Question: How do I know which bipolar medication is best for me?
Answer: One thing we normally struggle with is what do you start with, what type of mood stabilizer do you start with when it comes to the treatment of bipolar disorder.
So here's what you need to do. The first thing you need to do is look at someone's history. And if the preponderance of their time spent ill has been in the manic or the hypomanic phase of the illness, well the first thing you want to start is a medicine that targets the symptoms of mania.
Now sometimes, and actually it's much more frequent that people will spend the majority of their time below baseline, and by that I mean they'll spend the majority of their time depressed. Now in that instance, you want to start off with a mood stabilizer that has a special efficacy in the treatment of the depressed phase. So if someone was living their life below baseline, they need a mood stabilizer that stabilizes mood from below. If someone is living the majority of their life hypomanic or manic, they need a mood stabilizer that stabilizes mood from above baseline.
And what we have observed over time is if someone comes in and gets started on something that works for depression, they will eventually need something that is used to treat the manic phase of the illness as well and vice versa.