What are the main medicines for mania or hypomania?
If you are prescribed a medicine, then there may be many reasons why that one has been chosen. These might include:
- side effects (which ones are important to you)
- local policies or agreements (such as what your GP surgery uses or agreements in your area)
- national policies (e.g. NICE, SIGN - see last question)
- familiarity (it may be better for prescribers to use medicines they are familiar with)
- relative costs for similar medicines (if two medicines are very similar, why waste money on the more expensive one?)
- personal preference (either yours or your prescriber)
- how bad your symptoms are
- any medicine you might have done well with in the past (as it's more likely to work again)
The main medicine treatment options in UK are listed below. They are divided in "BNF" and "Others".
For convenience, the "Main medicines” are those medicines that are officially "approved" to treat the condition or symptoms (www.bnf.org/bnf/) and which are listed in the British National Formulary (BNF). To be listed in the BNF there needs to be good evidence that the medicine works and that the manufacturers have applied for a license (a long and costly exercise). "Others" are those medicines where there is some evidence that they help, but either not enough for a license or that no license has been applied for. These should usually only be used where other standard treatments have failed.
Main medicines:(BNF Listed)
Lithium - difficult to use in acute mania so it is not often used for mania, although it is good at preventing it coming back
Olanzapine - can be sedative to start with, can be given by injection and can prevent relapse
Quetiapine (Seroquel ® and Seroquel XL ®) - this is sedative to start with, and the dose can be built up over 2 days with the XL tablets
Risperidone - dose has to be built up over a few days, and it may help reduce relapse
Valproate semisodium (Depakote ®) - can be used at a higher dose to start with and can help prevent relapse
Asenapine (Sycrest® or Saphris®) - launched in UK in 2012
Hypnotics (such as those below) to try to help the person sleep and becoming too exhausted e.g. the benzodiazepines (such as flunitrazepam, flurazepam, loprazolam, lormetazepam, nitrazepam and temazepam) or the 'Z' hypnotics (such as zaleplon, zolpidem and zopiclone).
Sometimes the symptoms of mania or hypomania can become very severe. This can result in the person becoming very distressed and too difficult to cope with and needs to be admitted to hospital. This might then become what is called an "acute psychiatric emergency" or crisis. The treatments for this may need to include some other medicines just to calm the person down and prevent harm to that person, or others. If this happens, follow the link to some information that might help explain what might be going on.
Many medicines have been tried but not all have been successful e.g. Omega-3 fatty acids (an analysis of 5 studies showed no effect; Sarris 2011)