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Table of Contents
According to The American Psychiatric Association's "Guideline
For The Treatment Of Patients With Bipolar Disorder" acute
episodes of mania are usually treated with a mood stabilizer (lithium
or valproate) plus an antipsychotic. Once the patient has been stabilized,
the psychiatrist may reassess the continuing need for an antipsychotic
medication in addition to the mood stabilizer. For acute depressive
episodes, APA guidelines recommend a mood stabilizer. Use of anti-depressants
must be used judiciously because of their tendency to trigger a manic
episode (although this is less likely in patients diagnosed with Bipolar
II). If used, an anti-depressant should always be taken in conjunction
with a mood stabilizer.
In both the acute and the maintenance phase of treatment, psychotherapy
(always in addition to pharmacological treatment) may be helpful to
address illness management, social/vocational rehabilitation, and adherance
to a treatment plan. Another treatment sometimes used for medication-resistant
bipolar disorder is electroconvulsive therapy (ECT), for depression.
- General Reading
- Information on free or low-cost medications
provided by pharmaceutical companies
- Recommended Books on Bipolar
Disorder-related Psychiatric Medications
- Side-Effects of Some Psychiatric Medications
- Medications prescribed for mania (mood
stabilizers, anti-convulsants)
- Lithium - the most commonly prescribed
mood stabilizer to treat both manic and depressive episodes. It is
most helpful as a maintenance medication, because it works more slowly
than some of the atypical neuroleptics used to treat acute mania.
Common side effects include: excessive thirst, urinary problems, lack
of coordination, tremors, nausea/vomiting, fatigue, weight gain, hypothyroidism.
- Valproate/Divalproex (Depakote, Depakene)
- an anticonvulsant approved for use as a mood stabilizer medication
in 1995 ((the first approved medication for bipolar in 25 years, since
lithium). Previously it was prescribed only as an epilepsy medication.
Side effects include: liver problems, tremors, weight gain, nausea,
drowsiness, and dizziness.
- Carbamazepine (Tegretol) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: liver problems, skin reactions (rash),
drowsiness, dizziness, blurred vision, unsteadiness, nausea/vomiting.
- Lamotrigine (Lamictal) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: drowsiness, dizziness, blurred vision,
unsteadiness, nausea/vomiting.
- Topiramate (Topamax) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: drowsiness, constipation, numbness/tingling,
loss of coordination, tremors, decreased sweating, changed speech,
loss of concentration.
- Gabapentin (Neurontin) - an anticonvulsant
medication also used as a mood stabilizer in the treatment of bipolar
disorder. Side effects include: dizziness, drowsiness, dry mouth,
upset stomach.
- Other Medications Prescribed for Bipolar
(adjunct treatments for mood stabilizers)
- Benzodiazepines (most common include:
alprazolam/Xanax, diazepam/Valium, lorazepam/Ativan, and Clonazepam/Klonopin)
- these drugs are sometimes prescribed in addition to a mood stabilizer
because they reduce tension and improve sleep. However, they are not
by themselves an adequate control for mania. Moreover, they are not
recommended for long term use because of some indications that they
may be addictive.
- Atypical Antipsychotics - may be prescribed
to quickly control acute manic episodes, and may be continued as an
additional maintenance medication if the bipolar patient experiences
psychotic symptoms as part of the disorder. Most of these drugs are
dopamine-blockers, and are used as primary medications for the treatment
of schizophrenia. Major medical side effects can include: hyperglycemia
and/or diabetes, excessive weight gain, heart arrythmias, sexual disfunction,
and raised prolactin levels.
- Calcium Channel Blockers (examples:
Verapamil, Diltiazem, Nifedipine, and Nimodipine) - these medications
are not prescribed very often for the treatment of bipolar disorder.
They slow the uptake of calcium ions into cells, relaxing blood vessels
and reducing stress on the heart. Side effects include: dizziness,
nausea, headache, and flushing.
- Antidepressant Medications (may be
used in addition to mood stabilizers to control depressive episodes)
- Antidepressants, particularly the older ones, have been known to
induce a manic episode in people with bipolar disorder. Because of
this, they are used with caution, and always with a mood stabilizer.
Clinical recommendations discourage the use of an antidepressant for
anyone who has had at least one dangerous episode of mania (New England
Journal of Medicine, 2004:351:5:479). Preliminary research indicates
that the newer SSRI medications may be less likely to cause a manic
episode. As with most medications, an antidepressant can take 3-6
weeks to show effects.
- Tricyclic Antidepressants
- Selective Serotonin Reuptake Inhibitors
(SSRIs)
- Monoamine Oxidase Inhbitors (MAOIs)
- Bupropion (Wellbutrin, Zyban)
- NIMH and Government
Clinical Trials - New Medications for Bipolar Disorder
| Compound |
Trade Name |
Method of Action and Proposed Effect |
FDA Trials Phase |
| RU 486 |
Mifepristone |
glucocorticoid antagonist; antidepressant |
Phase II |
| Riluzole |
Rilutek |
glutamate antagonist; antidepressant |
Phase II |
| Pramiprexole |
Miraprex |
dopamine agonist; antidepressant |
Phase II |
| Tamoxifen |
|
PKC inhibitor; mood stabilizer |
Phase II |
| Felbamate |
Felbatol |
glutamate antagonist; antidepressant |
Phase II |
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