Medication management can be incredibly difficult for people with bipolar disorder. Finding the right combination of medications can take months or years. Some medications can even work for a time and then suddenly become ineffective. Then there are side effects. One of the most common reasons people with bipolar disorder do not take their medication as directed (noncompliance) is due to side effects. Some are just too severe to make the medication worthwhile. A new study looks at how common some side effects are and their severity in order to see if the side effects can be preventable and thus help people comply with their treatment plan.

The World Health Organization defines side effects (adverse drug reactions) as “A response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease, or for the modifications of physiological function.” Basically, side effects are reactions that the drug was not designed to produce. They are typically negative reactions.

The study, led by Aashal Shah of Government Medical College, Surat, Gujarat, India, looked at the most common medications used to treat bipolar disorder- mood stabilizers, atypical antipsychotics and antidepressants. They found that 97% of patients in the study experienced adverse drug reactions. Side effects were slightly more common in men than women.

Examples of side effects of the drugs included:

  • Physical weakness or lack of energy
  • Difficulty concentrating
  • Digestive distress
  • Decreased libido
  • Failing memory
  • Hypothyroidism
  • Increased urination
  • Sedation
  • Tremors
  • Weight gain

Approximately 60% of the side effects experienced were due to mood stabilizers, especially lithium. Around 25% of side effects were due to atypical antipsychotics. The medications most associated with increased side effects were:

  • Lithium
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Clozapine (Clozaril)
  • Quetiapine (Seroquel)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)

Sixty-one percent of side effects in mood stabilizers were caused by lithium, followed by valproate. Olanzapine was responsible for 49% of side effects among atypical antipsychotics, followed by risperidone at 25%. Approximately 16% of side effects were due to antidepressants and sedative-hypnotics.

The most common side effects found were:

  • Weakness/lack of energy (12%)
  • Sedation (10%)
  • Frequent urination (10%)
  • Weight gain (9%)
  • Tremor (8%)
  • Extrapyramidal symptoms (6%)
  • Dependence (5%)
  • Impaired motor or cognitive performance (4%)

Hypothyroidism was most commonly seen in lithium. Sexual side effects were typically seen in antidepressants, especially fluoxetine. Other side effects like tardive dyskinesia, anemia and digestive distress only occurred in 1-2% of patients. The cases of impaired motor or cognitive performance and extrapyramidal symptoms mostly occurred with antipsychotics.

The vast majority of side effects experienced by the patients in this study were mild to moderate. If the patients considered them intolerable, as in the cases of impaired cognition, they were typically switched to another medication with less likelihood of side effects.

The study found no medications that had side effects that were considered “certain.” Most of the side effects (approximately 55%) were considered probable, closely followed by possible. Most of the side effects were considered mild, followed by moderate. That being said, a 55% probability of a side effect that affects 12% of patients is still rather low, making these medications both safe and effective.

Unfortunately, most of the side effects are not considered preventable. However, side effects like digestive distress were considered preventable and others were at least treatable. This is good news for people with bipolar disorder seeking treatment. Even if one drug does cause intolerable side effects, there are many other options of medications to try. You just have to add a dose of patience.

 

 

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