Bipolar Disorder Options

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.

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.

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.)

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.

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.