Many medications on the market are prescribed for bipolar disorder, and many more are prescribed ‘off label’ for bipolar disorder. The medications designated for bipolar disorder include Seroquel (quetiapine, an atypical antipsychotic), Zyprexa (olanzapine, an atypical antipsychotic) Latuda (lurasidone, an atypical antipsychotic), Prozac and its generic equivalents (selective serotonin reuptake inhibitors or SSRIs), Silanor (doxepin, a TCA), Symbyax (Prozac and Zyprexa) and lithium. Many clinicians are now prescribing serotonin and norepinephrine reuptake inhibitors (SNRIs) for bipolar disorder as well. Some of the common SNRIS are Effexor (venlafaxine), Pristiq (Desvenlafaxine), and Cymbalta (duloxetine). Lithium (Eskalith, Lithobid) remains one of the most widely prescribed medications for treating bipolar disorder. Lithium is a chemical element formulated for oral use.
How Bipolar Medications Work
Each of these medications works differently in the central nervous system but are all prescribed to relieve the symptoms of bipolar disorder. Lithium is thought to strengthen nerve cell connections in brain regions that are involved in regulating mood, thinking and behavior. Like most bipolar medications, lithium takes several weeks to start working effectively. Lithium can affect kidney or thyroid function so that periodic blood tests should be taken throughout your treatment with lithium. Studies show that lithium can reduce suicide risk, and help prevent future manic and depressive episodes.
The atypical antipsychotics are considered to be second generation antipsychotics (SGAs) as they are a newer class of pharmaceuticals with a profile that is different from the older antipsychotics. These medications are most commonly used to treat acute mania and mixed episodes, often in tandem with mood stabilizers such as lithium or valproate. Both quetiapine and olanzapine have shown significant efficacy in all three treatment phases of bipolar disorder. Lurasidone (trade name Latuda) has shown some efficacy in the acute depressive phase of bipolar disorder.
The SGAs act on many receptors, but are more selective for the dopamine receptors. They appear to be more effective in treatment-resistant patients and have the advantage of fewer side effects than the older antipsychotics, although there are still the serious extrapyramidal side effects such as unsteady Parkinson’s like movements, body rigidity and involuntary tremors. Other side effects include neuroleptic malignant syndrome, sudden cardiac death, blood clots, diabetes, and increased risk of stroke.
Neuroleptic syndrome is a serious, life-threatening neurological condition caused by an adverse reaction to SGAs. Symptoms include high fever, stupor, muscle rigidity, unstable blood pressure, and autonomic dysfunction. Some researchers believe that the term ‘second generation antipsychotics’ should be abandoned because of the range of side effects actually reported. Another side effect may be significant weight gain. Open discussion with your provider should include your medical history and every drug or supplement you are taking.
The selective serotonin reuptake inhibitors (SSRIs) are a different pharmacological class of drugs, first prescribed for major depressive disorder. They are considered to be third generation antidepressants. The exact mechanism is not known, however, it is thought that the when the medication prevents reuptake of serotonin in the brain it results in relief of symptoms. Controversy surrounds the use of SSRIs in the treatment of bipolar disorder, as twenty years of research suggest that antidepressants induce mania or accelerate cycling in a small minority of patients. This is a lower number than previously suggested, although questions remain.
These drugs are not recommended for pregnant women. Side effects of SSRIs include: commonly reported cases of drowsiness, dry mouth, nausea, diarrhea, insomnia, dizziness, nervousness, agitation, restlessness, and sexual problems.
Doxepin (Sinequan, Silanor are some brands) is known as a dibenzoxepin tricyclic drug in the general class of tricyclic antidepressants (TCAs). It is marketed worldwide under many brand names. Known contraindications include glaucoma, a predisposition to developing urinary retention, use of MAO inhibitors, or hypersensitivity to other tricyclic antidepressants. The adverse effects include the central nervous system symptoms such as fatigue, dizziness, drowsiness, agitation, insomnia, seizures, delirium, rarely induction of hypomania and schizophrenia (stop medication immediately), and rarely, extrapyramidal side effects.
Other side effects include dry mouth, difficulties in urinating, constipation, sweating, and precipitation of glaucoma. Additional side effects include increased appetite, weight gain, impaired sexual function in men, and rarely hypertension. There may also be a negative effect on the liver.
The serotonin and norepinephrine reuptake inhibitors (SNRIs) are a relatively new class of antidepressants also prescribed for bipolar disorder. They are typically prescribed for major depressive disorder and are considered by some to be superior to the SSRIs because of the ‘dual uptake’ presumed mechanism of action. Most common side effects of SNRI’s include dizziness, nausea, and sweating.
Some SNRIs may cause sexual dysfunction, and other side effects include constipation, tiredness, anxiety, headache, insomnia and loss of appetite. Some SNRIs are associated with an increased risk of suicidal behavior in children and young adults.
Because of the wide range of medications used to treat bipolar disorder there is significant decision making power in the hands of the physician. Often drugs are prescribed through a trial and error which can be effective but can also be costly and user may suffer adverse reactions.
Many side effects may be the result of specific genetic variations in your genome (your individual collection of genes in your chromosomes). Pharmacogenetic research has shown that the varying responses too many drugs on the market are due to variations in the genes that code for the enzymes or other molecules targeted in the medication. Variation in a particular gene means that the enzyme or protein is varied as well, and may not work as well or at all in its normal function, which is to metabolize (process) the drug. The Rxight® pharmacogenetic test from MD Labs is designed to test and measure your individual response to over 200 drugs on the market. With this knowledge, you and your physician can decide which drugs are safe for you to take, or what doses are appropriate for your genetic makeup.