Drugs for bipolar disorder

Bipolar disorder, also known as manic depression, is a condition that causes patients to have very unstable emotions, and it occurs more frequently in foreign countries. This disease may accompany patients throughout their lives, because mild cases do not show obvious changes, but mental problems can cause abnormalities in a person's neurological function, so the treatment of bipolar disorder must be carried out through these methods.

Bipolar disorder, also known as manic-depressive illness, is a condition that involves one or more severe manic and depressive episodes. The disorder causes a person's mood to swing between extreme elation (or irritability, or both) and sadness and despair, with periods of normal mood in between. More than two million people in the United States suffer from bipolar disorder.

Bipolar disorder generally begins in adolescence or early adulthood and lasts a lifetime. Because bipolar disorder is often not recognized as a disorder, people with it may suffer for years unnecessarily.

Bipolar disorder can be extremely distressing and disruptive to patients, their spouses, family members, friends, and employers. Although there is no known cure, bipolar disorder is treatable and recovery is possible. It is possible to have successful relationships and meaningful work with bipolar disorder. A combination of medication and psychotherapy can help the vast majority of patients return to productive, fulfilling lives.

First-line treatment

First-line treatments for acute mania include lithium, valproate, first-generation antipsychotics (only chlorpromazine is approved by the US FDA), and second-generation antipsychotics (including olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole). Although there is insufficient evidence to support carbamazepine as a first-line treatment for acute mania, two recent studies have shown that carbamazepine extended-release is effective in treating acute mania. Therefore, carbamazepine extended-release has also been approved by the FDA for the treatment of acute mania.

Until 2003, lithium salts were the only mood stabilizer approved by the FDA for the maintenance treatment of bipolar disorder. In recent years, three other drugs have been approved by the FDA for the maintenance treatment of bipolar disorder, namely lamotrigine, olanzapine, and aripiprazole. Compared with placebo, lamotrigine can delay the recurrence of mania and depression, but its effect in delaying the recurrence of mania is not as good as lithium salt, while its effect in delaying the recurrence of depression is equivalent to lithium salt. Olanzapine was slightly better than lithium in preventing recurrence of affective symptoms. Aripiprazole was superior to placebo in preventing affective events.

Treatment of refractory patients

In the case of regular treatment with first-line drugs, a considerable number of patients still have poor efficacy. At this time, the following options are available:

1. Other anticonvulsants include newer drugs such as topiramate and tiagabine and the older drug phenytoin.

2. Combination therapy is also routinely used in clinical practice. For acute mania, there is ample data showing that combination therapy is superior to monotherapy, the most common of which is a second-generation antipsychotic combined with a traditional mood stabilizer such as lithium or valproate. Existing placebo-controlled studies have found that the efficacy of combined use of risperidone, olanzapine and quetiapine is 20% to 25% higher than that of lithium salts or valproate alone.