Psychopharmacology is the use of psychotropic medications (any prescription meds that affect mood, emotion, behavior, or perception) to treat mental illness. In the case of bipolar, psychopharmacology has four primary goals:
Alleviate acute manic symptoms
Ease depressive symptoms
Eliminate or lessen any psychosis
Maintain mood stability and reduce the likelihood or frequency of future mood episodes
The treatment goals are clear, but psychiatrists sometimes have trouble meeting these goals for the following reasons:
Symptoms vary dramatically. Depending on the pole of the episode — whether it's primarily depressive or primarily manic — the symptoms being treated aren't just different, but they're almost mirror images. When treating bipolar disorder, doctors must target individual poles and broader illness itself (the fact that cycles re-occur).
Symptoms change over time. Someone experiencing a manic episode may quickly begin to experience depression or vice versa. Target symptoms can seem hard to pin down.
Some episodes can have mixed features. Although someone may be experiencing primarily manic symptoms, she may also experience hopelessness or other depressive symptoms; people in a bipolar depression may be quite agitated and irritable. These mixed features further complicate treatment planning.
Symptom stories differ from person to person. One person's mania may be primarily irritable whereas another person may seem quite euphoric. Sometimes depression presents with a lot of irritability.
Other conditions may impact diagnosis and treatment. An individual may have bipolar disorder coupled with anxiety or substance use disorder, for example. Having a coexisting condition may affect how the bipolar disorder presents and progresses. Treatment for each of these conditions can interact, causing negative physical responses or making treatment ineffective.
Effectiveness and side effects differ for each individual. A medication that works for one person may have no effect or the opposite effect on another. One individual may feel fine taking a particular medication, whereas another may feel groggy or gain weight.
Medications can worsen symptoms. For example, some antidepressants can induce mania or increase anxiety or agitation in certain individuals.
Medications can interact with each other. Treatment often requires the use of two or more medications at the same time, which can affect the efficacy or side effects of either or both medications.
