Bipolar Disorder Part 4



Posted: Monday, December 27, 2004

by Anthony Kane MD
ADD ADHD Child Behavior Treatment and Medication

Bipolar Disorder Part 4

by Anthony Kane, MD

Valproic acid

This is an antiseizure medication that has proved very effective in treating bipolar disorder.

Some of the mild side effects are sedation, nausea, and vomiting. Rarely, valproic acid has been associated with fatal hepatic toxicity, hemorrhagic pancreatitis, and agranulocytosis. There also seems to be an association with valproic acid and ovarian abnormalities when it is used for longs periods of time.

Toxicity from overdose is rare but can lead to somnolence, heart block, coma, and death. Overdose is treated with hemodialysis.

Carbamazepine

This is also an antiseizure medication. Unlike, valproic acid, the side effects of carbamazepine are common and often may be serious. Side effects include:

Overdose of Carbamazepine can be fatal.

Other Anticonvulsants

There are other antiseizure medications currently being used to treat bipolar disorder. Here are some of the common ones:


Antipsychotics

  • Chlorpromazine
  • Risperidone
  • Ziprasidone
  • Olanzapine
  • Chlorpromazine

      Combination Therapy

      Lithium or valproic acid in combination with an antipsychotic medication is more effective and faster acting than either of these drugs alone.

      Some Less Conventional Treatments

      Omega-3 fatty acids

      Omega-3 fatty acids may inhibit nerve cell conduction pathways in a manner similar to that of lithium carbonate and valproic acid. One study in bipolar patients used 9-10g/day of omega-3 fatty acids, in the form of fish oil, and found significant mood-stabilizing effects.

      The omega-3 fatty acids found effective for mood stabilization are EPA (eicosapentenoic acid) and DHA (docosahexenoic acid), both from fish oil. Maintaining a high EPA to DHA ratio may be important for the mood effects.

      Melatonin

      One study done in Italy suggested that 3mg at bedtime of melatonin can treat insomnia associated with mania that does not respond to usual drug therapies.

      Depressive Episodes

      The primary goal of treatment in depression is remission of the symptoms of major depression with return to normal levels of psychosocial functioning. An additional focus of treatment is to avoid precipitation of a manic or hypomanic episode.

      The first-line pharmacological treatment for bipolar depression is either lithium or lamotrigine.

      Standard antidepressants that are useful in regular depression are not recommended, since they can precipitate a switch into mania or into rapid cycling. When used, they are supplementary.

      ECT is a possible alternative to drug treatment.

      Drugs used to treat the depressive episodes of bipolar disorder include:

      • Lithium
      • Valproic Acid
      • Carbamazepine
      • Lamotrigine: This is an anti seizure medication. Its side effects include serious rash and toxic epidermal necrolysis.
      • Topiramate
      • Antidepressants: including the tricyclic antidepressants, serotonin reuptake inhibitors (SSRI’s) and the monoamine oxidize inhibitors.
      • Antipsychotic medications
      • ECT
      To Page 5

       


      Anthony Kane, MD



      ADD ADHD Advances


      Anthony Kane, MD is a physician and international lecturer.
      Get ADD ADHD Child Behavior and Treatment Help for your ADHD child, including child behavior advice and information on the latest ADHD treatment. Sign up for the 
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