TREATMENT OPTIONS IN BIPOLAR DISORDER, excerpts from a report on a presentation 1 by Charles L. Bowden, M.D., 2 Smooth Sailing, Spring 1996 Dr. Bowden began by noting that responses to medication vary among different presentations (diagnostic varieties) of bipolar disorder. Among these presentations are: pure mania mixed mania (symptoms of mania and depression appearing simultaneously) rapid cycling (four or more cycles or episodes per year) secondary mania (appearance of mania after the occurrence of another illness) bipolar disorder with comorbid (coexisting) substance abuse bipolar disorder type II (characterized by relatively mild manic states) cyclothymia (chronic mood cycles in which episodes are too mild to be classified as clinical depression or mania).
Dr. Bowden ... discussed three medication options for bipolar disorder: lithium, divalproex (also known as valproic acid [Depakote]), and carbamazepine (Tegretol). is the best choice for patients experiencing pure mania, but patients with more history of depressive features and some of the other presentations of bipolar disorder may not respond to it. It is the least expensive of the three options, and it may have antidepressant effects. Patients likely to respond favorably to lithium include those with a family history of bipolar disorder, a previous favorable response to lithium, only a few previous episodes of illness, a history of full relief from symptoms between episodes.
Disadvantages to lithium treatment include problems with patients' noncompliance (failure to take the medication as directed) because of distressing side effects (including memory problems, confusion, poor concentration, and weight gain); the narrow range of blood levels at which lithium is effective but not toxic; and the potential for more serious side effects. (Depakote) is an effective anti-manic and mood-stabilizing treatment for various presentations of bipolar disorder. In a study of acute mania, outcomes were similar in patients treated with lithium or divalproex, except that problems related to premature discontinuation and adverse effects were less severe with divalproex than with lithium; divalproex was more effective than lithium in patients who previously have not responded to lithium; only divalproex was effective in mixed mania ....
In adolescents, the most common symptoms of bipolar disorder are irritability and anger. This form of illness is often misdiagnosed as attention deficit hyperactivity disorder (ADHD) and is often accompanied by substance abuse. Divalproex is an effective treatment. (Tegretol) has been found to be about as effective as the antipsychotic medications and lithium. Most studies of carbamazepine have involved its use in combination with another medication, so that the contribution of carbamazepine alone to the outcome cannot be determined. Patients likely to respond favorably include those with a previous lack of response to other treatment no family history of bipolar disorder bipolar disorder that is secondary to another illness.
Among the side effects of carbamazepine are sedation, dizziness, and vision problems. may be combined with these mood stabilizers to increase effectiveness. These include thyroid supplements, benzodiazepines (certain antianxiety agents), neuroleptics (antipsychotic medications), and calcium channel blockers. (Dr. Bowden)... recommended the use of antipsychotic medication only for people who are having auditory hallucinations ("voices") or bizarre delusions, and then in combination with divalproex (Depakote), not lithium. ...When asked for a "prescription" for bipolar disorder patients, he mentioned finding a place where you can experience collegiality (such as a support group) and participating with your mental health professional in decisions about your treatment. 1 Presented at a Johns Hopkins symposium March 9, 1996 2 Deputy Chairman and Chief, Division of Biological Psychiatry, University of Texas Health Center by Anne Heasty, M.S.
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