Pillwatch.com : Summary of Bipolar Depression Treatments

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 amitriptyline 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 venlafaxine	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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