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How do antipsychotics work for bipolar


Antipsychotic Medication for Bipolar: Uses & Side Effects

Written by WebMD Editorial Contributors

In this Article

  • Side Effects of Antipsychotic Drugs

Antipsychotic medications are used as a short or long-term treatments for bipolar disorder to control psychotic symptoms such as hallucinations, delusions, or mania symptoms. These symptoms may occur during acute mania or severe depression. Some also treat bipolar depression, and several have demonstrated long-term value in preventing future episodes of mania or depression.

In people with bipolar disorder, antipsychotics are also used "off label" as sedatives, for insomnia, anxiety, and/or agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect.

Some antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don't tolerate or respond to lithium (Eskalith, Lithobid) and anticonvulsants.

Antipsychotic drugs help regulate the functioning of brain circuits that control thinking, mood, and perception. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly.

The newer antipsychotics, sometimes called atypical antipsychotics, usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a few weeks.

Antipsychotics used to treat bipolar disorder include:

  • aripiprazole (Abilify)
  • asenapine (Saphris)
  • cariprazine (Vraylar)
  • clozapine (Clozaril)
  • lumateperone (Caplyta)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

 

Certain antipsychotic drugs cause significant weight gain and high cholesterol levels, and they may increase the risk of diabetes. People considering an antipsychotic for bipolar disorder should be screened for their risk of heart disease, stroke, and diabetes, according to a study published in Diabetes Care.

Common side effects of antipsychotic medications include:

  • Blurred vision
  • Dry mouth
  • Drowsiness
  • Muscle spasms or tremors
  • Weight gain

Note: Clozaril is not used often, despite its effectiveness for bipolar disorder. The drug can cause a rare, potentially fatal side effect that requires weekly or biweekly blood test monitoring. Also, Geodon is linked to a rare but potentially fatal skin reaction.

Older antipsychotic drugs are generally not used as a first-line treatment for bipolar disorder, and they are less established for treating depressive symptoms or preventing episodes during long-term use. However, they may be helpful if a person has troublesome side effects or doesn't respond to the newer drugs. Older antipsychotics include chlorpromazine (Thorazine), haloperidol (Haldol), and perphenazine (Trilafon). These drugs may cause a serious long-term side effect called tardive dyskinesia, a movement disorder characterized by repetitive, involuntary movement like lip smacking, protruding the tongue, or grimacing. Newer atypical antipsychotics also have the potential to cause this side effect, but have a relatively lower risk than the older conventional antipsychotics.

The medications deutetrabenazine (Austedo) and valbenazine (Ingrezza) have proven effective in treating adults with tardive dyskinesia.

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Antipsychotic drugs in bipolar disorder

Review

. 2003 Sep;6(3):277-84.

doi: 10.1017/S1461145703003560.

Aygun Ertugrul  1 , Herbert Y Meltzer

Affiliations

Affiliation

  • 1 Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
  • PMID: 12974994
  • DOI: 10. 1017/S1461145703003560

Free article

Review

Aygun Ertugrul et al. Int J Neuropsychopharmacol. 2003 Sep.

Free article

. 2003 Sep;6(3):277-84.

doi: 10.1017/S1461145703003560.

Authors

Aygun Ertugrul  1 , Herbert Y Meltzer

Affiliation

  • 1 Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN 37212, USA.
  • PMID: 12974994
  • DOI: 10. 1017/S1461145703003560

Abstract

Antipsychotic drugs are useful in the treatment of acute mania and as maintenance treatment. While both typical and atypical antipsychotic drugs are able to diminish manic symptoms, agitation and aggression in acute mania, the atypical antipsychotic drugs enjoy a number of advantages, including significantly less extrapyramidal symptoms, diminished risk of tardive dyskinesia, lack of increase in serum prolactin levels (with the exception of risperidone), improvement in cognition, and possible decrease in suicidality. Most of the atypical antipsychotic drugs have been found to be effective as an add-on treatment (with mood stabilizers and antidepressant drugs) and sometimes as monotherapy in treatment-resistant bipolar patients. Long-acting typical neuroleptic drugs may be useful in the treatment of non-compliant bipolar patients. A small number of patients with schizophrenia treated with risperidone, olanzapine, or quetiapine experience a first episode of hypomania or mania. It is not apparent if this is a true drug-induced event or coincidental. Side-effects of note with the atypical antipsychotic drugs are weight gain (most prominently with olanzapine and clozapine), sedation, and agranulocytosis (clozapine). Atypical antipsychotic drugs are recommended for use in bipolar disorder for acute treatment, maintenance treatment, and for treatment-resistant patients.

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How to treat bipolar disorder? All About Medications

Bipolar disorder can be difficult to treat and finding the right regimen can take a long time, so be patient.

Contents

Getting an accurate diagnosis is the first step in successfully treating bipolar disorder.

Building a therapy strategy can only be entrusted to an experienced psychiatrist. In no case should patients self-medicate, as this may lead to a worsening of the condition. All information in this article is for informational purposes only.

Treatment is primarily medical, but psychotherapy and lifestyle changes are also recommended. The treatment regimen is selected by the doctor individually, depending on the characteristics of the course of the disease and the psychotype of the patient.

Abuse of antidepressants or refusal to take medications with a temporary improvement in well-being can lead to complications, so the patient should be constantly under the supervision of the attending physician.

We have prepared a translation of a chapter from the book Living with Bipolar Disorder. A guide for people with bipolar disorder and their families. ” This chapter will focus on medications that are commonly used to treat bipolar disorder.

It is important for you, as an active participant in the treatment, to know the purpose of the therapy, the effect of the drugs, the appropriate dosage of the drug, possible side effects, and how and at what time to take the drugs (dosing regimen).

This information will help you and your psychiatrist find the drugs that are best for you. Please discuss your concerns about medications with your doctor. He will dispel your fears and, if necessary, help you cope with the side effects of therapy or find an alternative method of treatment.

Is it necessary to take medicine?

Many people have mixed feelings about taking medication; in an ideal world, they would prefer not to accept them. However, numerous studies have proven the beneficial effects of medications in the treatment and prevention of depressive and manic episodes. You can think of drugs like mood stabilizers and antidepressants as things that can help you feel better and take control of your life.

How to treat bipolar disorder?

The following sections describe four types of medications used to treat bipolar disorder: mood stabilizers (normothymics), antidepressants, antipsychotics (neuroleptics), and tranquilizers (anxiolytics, anti-anxiety drugs). These drugs represent the main groups of drugs for the control of bipolar disorder, they are used individually or in combination. Other medications may also be used to treat other symptoms.

Before we describe these groups of drugs, their purposes and side effects in more detail, we would like to share information about the names of these drugs.

Drugs are often classified according to the purpose for which they were first approved (licensed) for use in the US, although many drugs have many additional uses in addition to those already approved. For example, doctors use antidepressants to treat anxiety disorders and tranquilizers to treat insomnia.

For this reason, it is very important to understand the purpose of prescribing a drug, and not just to know its name. This makes it easier to see the situation when you are asked about your medicines, because people only see and understand the names. For example, a family member may ask why you are taking medication for an anxiety disorder if you have bipolar disorder.

Similar questions may arise when you order medicines at a pharmacy, when you communicate with friends or relatives, when you just meet with a doctor. If you have questions about medications, be sure to talk to your psychiatrist before changing anything.

Mood Stabilizers (Mood Stabilizers)

The purpose of using mood stabilizers is to keep your mood within the normal range. While experts believe that mood stabilizers are the best group of medications for treating bipolar disorder, the term "mood stabilizer" is scientifically ambiguous.

There is a mutual agreement among experts that lithium (trade name Sedalit), valproic acid + sodium valproate (Depakine), lamotrigine (Lamiktal), carbamazepine (Tegretol), and olanzapine (Zyprexa) are mood stabilizers.

Each of these drugs has been shown to be effective in treating and/or preventing mania and/or depression in two or more studies. There are many studies showing that lithium is effective both in treating manias and depressions and in preventing their relapses.

Several studies have proven the effectiveness of lamotrigine in the treatment of bipolar disorder and two studies have shown its ability to prevent relapse, especially in recurrent (recurrent) depressive phases. Olanzapine has shown excellent ability in combating acute mania and also has some antidepressant effect and is particularly useful in preventing relapse of mania. many names 5000 mg 5000-30000 mg

[I] - The starting dose for lamotrigine is 12.5 mg/day if you are also taking valproic acid. If not, then 25 mg/day.

Other medicines also have mood stabilizing properties.

To be called a mood stabilizer, a drug must: (1) work for mania, depression, or prevent relapse, and (2) not cause mood swings or abrupt transitions from one state to another. Drugs occasionally used by doctors as mood stabilizers also include verapamil (Isoptin), oxcarbazepine (Trileptal), and ω-3-polyunsaturated fatty acids (PUFAs), however, the benefits of their use are considered to be not fully proven.

None of these drugs have been studied in bipolar disorder or approved by the main US regulatory agency, the Food and Drug Administration (FDA).

All medicines can cause side effects. Your goal is to work with a psychiatrist to find the mood stabilizer that will best protect you or help you recover from an episode of depression or mania without uncomfortable side effects.

Antidepressants

A wide range of antidepressants can be used to control depressive episodes of bipolar disorder. However, their use should be monitored very carefully, as some patients go from depression to mania (so-called "phase inversion") when treated with antidepressants. In other words, an antidepressant used to control depression can cause mania.

In contrast, some BD patients who take antidepressants do not experience a switch to mania, but instead suffer from worsening depression or more depressive episodes. For this reason, regular and ongoing communication with your doctor is essential to ensure that the prescribed treatment does not worsen your general condition. Your psychiatrist will watch for manic symptoms, but he/she will not be able to do his job without your help and members of your support group.

Talk to your doctor about how you feel. If during treatment with antidepressants you feel restless, excessive talkativeness, have trouble sleeping, and have a rush to run, "jump" thoughts - immediately report these symptoms to your psychiatrist. While the mood swings can be pleasant, you don't want these symptoms to turn into a full-blown mania.

Remember that mania is an illness that causes problems in your life. To keep your life and your ability to achieve your goals under control, report early symptoms of mania or hypomania to your doctor. Through monitoring, antidepressant treatment can be a valuable addition to your recovery.

Table lists some antidepressants. You will notice that some antidepressants are listed first because these drugs were originally developed to treat depression specifically in bipolar disorder and reduce the possibility of mania, unlike older drugs.

International nonproprietary name (MIN) Trade name Average starting daily dose 150-450 mg

Antipsychotics (neuroleptics)

Antipsychotics were originally developed as a treatment for hallucinations and delusions in schizophrenia. However, antipsychotics have been shown to have specific anti-manic properties even in patients without evidence of psychosis. Antipsychotics are often prescribed for a manic episode and may be helpful in cases of disorganized behavior, confused thinking, as well as hallucinations.

A common property of these drugs is the ability to block the receptors of a neurotransmitter called dopamine. Too much dopamine in the brain can contribute to manic symptoms. You will often hear the term "neuroleptics" from doctors - this is an outdated name for antipsychotics.

Older antipsychotics, also called “typical antipsychotics,” include chlorpromazine (Aminazine), haloperidol, zuclopenthixol (Clopixol), flupentixol (Fluanxol), trifluoperazine (Triftazine), and a lot others. They are powerful blockers of dopamine receptors. They are useful in cases of acute mania. Unfortunately, they can often cause side effects that worsen their tolerability. 2.5-20 mg Kvetiapin Serokvel 100 mg 25-800 mg

at the beginning of the course of treatment for treatment, and sometimes patients, thrill in the end. restlessness and agitation. Long-term use of typical antipsychotics is often associated with a potentially irreversible side effect known as tardive dyskinesia (TD), a disorder characterized by repetitive, involuntary, purposeless muscle contractions, especially of the tongue and facial muscles.

Newer antipsychotic drugs are now available for the treatment of mania, called “atypical antipsychotics”. Clozapine ("Azaleptin", "Klozasten") was the first synthesized drug of this class. This class also includes risperidone (Rispolept), ziprasidone (Zeldox), olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), asenapine (Safris) and some others.

Like the older drugs, they also block dopaffin receptors, but are less powerful than typical antipsychotics. Atypical antipsychotics also block certain receptors on another neurotransmitter called serotonin. Antipsychotics with a combination of dopamine and serotonin blockade generally cause fewer side effects and are better tolerated by patients. They are often used in combination with mood stabilizers to treat acute mania.

Standard practice after recovery is to reduce the dose of the antipsychotic. Be that as it may, some patients begin to experience manic symptoms soon after the dosage is reduced. In this case, they are prescribed antipsychotics on an ongoing basis to contain the relapse of mania. Therefore, antipsychotic drugs can be considered as the drugs of choice for the treatment of acute mania, as well as drugs for the prevention of mania and psychotic symptoms.

Tranquilizers (anxiolytics, anti-anxiety agents)

Anxiety is a symptom that often accompanies episodes of depression and mania. In addition, sleep problems are also common in depression, hypomania, and mania. Benzodiazepines are the most commonly used tranquilizers. These include lorazepam (Lorafen), clonazepam, diazepam (Relium, Sibazon), alprazolam, chlordiazepoxide (Elenium), and phenazepam.

They are used to quickly reduce anxiety and insomnia. Benzodiazepines may also control early symptoms of hypomania. All these drugs can cause addiction, physical and psychological dependence, especially when taken uncontrolled.

Potential for abuse is greater for drugs that are potent and rapidly absorbed into the blood, such as alprazolam.

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