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Therapy of bipolar disorders

What medicinal therapies are available?

There are a great number of medicines available for the treatment of bipolar disorders. To make a selection, the doctor orients him/herself on the current episode (depressive, manic or mixed), on the symptoms which stand in the foreground, the positive experiences made by the person who is afflicted during previous phases of the illness, the profile of side effects and the contraindications. Frequently, combination therapies are employed, especially using mood stabilisers in combination with antipsychotics or antidepressive agents. In the following, you will find a table summarising all of the possible therapies to be used for bipolar disorders.

Type of medication Name of active agent Trade name (examples)
Mood stabilisers Lithium Quilonum, Hypnorex retard
  Valproate Orfiril, Ergenyl
  Carbamazepine Tegretal, Timonil
  Lamotrigene Lamictal
  Oxacarbazepine Trileptal
Atypical antipsychotics Amisulprid Solian
  Aripiprazole Abilify
  Clozapine Leponex
  Olanzapine Zyprexa
  Paliperidone Invega
  Quetiapine* Seroquel
  Risperidone Risperdal
  Ziprasidone Zeldox
Typical antipsychotics Haloperidol Haldol
  Flupenthixol Fluanxol
  Zuclopenthixol Ciatyl
Benzodiazepines (examples) Diazepam Valium
  Lorazepam Tavor
  Oxazepam Adumbran
Hypnotics (examples) Zolipdem Stilnox
  Zopiclone Ximovan

 

Types of antidepressives (AD; examples) Active agent Trade name (examples)
Selective serotonin
reuptake inhibitor (SSRI)
Fluoxetine Fluktin
  Paroxetin Seroxat
Selective serotonin
and noradrenalin reuptake
inhibitor (SSNRI)
Venlafaxine Trevilor
Tricyclic AD Amitryptiline Saroten, Amineurin

What must I know about mood stabilisers?

Mood stabilisers are pillars in the medicinal therapy of bipolar disorders. They can smooth excessive mood swings, both in a manic as well as in a depressive episode of the illness, and are accordingly employed in the acute phases as well as for the prophylaxis against relapses. Whereas only few preparations were previously available, there are numerous such drugs available today. In the following table, you will find the most important knowledge summarised concerning the most important and most frequently used mood stabilisers.

Important knowledge


Lithium

  • Lithium is a salt.
  • It is approved for the prophylaxis of re-occurring bipolar disorders, for acute therapies in cases of mania and as an additional therapy against recurring depressions.
  • The anti-manic effect comes into effect within from one to three weeks, and the antidepressive effect arises after four to six weeks.
  • In up to 80% of the cases, it hinders the re-occurrence of manic and depressive episodes. In the event that such an episode is not hindered, lithium substantially reduces the intensity of symptoms.
  • There are indications that low levels of lithium function better against depression and, at higher levels, it functions better against mania.
  • Lithium must be administered long-term, and discontinuing its use suddenly initiates a new episode of the illness in 50% to 90% of the cases.
  • Lithium salts have a narrow therapeutic window, meaning that they can easily be overdosed. Therefore, it is important that this medication be carefully controlled (reliably administered, routine blood monitoring).
  • Before and during the lithium therapy, some controls must be carried out, among other things involving the body weight, circumference of the neck, thyroid and kidney values, blood levels of the lithium salts, ECG and EEG.

Antiepileptic agents (anticonvulsives): Valproate

  • Valproate is an antiepileptic agent.
  • It is approved for the prophylaxis of re-occurring bipolar disorders and for the acute therapy of mania.
  • Valproate is equally as effective as lithium and is employed especially in the event of manic episodes, for mixed forms and in cases of rapid cycling.
  • An advantage to valproate is that it can also be employed as an infusion therapy for acute manic episodes. In this manner, an anti-manic effect can be brought about especially rapidly.
  • The therapeutic window for valproate is a great deal larger than that for lithium. Valproate is generally tolerated well.

Antiepileptic agents (anticonvulsives): Carbamazepine

  • Carbamazepine is an antiepileptic agent.
  • It is approved for the prophylaxis of re-occurring bipolar disorders, if lithium does not prove to be sufficiently effective.
  • In cases of mixed episodes and for rapid cycling, carbamazepine appears to be superior to lithium.
  • The effective dosage varies quite differently between individuals. Consequently, it is mandatory that the afflicted persons be controlled and that the dose be adjusted carefully.
  • A disadvantage to carbamazepine is the high interaction of this medication with a large number of preparations. Therefore, the use of this medication in combination therapies is questionable.

Antiepileptic agents (anticonvulsives): Lamotrigene

  • Lamotrigene is an antiepileptic agent.
  • It is approved for the prophylaxis of re-occurring bipolar disorders.
  • It is generally employed in cases of bipolar II illnesses for the prophylaxis of re-occurring depressive phases or as a co-medication for the treatment of bipolar I illnesses.
  • A limitation to its use is that the dose must be increased very slowly.

Atypical antipsychotic: Olanzapine

  • Olanzapine is an atypical antipsychotic.
  • It is approved for the prophylaxis of recurring bipolar disorders and for the acute treatment of mania.
  • Especially when psychotic symptoms are demonstrated concomitantly, olanzapine is also employed as a co-medication for the acute therapy of bipolar I illnesses.
  • It has a preventative effect against manic, depressive and mixed episodes, but is most effective against manic episodes.
  • There are indications for its efficacy against rapid cycling as well.

Atypical antipsychotic: Quetiapine

  • Quetiapine is an atypical antipsychotic.
  • It is approved for the prophylaxis of recurring bipolar disorders and for the acute treatment of mania.
  • Quetiapine is also employed as a co-medication for the acute therapy of bipolar I illnesses, especially when psychotic symptoms are demonstrated concomitantly.
  • It has a preventative effect against manic, depressive and mixed episodes, but is most effective against manic episodes.
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