Bipolar disorder (sometimes called manic-depressive disorder) is a psychiatric condition characterized by periods of extremely high (manic) and low (depressive) mood. Medications are available to help those with bipolar treat symptoms that arise in high or low mood cycles. Some drugs have also been proven effective in helping to prevent the recurrence of manic and depressive episodes, facilitating maintenance of stable mood.
Bipolar Mania or Mixed Episodes
Episodes of bipolar mania involve symptoms of extreme emotion (euphoria, agitation), creativity, physical and mental energy, risk-taking, and impulsive behavior, while mixed episodes involve a combination of both manic and depressive symptoms. Research has identified a number of medications that can effectively treat the symptoms of these episodes, including several atypical antipsychotics like risperidone, ziprasidone, quetiapine and aripiprazole. Atypical antipsychotics are second-generation antipsychotic medications that have fewer side effects than their predecessors and are effective in treating psychotic symptoms such as hallucinations and delusions. Haloperidol--one of these earlier antipsychotics (called a typical antipsychotic)--may also be effective, and studies have shown that risperidone is equivalent to haloperidol in the treatment of manic episodes. Aripiprazole alone also performs as well as haloperidol at treating manic and mixed episodes, and it produces fewer extrapyramidal side effects (problems with movement such as tremor, muscle rigidity and motor restlessness).
The combination of risperidone plus mood stabilizers like lithium or lamotrigine may significantly outperform mood stabilizers alone, but the addition of risperidone significantly increases extrapyramidal side effects.
Quetiapine may be useful for those who have not responded to other treatment. A study published in the June 2004 issue of "Bipolar Disorders" reported that patients who were unsuccessfully treated with lithium (a mood stabilizer) or divalproex (an anticonvulsant/anti-seizure medication) for seven days showed a significant reduction in manic symptoms after receiving quetiapine.
Bipolar Depression
Individuals suffering from an episode of bipolar depression may alleviate their symptoms by taking one of several drugs shown to be efficacious in improving mood. The Food and Drug Administration has indicated that combination treatment with olanzapine (an atypical antipsychotic) and fluoxetine (an antidepressant in the class of selective serotonin reuptake inhibitors, or SSRIs) is effective. A drug combining an SSRI and antipsychotic medication, fluoxetine and olanzapine, is also approved for the treatment of bipolar depression.
Monotherapy with quetiapine, pramipexole (a dopamine agonist), paroxetine (SSRI) or venlafaxine (selective serotonin and norepinephrine reuptake inhibitor, or SNRI) has also proved to alleviate symptoms of bipolar depression.
Maintenance
Some medications have been successful in helping people to maintain a stable mood and prevent the recurrence of manic or depressive episodes. The mood stabilizer lamotrigine may help to prevent depressive episodes, while lithium can help in preventing recurrence of manic, hypomanic or mixed episodes. Olanzapine and divalproex both help to prevent manic and mixed episodes.
References
- APA Practice Guidelines: Bipolar
- "Bipolar Disorders;" Quetiapine with lithium or divalproex for the treatment of bipolar mania: a randomized, double-blind, placebo-controlled study; Sachs G et al.; 2004
