The Corpus Callosum

Bipolar Disorder Options

For
anyone who is interested, Medscape has a nice, concise href="http://www.medscape.com/viewarticle/554128">summary
article about medication treatment options for bipolar
disorder.  They focus on the atypical antipsychotics, but
cover the mood stabilizers, too.

width="500">
Generic Name Trade Name Manic Mixed Maint. Depr.
Valproate Depakote X      
Carbamazepine extended release Equestro X X    
Lamotrigine Lamictal     X  
Lithium X   X  
Aripiprazole Abilify X X X  
Ziprasidone Geodon X X    
Risperidone Risperdal X X    
Quetiapine Seroquel X     X
Chlorpromazine Thorazine X      
Olanzapine Zyprexa X X X  
Olanzapine/fluoxetine Combination Symbyax       X


The entire topic is complex, and sometimes it is nice to have a
condensed article to get oriented.  A more thorough treatment
guideline is href="http://www.bap.org.uk/consensus/FinalBipolarGuidelines.pdf">here
(PDF), and a longer one is href="http://www.psych.org/psych_pract/treatg/pg/Practice%20Guidelines8904/BipolarDisorder_2e.pdf">here
(PDF).

Comments

  1. #1 Tyler DiPietro
    May 13, 2007

    Two of the medications I take are on that list. I didn’t know it was very atypical for bipolars like myself to take anti-psychotics.

  2. #2 Joseph j7uy5
    May 13, 2007

    Let me clarify a couple of points.

    1. Nowadays it is common for persons with bipolar disorder to be treated with antipsychotics, both in an acute (say, manic) episode, and for maintenance. Formerly, antipsychotics would be used for acute mania or psychotic depression, then (generally) would be tapered off.

    2. The use of the word “atypical” in this context refers to a class of antipsychotic medications. The exact definition of “atypical” is open to debate, but most commonly it would refer to medications that block both D2 and 5-HT2 receptors. They all do other things, but those two effects in conjunction seem to define atypicality.

  3. #3 sm
    May 13, 2007

    This is a nice resource, but probably overemphasizes the atypicals. Charlie Nemeroff’s conflicts of interest are legendary. He’s well-compensated to underplay both the effectiveness of older treatments and the side effect burden of the newer drugs. (I give primary responsibility to Nemeroff since the first author is just a resident, and the paper reads a little like a book report.)

  4. #4 stumpy
    May 13, 2007

    I didn’t read the articles, but, judging from the chart, it looks as tho the authors are overlooking lamotrigine and lithium for bipolar depression. Also, to say that Seroquel and Zyprexa are useful (at least as monotherapy) for bipolar depression, is a bit of a stretch, in my experience. I wonder if Nemeroff’s alleged conflicts of interest might be in evidence here.

  5. #5 Joseph j7uy5
    May 14, 2007

    Oddly, the article was sponsored by Glaxo, makers of lamotrigine, although lamotrigine has gone generic. They also make paroxetine, which is available as a generic. So the sponsors themselves do not stand to benefit directly from this. As for the authors, we do have to wonder if they have some kind of agenda. My take on it is that they were overly swayed by which drugs have FDA approval, rather than which drugs have good evidence to back them up. The two don’t always go together.

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