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DEAR DOCTOR K: I have bipolar disorder. I’ve experienced the highest highs and the lowest lows. How can one medication — lithium — treat both extremes?

DEAR READER: Bipolar disorder is certainly a condition of extremes — extreme opposites.

On the one hand are episodes of mania. During these episodes people with bipolar disorder feel like they’re “on a high.” They have grandiose thoughts and pumped-up self-esteem. They need a lot less sleep than normal, but feel energized to the extreme. That energy may go into something productive, such as accomplishing a goal. But it can just as easily veer into negative territory, with racing thoughts, agitation, erratic behavior, or destructive, pleasure-seeking urges.

Then there’s the other side of bipolar disorder: the sadness and hopeless feelings of depression. The feeling that you don’t have the energy or desire to do much of anything. The lack of interest in things that used to give you pleasure. Even the thoughts of ending the pain of the extreme sadness and hopelessness you feel — and the pain you may see you are causing the people you love — by ending your life.

While it may seem unlikely that one treatment can affect both “poles” of bipolar disorder — the mania and the depression — it’s true. I think of it as the treatment pulling both poles back toward the middle, evening out the peaks and valleys. It diminishes thoughts of suicide.

Lithium is the most widely known medication used to treat bipolar disorder, as it helps to stabilize mood, the chief goal of treatment. Like any drug, it can cause side effects — dizziness, difficulty with concentration, thyroid problems and others. And lithium doses that are too high can quickly become dangerous, causing confusion, loss of consciousness and dangerous heart rhythms. As a result, people taking the drug need to have regular blood tests.

The main alternatives to lithium are anti-seizure drugs (anticonvulsants). These drugs also treat mania and stabilize moods, but they aren’t as effective as lithium for protecting against depression and preventing suicide.

Other drugs prescribed for bipolar disorder include antipsychotic, antidepressant or anti-anxiety medications. Antipsychotics can help treat distorted or psychotic thinking that may occur during an episode of mania. Antidepressants are effective for depression, but they can trigger a manic episode. Anti-anxiety drugs can help with the jitters, racing thoughts and overall worry and distress that often accompany manic episodes.

There’s a good chance of relapse when you go off medications. As a result, you may need to stay on some medication or combination of medications indefinitely to keep your mood stable.

Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.


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