|Bipolar Home |Site Search |  | Updated January 08, 2006

Bipolar Disorder - Medication

Bipolar Medication Research

Overviews
Bipolar Spectrum
Migraines
Causes
Dual Diagnosis

Diagnosis
Criteria
Bipolar Spectrum
Screening Tools

Treatment
Medications
Psychotherapy
Non-Prescription
   Exercise
   Omega3
   Sleep

Drug Info
Medication List
Zyprexa/olanzapine
Lamictal/lamotrigine
Prozac/fluoxetine
Mood Stabilizers
Antidepressants
Side Effects
Studies-Bipolar
Studies-Other
Drug Searches

Links
SO Support
Transcripts
Interviews
Famous Bipolars
Misc
Brain Research
Updated Sites

Juvenile Bipolar
Overviews
Diagnosis
Treatment
Medications
Bipolar and ADHD
Psychotherapy
School
Family Experiences
Substance Abuse
Articles
Scales and Charts
Links

Award

Direct link

 

Zyprexa/olazapine	Clozapine	Lithium
Lamictal/lamotrigine	Tegretol/carbazepine	Geodon/ziprasidone
risperidone (Risperdal)	Antipsychotics	AntiEpileptics
Depakote/divalproex	Seroquel/quetiapine	Other

Accurian this site requires registration but includes a list of clinical trials, drug information and news in an easily navigable  format.

Mood stabilisers for bipolar mood disorders during pregnancy Evidence Centre Report pdf

Effects of Antimanic Mood-Stabilizing Drugs on Fetuses, Neonates, and Nursing Infants 16 page article includes page on each of the most commonly used medications

Managing Psychiatric Medications in the Breast-Feeding Woman medscape newlink Feb 1998

Antipsychotics

A Rational Approach to Antipsychotic Pharmacotherapy Medscape CME Sept 2003 Henry A. Nasrallah, MD; Martin L. Korn, MD
clinician must therefore balance the positive effects of the medications against the negative consequences to determine the best choice of medication for the individual patient. Discussion of side effects and risk factors for various atypical antipsychotics.

Recent Developments in Antipsychotic Use in Adults Psychiatric Times May 2003 Table
Ziprasidone does not have significant effects on weight, lipid profile or glucose metabolism.......concerns about its cardiac safety....should not be prescribed for patients with an overt cardiovascular disease or a history of cardiac arrhythmias
Aripiprazole no elevation of prolactin levels and no clinically meaningful prolongation of the QT interval Preliminary evidence suggests that weight gain is minimal over a 52-week period
Clozapine increasing evidence that clozapine also reduces the risk of recurrent aggressive behavior
Recent developments in antipsychotics show no major breakthroughs in terms of antipsychotic efficacy, but they do promise treatments that are safer, easier to administer and more acceptable to patients

Atypical antipsychotics no more effective than conventional drugs News @ PharmiWeb Dec.1,2000 Reuters Despite recommendation that conventional antipsychotics be used as first line treatment , they do note that the atypical antipsychotics have fewer side effects. In a related editorial, Drs. Shitij Kapur and Gary Remington, from CAMH, Toronto, in Canada, comment that most of their patients, who do not pay for medications, prefer atypical antipsychotics because of the lower incidence of side effects.
New schizophrenia drugs may be no more effective than conventional therapy shorter report on same study

Medscape Psychopharmacology Today - Polypharmacy-in-a-Pill Article questions whether research should go in the direction of single or multiple receptor action. Also includes an explanation on how Clozapine works

Effects of Antimanic Mood-Stabilizing Drugs on Fetuses, Neonates and Nursing Infants  medscape

Is Treatment-Emergent Weight Gain Linked To Diabetes? medscape Studies have shown that clozapine, olanzapine and risperidone (Frazier et al., 1999) tend to cause a fair amount of weight gain [while] quetiapine and ziprasidone don't cause as much weight gain. It may be particularly important when  at-risk patients are in need of antipsychotic therapy that their physician consider the diabetogenic potential of the antipsychotic when choosing among these vital medications. (children and adolescents)

Comparing Atypical Antipsychotics Jan.2002 Psychiatric Times

Novel Antipsychotics in Bipolar Disorder current recommendations suggest that first-line acute and maintenance treatment for bipolar disorder should be accomplished with a mood stabilizer and that novel antipsychotics should be used adjunctively among patients who fail to achieve or maintain response with mood stabilizing medication

Genetic Predisposition Affects Weight Gain With Antipsychotic Use medscape Reuters June, 2002 If confirmed, these findings could provide the basis for a simple test to determine a patient's liability to develop drug-induced weight gain, and assist the doctor in choosing the most appropriate drug treatment.

Adherence Issues and Solutions With Antipsychotic Therapy September 25, 2002 medscape Cme

Antipsychotic Dopamine Antagonists May Increase Breast Cancer Risk Medscape Medical News Dec. 27, 2002 16% increased risk of developing breast cance but The authors note that even if their preliminary results are verified, there is less than a 14% chance that a dopamine antagonist user who develops breast cancer did so on the basis of her antipsychotic drug use.

Antipsychotics Side Effects

AntiEpileptics

• Antiepileptic therapy in children may cause tubular renal injury News @ PharmiWeb We suggest that combined therapy, and in certain cases also monotherapy longer than 10 years, results in a higher risk of tubular functional impairment," the authors conclude
• Some epilepsy drugs taken during pregnancy may impair brain development  EurekAlert Dec. 20, 2000 J Neurol Neurosurg Psychiatry 2001;70:15-21. Children whose mother's took Valproate during pregnancy were more likely to have increased educational needs. Correlation not causation shown.
• Medscape In Utero Exposure To Antiepileptic Drugs INCREASES RISK OF DEVELOPMENTAL DELAY newsbrief on same study
• National Study to Assess Impact of Anti-Seizure Medications on Unborn Children .Jan. 10, 2001..........what impact (prenatal exposure to) lphenytoin (Dilantin), carbamazepine (Tegretol) and valproate (Depakote) have on the children’s ability to think and learn.
• Study- Anticonvulsants Do Cause Birth Defects about.com
• Review of Anti-Seizure Drugs for Treatment of Bipolar Disorder  Jan, 2001 eletter
• Anticonvulsants- Treatment Options and Their Implications for Women April 2002 Psychiatric Times
• Developments in the Treatment of Bipolar Disorder Medscape newlink Martin Korn  antiepileptic drug overview
• Critical Issues in the Use of Antiepileptic Drugs- Mar 2000
• Neurology Treatment Updates - Issues in the Use of Antiepileptic Drugs March 17, 2000 medscape
  Psychiatric Uses of the New AEDs most relevant section of above article
• Basic Mechanisms of Action of New Antiepileptic Drugs medscape lamictal and topiramate

• Focus on Clozapine  medscape Mar. 2002 very detailed description
• Clinical Outcome in a Randomized 1-Year Trial of Clozapine Versus Treatment as Usual for Patients With Treatment-Resistant Illness and a History of Mania
  Trisha Suppes, M.D., Ph.D., Andrew Webb, B.A., Betty Paul, L.V.N.,
  Thomas Carmody, Ph.D., Helena Kraemer, Ph.D. and A. John Rush, M.D. AJP
• Therapeutic Options in the Treatment of Clozapine-Induced Sialorrhea Medscape Treatment options have been reported, but further investigations are necessary.
  sialorrhea = excessive salivation
• Thromboembolism, Five Deaths Associated With Clozapine Use medscape Reuters medical newsMar 31 the assumed risk of venous thromboembolism would, be at least one per 2,000 to 6,000 treated patients. 
• Clozapine - a survey of patient perceptions  [Full Text] Psychiatric Bulletin 2000
• Clozapine-Associated Reduction in Arrest Rates of Psychotic Patients With Criminal Histories  Frankle et al. 158 (2) 270 Am J Psychiatry 158:270-274, February 2001 abstract only. preliminary study which concludes the positive correlation of fewer arrests of patients on clozapine warrants further investigation
• Arrest rates, high among psychotic patients, decline after clozapine treatment News @ PharmiWeb Feb 20,2001 The number of arrests averaged 5.1 per person among patients being treated with clozapine and 7.9 per person among those not receiving the drug
• Arrest Rates, High Among Psychotic Patients, Decline After Clozapine Treatment medscape(not working)
• Clozapine Use Linked to Onset of Diabetes and Hyperglycemia medscape
• Clozapine Reduces Suicide Attempts in Schizophrenic Patients Medscape Jan,2003

• Lithium for maintenance treatment of mood disorders medscape newlink jan 2002 short Cochrane review abstract
• Efficacy of Lithium in Patients with Bipolar Disorder - May 15, 2000 - American Academy of Family Physicians
• Recurrence of Bipolar Disorder After Discontinuing Lithium -- August 1, 2000 - American Family Physician
• Recurrence Risk in Bipolar Manic-Depressive Disorders after Discontinuing Lithium Maintenance Treatment- An Overview Medsape newlink Apr 1998
• Lithium Therapy Increases Gray Matter Volume medscape reuters Oct.9,2000 The Lancet 2000;356:1241-1242. Previous studies have shown that bipolar disorder is associated with cell loss or atrophy in the subgenual prefrontal cortex and other areas of brain, and that lithium therapy can restore subgenual prefrontal cortex volume to normal
• Research explains lithium's dual anti-manic- anti-depressive effect Explanation of how Lithium works posted 7/1/98
• Research Explains Lithium's Dual Anti-Manic/ Anti-Depressive Effect 7/6/98 University of Wisconsin
• New Advances in the Use of Lithium  Thomas AM Kramer MD medscape
• Lithium - the first mood stabilizer for treating manic depression - bipolar disorder about com Part 1 of a 4 part series on lithium (short articles) Part 2 Part 3 , Part 4
• Effects of Lithium during Pregnancy Medscape
• Lithium in bipolar mood disorder [Full text] Bmj Apr. 2002 editorial extolling the virtues of lithium as first line medication.

• Retrospective Analysis of Serum Valproate Levels and Need for an Antidepressant Drug medscape preliminary study higher dosages of Valproate may have an anti-depressant effect

• Fewer Side Effects With Depakote (Divalproex) Than With Olanzapine For Acute Mania Doctor's Guide December 12, 2000

• Valproate-Induced Tinnitus Misinterpreted Medscape 1 case and symptoms subsided over a period of 10 days after Depakote was removed. His complaints of noises in his head was incorrectly interpreted as evidence of auditory hallucunations.

• Oral loading of Divalproex safe for Bipolar Patients With Acute Mania Medscape (depakote)

• Abbott Issues Important Change In Labeling For Divalproex And Valproate  Special Medscape Newsbeat Report Based on discussions with the FDA, the labeling for divalproex and valproate has been revised to provide additional information regarding pancreatitis.

• Anti-Convulsant Depakote (Divalproex) May Improve Behavior In Disruptive Youths 

• Valproic acid therapy during pregnancy can lead to developmental abnormalities Reuters Jan.16,2001 from American Journal of Medical Genetics  69 cases found in a review of literature from 1978-2000 Valproic Acid Therapy During Pregnancy Can Lead to Developmental Abnormalities medscape

• Thrombocytopenia Common in Psychiatric Patients Taking Valproate   Reuter's Medscape Jan.23, 2001 According to the report, elderly patients were significantly more likely to develop thrombocytopenia than the nonelderly group (Thrombocytopenia : A decrease in the number of platelets in the blood, resulting in the potential for increased bleeding and decreased ability for clotting.)

• Drug for bipolar disorder linked to to menstrual woes  Medical Post Bipolar women treated with the anti-convulsant divalproex sodium are at greater risk of developing symptoms of polycystic ovarian syndrome (PCOS),

• Divalproex as Effective as Olanzapine in Bipolar Mania Medscape Medical News Dec. 26, 2002  Abbott Laboratories supported this study and has financial arrangements with some of its authors

• AstraZeneca Submits SNDA For SEROQUEL(R) For Bipolar Depression Treatment Medical News Today Jan 2006 If SEROQUEL receives approval from the FDA to treat bipolar depression, it would be the only single agent indicated to treat both the depressive and manic episodes associated with bipolar disorder.
• Bolder II study confirms therapeutic potential of 'Seroquel' in bipolar depression  26 Oct 2005 Seroquel' 300mg and 600mg doses achieved a statistically significant reduction in levels of bipolar depression compared with placebo also reduction of anxiety symptoms and 53% achieved remission.
• AstraZeneca Initiates Phase III Seroquel Study reuter's news release Nov. 15,2000  medscape  Atypical antipsychotic approved for schizophrenia being tested for efficacy in treating bipolar disorder.
• APA- Seroquel (Quetiapine Fumarate) Effective for Depressive Symptoms in Patients With Psychotic Disorders May 16, 2000
• APA Meeting: Seroquel Appears To Work In Some Bipolar And Schizoaffective Patients  
• News - Antipsychotic Seroquel (Quetiapine) Does Not Cause Weight Gain December 14, 2000
• Quetiapine May Not Cause Weight Gain medscape Feb 15, 2001 Long term study  underweight patients did experience weight gain
• Quetiapine Improves Symptoms of Parkinson's Disease medscape Mar.2,2001 Seroquel improved both cognitive and psychotic symptoms in patients who suffered from both Parkinson's disease and psychosis.
• Atypical Antipsychotic Drug May Be Effective Treatment psychport Aug 2001
• Antipsychotic Quetiapine Associated With Priapism medscape Reuters Sept 2001 very rare less than 1 in 10,000. Also rare cases of rare cases of peripheral oedema (I think this means swelling of the extremeties)

• Carbamazepine Intoxication Is Common medscape Nov,20,2000 Dosage errors because of confusion between the standard and modified release formulas. (not working)
• St. John's Wort Seems to Have No Effect on Carbamazepine Clearance medscape Feb 5, 2001 14 day trial unexpected results ( not working)

• Adjunctive Topiramate and Weight Loss antiepileptic drug
• FDA Issues Topamax Warning about.com September 26, 2001 A syndrome consisting of acute myopia associated with secondary angle closure glaucoma has been reported in patients receiving TOPAMAX
• MedWatch - Topamax Dear Doc Letter

Thyroid Hormone Offers Hope Medscape Jan. 2003 L-thyroxine (T₄) has been reported as beneficial in the treatment of rapid cycling bipolar disorder..............further investigation utilizing a more rigorous scientific design that includes an active comparator or a placebo group is warranted.

Bipolar disease responds well to antiarrhythmic mexiletene hydrochloride August 11, 1998
Mexiletine in treatment-resistant Bipolar Disorder. abstract

Aripiprazole Emerging as Next Great Hope for Schizophrenia (new medscape)Explains how the drug works. Not tested for bipolar.(dopamine system stabilizer)

Dopamine System Stabilizers (new medscape) Since we assume that the state of being psychotic has something to do with an overactivity in the dopamine system, if you put in a drug that gets in the way of dopamine but still does some of the good stuff that dopamine does, you will effectively "stabilize" the system

Tamoxifen - Serendipity for Bipolar Disorder- protein kinase C inhibitor Protein kinase C "regulates how fast nodes fire; how much neurotransmitter is released.

 The use of nimodipine in the treatment of mood disorders Paul J Goodnick abstract only

 Intercellular calcium and mood disorders medscape Calcium channel blockers may be effective as a mood stabilizer

Visual Function in Patients Treated With the GABAergic Anticonvulsant Drug Tiagabine medscape Clin Drug Invest 20(5):393-400, 2000

Clotiapine for acute psychotic illnesses (Cochrane Review) found no significant evidence to support the use of clotiapine rather than other 'standard' or 'non-standard' treatments for the management of acute psychotic illness

• Gabapentin Prevents Bipolar Disorder in Lithium-Resistant Patients medscape June 25, 2001 outdated
• Gabapentin- A Review of Published Experience in the Treatment of Bipolar Disorder and Other Psychiatric Conditions

•  Ziprasidone, a New Atypical Antipsychotic Drug medscape June 2001
• Pfizer's Zeldox Wins FDA Approval as Schizophrenia Treatment medscape atypical anitpsychotic
• FDA Advisory Panel Rejects Bid for IM Ziprasidone medscape reuters feb. 15, 2001 the 20-mg dose might carry an unacceptable QT risk
• New Pfizer Schizophrenia Drug as Effective as Lilly's, and Safer medscape reuters May 9,2001 ziprasidone less weight gain
• Pfizer Clarifies Cardiac Warning for Geodon medscape April 2002

  Ziprasidone Safe, Effective in Acute Mania medscape April 10, 2003

  ---

APA- Adjunctive Therapy with Risperdal (Risperidone) Improves Treatment in Manic Phase of Bipolar Disorder Doctors's Guide 

Study: Risperdal Proves More Beneficial for Preventing Relapse medscape

2004 Safety Alert Increased risk of  hyperglycemia and diabetes

Combinations

Lamotrigine, Olanzapine Stabilize Mood in Bipolar Disorder  MedscapeWire 2002 Lamotrigine prolongs remissions; olanzapine reduces agitation.