after starting, when changing doses or when starting a new medicine while already on Lamictal. Gabapentin (Neurontin) has become popular, although there is less evidence that it works than there is for the treatments listed above. Possible side effects include fatigue, stomach upset, dry mouth and constipation.

CAUTION: NAMI-NYS does not give medical advice. This page is for informational purposes only. Discuss all medication and medical decisions with your physician.