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Summary of Bipolar Depression Treatments

Mood Stabilizers

Should be combined with other drugs to work effectively

Effective against acute mania if combined with atypical anti-psychotics

 
Mode of Action
Benefits
Drawbacks
Notes
     lithium

not well studied, is supposed to decrease norepinephrine release and serotonin synthesis

effectively lessens both mania and depression symptoms; may have anti-suicide effect

not used for acute mania, since it needs time to offer benefits;

high risk of overdose
first-line treatment for mania
Anticonvulsants
 
 
 
 
    valporate
   
   
 
 
  
 
 carbamazepine
  
 
  

increases GABA levels in the brain; positively influences brain cells membranes

 
blocks sodium channels making brain cells less excitable
works well for acute mania due to rapid onset of action
 
 
 
 
effective for rapid cycling

may cause liver damage, decreased platelet count, inflammation of the pancreas

may rarely cause low white blood cells count, fatal skin conditions, and psychosis

First-line treatment of manic symptoms
Calcium Channel Blockers
originally used for cardiovascular disorders
comparatively safe to be used in pregnant women
are not well studied for the use in bipolar disorder
third-line choice for mood stabilizing
    verapamil
   
 
 
   nimodipine
 
blocking calcium channels results in the mood stabilizing
helpful in mania
 
 
 
easily enters the brain, helpful in rapid cycling
is difficult to enter the brain
 
 
more research is needed
immediate-release verapamil is more effective
Antidepressants

May cause mania episodes

Should be used in combination either with mood stabilizers or antipsychotics

Used to lessen depressive phase symptoms

 
Mode of Action
Benefits
Drawbacks
Notes
SSRIs

increase serotonin levels in the brain without affecting other neurotransmitters

seldom associated with the aggravation of manic symptoms, side effects subside with time

may cause serotonin syndrome

should not be used with MAOIs in view of sever side effects

    fluoxetine
   
     
    sertraline
   
  
    paroxetine
   
 
  
 
    fluvoxamine
   
  
    citalopram
has stimulating effects
 
  
neither stimulating nor sedating
 
 
 
 
 
 
sedating
 
 
neither stimulates nor sedates
has low risks of withdrawal symptoms
  
has fewer reports on convulsions
 
is commonly well-tolerated
 
 
  
is not associated with convulsions
 
has the lowest rate of side effects, fewer drug interactions
nausea is frequent,
has the longest onset of action
 
  

nausea is the most common side effect, high risk of weight gain

more sedating than the others
the first FDA approved SSRI antidepressant
 
 
 
 can increase the risk of self-harm in children

Tricyclics     

    desipramine
    nortriptyline
    protriptyline
    dopexin
    imipramine

affect the levels of such neurotransmitters in the brain as serotonin and norepinephrine, thus are nonselective

very effective against depressive episodes of bipolar disorder

have high risks of switching to mania episodes, overdose can be fatal

have a long history of use as antidepressants
MAOIs
    phenelzine
    tranilcypromine

inhibit monoamine oxidase in the brain increasing the levels of serotonin, norepinephrine and dopamine

effectively reduce depression symptoms, side effects subside with time

associated with numerous drug interactions

treatment is inconvenient due to multiple restrictions in the diet

Other   
    bupropion
   
   
 
 
  
   
 
 
 
inhibits neurotransmitter dopamine
 
 

 

lower doses increase serotonin levels, higher ones raise norepinephrine

 
has low potency of switching to mania, weight gain, and sexual dysfunction
 

efficacy is dose-related, non-responsive to other drugs patients may benefit from it

 
can cause seizures
 
 
 
 
 
high doses may cause hypertension
 
 
 
 
 
 
 
good for severe depressive phase
Antipsychotics

Used to treat bipolar disorder with psychotic features

 
Mode of Action
Benefits
Drawbacks
Notes
Typical
    fluphenazine
    haloperidol
    thioridasine
    molindone

affecting many neurochemical systems, blockage of dopamine receptors is the main action of antipsychotics

as effective against mania as lithium, may be used on a long-term basis with mood stabilizers

have many side effects, the most troublesome being movement disorder (e.g. parkinsonism)

have long history of use against mania
Atypical

affect dopamine and serotonin receptors, exact action is unknown

have lower risks of causing movement disorder side effects
have many potentially dangerous adverse reactions
newer drugs on the market
    clozapine
   
 
   
 
 
    risperidone
 
 
 
   
    olanzapine
binds to serotonergic and dopamine receptors in the brain
 
 
 
a strong dopamine antagonist, partially affects serotonin receptors
 
mainly affects serotonin levels

effective for both manic and depressive phases and rapid cycling

 
effective for both phases of the disorder
 
 
works well for eliminating acute mania symptoms

may cause decrease in the white blood cells count, seizures, and weight gain

is not associated with weight gain, may rarely aggravate mania

weight gain, diabetes, hyperlipidemia are frequent side effects

the first member of new drugs generation
 
 
 
 
 
 
 
 
approved for eliminating depressive symptoms
Benzodiazepines

Studied to be used in acute mania

Rarely used alone

May be stopped as soon as a patient becomes stable

Have rapid onset of action

 
Mode of Action
Benefits
Drawbacks
Notes
    clonazepam
   
 
 
 
    lorazepam
many-fold action on GABA and benzodiazepine receptor
 
has sedating, tranquilizing, and hypnotic effects
helpful in relieving acute mania
 
 
 
rectal and intramuscular administration is possible
has many side effects, habit-forming
 
 
high risks of tolerance, dependence, and withdrawal symptoms
 
 
benzos overdose is dangerous


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