Question: Why might I need a combination of medications for bipolar disorder?
Answer: It's true that combinations of medications are most often used to treat patients with bipolar disorder. The basic reason for this is because people with bipolar disorder present with different symptoms at different points in the illness, or even at the same time.
Examples of this include depressive symptoms and manic symptoms, which are often related but sometimes the opposite of depressive symptoms, and also psychosis and substance abuse. And there's different classes of medications that are used to treat each of these groups of symptoms.
So depending on what a patient is presenting with, for example, if a patient is manic and psychotic, anti-manic drugs and anti-psychotic drugs can be used in combination. That's really the basic response. There are certain cases if symptoms are not getting better quickly enough, or they're not resolving fully, the psychiatrist and the patient together may decide to use two medications from the same medication class to get the symptoms under control.
The most common example of this are what we call mood stabilizers. When one medication is actually helping a patient significantly, but is not allowing that patient to live the life that they want to live, the psychiatrist and the patient may decide to add a second mood-stabilizing medication and this will, in fact, give the patient the relief that they want.