Management of Bipolar Disorder (BPD)
o Drugs from other classes that can be used to treat BPD
BPD is treated with three major groups of drugs: mood
... [Show More] stabilizers,
antipsychotics, and antidepressants. In addition, benzodiazepines are
frequently used for sedation.
Mood Stabilizers
Mood stabilizers are drugs that (1) relieve symptoms during manic and
depressive episodes, (2) prevent the recurrence of manic and depressive
episodes, and (3) do not worsen symptoms of mania or depression or accelerate
the rate of cycling. The principal mood stabilizers are lithium and two drugs
originally developed for epilepsy: divalproex sodium (valproate)
and carbamazepine. These drugs are the mainstays of treatment. The
pharmacology of lithium and the antiepileptic drugs is discussed later.
Antipsychotics
In patients with BPD, antipsychotic drugs are given to help control symptoms
during severe manic episodes, even if psychotic symptoms are absent. Although
antipsychotics can be used alone, they are usually employed in combination
with a mood stabilizer. For reasons discussed later, the second-generation
antipsychotics (e.g., olanzapine, risperidone) are generally preferred to the firstgeneration agents (e.g., haloperidol).
Antidepressants
Antidepressants may be needed during a depressive episode. However, in
patients with BPD, antidepressants are almost always combined with a mood
stabilizer because of the long-held belief that, when used alone, antidepressants
may elevate mood so much that a hypomanic or manic episode will result.
However, data indicate that the risk for inducing mania may be much lower than
previously thought. Nonetheless, the current guidelines suggest continuing the
traditional practice of using an antidepressant only if a mood stabilizer is being
used as well.
Although antidepressants have been studied extensively in patients with major
depression, research is still lacking in patients with BPD. At this time there are
insufficient data on which to base drug selection. Even so, experts do have theirpreferences. Among clinicians with extensive experience in BPD, the following
are considered antidepressants of
choice: bupropion (Wellbutrin), venlafaxine (Effexor XR), and the selective
serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) and sertraline
(Zoloft). One thing we do know is that the use of tricyclic antidepressants
(TCAs) appears to promote more incidents of mania; therefore TCAs are not
recommended in the treatment of BPD.
o Drug Interacti [Show Less]