During an acute and severe manic episode, a doctor is likely to treat mania more aggressively, perhaps by taking the following steps:

• Prescribing substantial doses of medications such as Abilify or Seroquel.
• Using loading doses of Depakote to reduce acute mania more rapidly. A loading dose is a higher initial dose than normally prescribed. Loading doses are used to ramp up a medication to a therapeutic level more rapidly.

These more aggressive interventions for mania are often performed in hospital. When providing outpatient treatment, doctors usually ramp up these medications more slowly to reduce side effects. Lamictal, which is used to prevent mood cycles, requires many weeks to reach a therapeutic level because of the risk of a skin condition that is much lower if the doses are increased very slowly.

Antidepressants are another story. Routinely, patients are told that they won’t be likely to experience any benefits from their antidepressants for at least a few weeks. Sometimes it can take much longer, and doctors rarely, if ever, suggest what to do in the meantime. Patients are often expected to tough it out. And if the person complains, the doctor often advises them to “BE PATIENT.” Easier said than done in the midst of debilitating depression.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on medications that can help you sleep.

Over the past couple weeks, my wife, who happens to have bipolar, has not been sleeping well, which is always a bad sign. For two weeks, she’s been trying to get something to help her sleep – to get her through the often manic days that seem to reach full bloom about the time school lets out. You can read the whole account, “Tragedy of Errors” on our Bipolar Blog.