MOOD MEDICINE STABILIZER Benefits: very effective for depression and ; prevents suicide; strengthens brain cells. Well TREATMENT MENU tolerated in lower doses (for depression). Risks: nausea, tremor, thirst, low thyroid, kidney problems.

Mood stabilizers prevent both manic and ATYPICALS depressive episodes in . They treat Examples: (abilify), (saphris), manic and mixed symptoms including irritability, brexpiprazole (rexulti), (vraylar), impulsivity, , insomnia, agitation, iloperidone (fanapt), (latuda), and anxiety. (zyprexa), paloperidone (invega), (seroquel), (risperdal), (geodon). LIFESTYLE Benefits: all treat mania and mixed states. Some also treat depression (e.g. quetiapine, lurasidone, cariprazine, olanzapine-fluoxetine combination). DARK NIGHTS Risks: weight gain, drowsiness, restlessness, Sleeping in a pitch dark room (or with an eye mask) diabetes, high cholesterol, tardive dyskinesia helps stabilize mood. You can further this effect by (permanent muscle twitching). wearing blue-light blocking glasses in the evening. These orange glasses give a warm, yellowish hue to DEPAKOTE your vision and filter out the wavelengths of light that cause mood swings. However, they should only Benefits: treats mania and mixed states. be worn in the evening (after 6pm and before 8am). Risks: stomach distress, fatigue, weight gain, hair moodtreatmentcenter.com/darktherapy.pdf loss, low count, liver problems.

REGULAR ROUTINES Sticking with a few daily routines at regular times Examples: equetro, carbamazepine, tegretol are (give or take 30 minutes) also sets the brain’s the main ones. /trileptal is internal clock and stabilizes mood. The most sometimes better tolerated but not as effective. important activities to do at regular times are: Benefits: treats mania and mixed states. 1. Waking up Risks: fatigue, double-vision, allergic rash, 2. Starting work or chores pancreatitis, low sodium. Carbamazepine can lower 3. Starting contact with other people the levels of many other including birth 4. Exercise control. 5. Dinner

LAMOTRIGINE THERAPY Benefits: prevents depression and mania/mixed states, almost no side effects, but does not treat active mania or mixed states. SOCIAL RHYTHM THERAPY Risks: severe allergic rash (Stevens-Johnson) Through mood charting, clients learn which daily routines help stabilize their mood. The therapist also helps client build new skills to overcome the CALCIUM CHANNEL BLOCKERS effects of bipolar on relationships and identity. Examples: nimodipine, isradipine, amlodipine Benefits: treat mood swings that change daily or weekly. Well tolerated. FAMILY THERAPY Risks: low blood pressure. The therapist helps families live more effectively with mood problems in the home. Conflict resolution and specific communication skills are ALLOPURINOL taught. Benefits: this for gout has been successfully used experimentally for mania. Risks: well tolerated but not well tested. EDUCATIONAL GROUP In this weekly seminar a therapist teaches skills to live more effectively with bipolar. Much of the NATURAL learning comes from other patients who have struggled with bipolar PROBIOTICS Mechanism: reduces inflammation. SUPPORT GROUPS Benefits: depression, mania, memory, anxiety. Several local groups meet regularly to share Dose: 1 per day of probiotic with Lactobacillus information and support on living with bipolar: rhamnosus LG and Bifidobacterium lactis bb-12. Depression and Bipolar Support Alliance (DBSA), Brands: Usana Probiotic Sticks, Culturelle Baby First Presbyterian Church (for families and patients). Grow and Thrive Liquid, and Emergen-C Drink. The Mental Health Association keeps a listing of meeting times: www.triadmentalhealth.org.

OMEGA-3 FATTY ACIDS Mechanism: coats and protects brain cells; found in fish (salmon) and green leafy vegetables. Benefits: prevents depression, mania, irritability. Dose: 1,000-2,500mg daily of DHA + EPA (dose must have at least 1.5 times as much EPA as DHA) moodtreatmentcenter.com/omega3.pdf