HOW IS MANIC DEPRESSION TREATED?

Many manic depressives are treated with lithium alone, which helps smooth out the rough hills and valleys of the emotional landscape. (In some cases, if lithium cannot be tolerated or is simply ineffective, antiepileptic medications Tegretol or Depakote have been used to stabilize mood and behavior.) Often, however, lithium isn’t enough. The mania may be controlled, but the periods of depression are still too numerous and too deep. In about 30% of the cases, when the lows are not fully controlled even with lithium, the intermittent or permanent addition of an antidepressant may be called for. Before Prozac and other SSRIs became available, psychiatrists used almost every antidepressant drug on the market in combination with lithium. Now increasing successes have been reported with the combination of lithium and Prozac. Many manic depressives use both drugs simultaneously for an indefinite period of time. Others may need both drugs to get over a single depressive episode, but if the attacks recur while the patient’s on lithium alone, Prozac and lithium in combination can be used successfully on a long-term maintenance basis. Prozac should not be given to severe bipolar I manic depressives without lithium and/or other mood stabilizers, since it may make the manic high dangerously higher, requiring hospitalization for manic psychosis. Even with antimanic medications, manic breakthroughs and toxic drug reactions have occasionally been reported with Prozac and other SSRIs.

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