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Therapy of bipolar disorders

What do I have to know about the other medications?

Aside from the mood stabilisers, other medications are also applied in cases of bipolar disorders. In the following list, you will find a summary of the medications which are most important and which are employed most frequently.

Atypical antipsychotics

  • They do not only function against such psychotic symptoms as hallucinations and delusions, but also have a mode stabilising and, in part, also an antidepressive effect. Within this class, there are substantial differences to be seen for the spectrum of effects and side effects.

Typical antipsychotics

  • Typical antipsychotics (e.g. haloperidol, flupentixol) have a very good antipsychotic effect and are occasionally necessary in the acute therapy, among other things for controlling severe states of agitation.
  • Due to the unfavourable profile of side effects, however, their long-term use should preferably be avoided for treatment of bipolar disorders. Nevertheless, this does not contradict the fact that individual patients even get along better with this class of medications, so that a decision to use them must be made individually.

Benzodiazepines and hypnotics

  • They are employed for the treatment of states of fear, restlessness and agitation, as well as also for sleeping disorders. They are frequently prescribed in cases associated with an acute danger of suicide, in order to allow the often pressing thoughts of suicide to be suppressed.
  • They function very rapidly and effectively. However, they should only be administered in the case of an acute therapy, since they are associated with a substantial potential of addiction when used for longer periods of time.

Antidepressants

  • Antidepressants can modify the mood favourably, promote sleep and initiate a calming effect; however, the selection of a particular medication is made based upon the specific depressive condition (fearlessness, lack of drive, agitated depression, etc.).
  • Because of the so-called "switch risk", antidepressants should only be used in combination with mood stabilisers. "Switch risk" means that these antidepressants can initiate a manic phase. Whether this risk actually exists or if the change in the mania simply represents the natural course of the bipolar disorder, however, has not been clarified sufficiently.
  • Nevertheless, the possibility for a "switch risk" should be prevented. The "SSRIs" (selective serotonin reuptake inhibitors) are considered to be antidepressants associated with a mild "switch risk". Should you notice any manic symptoms when taking such antidepressants, these must be discontinued immediately after consulting with your physician!
  • In mixed states or in cases of rapid phase changes (rapid cycling), antidepressants should generally be avoided, since they can have an unfavourable influence on the further course of the illness.
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