Mood swings correspond to the ups and downs of our lives. But, when these mood swings occur quite frequently, last for several weeks and disrupts the day to day activities, it may be suggestive of Bipolar Disorder.<\/p>\n
Bipolar Disorder<\/strong>, formerly called as Manic-Depression, is a mental health illness characterized by episodes of mania and depression. Manic episodes are periods of high-energy when one feels elated. This is usually proceeded or preceded by depressive episodes, which are periods of feeling extremely low and hopeless. Sometimes, patients experience a less severe manic episode, known as hypomanic episode. Thus, experiencing emotions which are \u201cpoles-apart\u201d, is referred to as bipolar disorder.<\/p>\n It is a life-long condition. However, appropriate medical intervention has shown to improve the quality of life of patients to a large extent.<\/p>\n The characteristic feature of bipolar disorder is episode of mania, hypomania and depression, presenting as following symptoms.<\/p>\n The most advocated treatment of Bipolar disorder involves a combination of medications and psychotherapy.<\/p>\n Psychotherapy or talk therapy includes a variety of therapies, such as Cognitive Behavioral therapy (CBT) and Interpersonal and Social Rhythm Therapy (IPSRT), which aim at recognizing the negative feelings responsible for triggering manic-depressive episodes. It also aids in establishing a consistent daily rhythm, such as sleeping, waking and mealtimes, as a good routine helps in managing the mood changes.<\/p>\n Along with psychotherapy, medications such as mood stabilizers, antipsychotics, anti-depressants and anti-anxiety drugs are used to alleviate the mood disruptions in bipolar disorder. Since bipolar disorder tends to recur on withdrawal of medications, these must be consumed life-long to prevent future episodes.<\/p>\n Besides medications and psychotherapy, certain advanced therapies have also emerged as effective treatment options in bipolar disorder. These include Electroconvulsive Therapy (ECT) and Transcranial Magnetic Stimulation (TMS).<\/p>\n Various medications that can effectively manage symptoms of bipolar disorder are described below.<\/p>\n Lithium carbonate is an anti-manic and a mood-stabilizing drug. It reduces the frequency of manic episodes and stabilizes the mood in bipolar disorder. The exact mechanism of action of lithium carbonate is not known. However, several theories have been proposed in this context.<\/p>\n One theory points to the fact that lithium carbonate acts by replacing the sodium ions in the body, thus affecting the ionic reflexes of the brain. Some researchers suggest that it inhibits the release of brain chemicals (medically termed as neurotransmitters), namely Noradrenaline and Dopamine, thus correcting the chemical imbalance in the brain. Another theory states that lithium carbonate blocks the supply of a chemical, called inositol to the brain, thus specifically affecting the hyperactive neurons.<\/p>\n Therefore, lithium carbonate alters the brain chemicals and affects the signal transduction of the brain, thus normalizing the brain functioning.<\/p>\n Available as:<\/strong> Oral preparations<\/p>\n US-FDA Status: Approved for Bipolar Disorder<\/strong> These are also known as first-generation anti-psychotics and constitute the older anti-psychotic drugs. This group of drugs blocks a specific Dopamine receptor, namely D2 receptor in the brain. Dopamine is a brain neurotransmitter that regulates various bodily functions, such as sleep, learning, attention and motivation. Bipolar disorder has a strong association with dopamine imbalance. By blocking D2 dopamine receptors, typical anti-psychotic drugs normalize the dopamine imbalance and are used to treat the manic episode of bipolar disorder.<\/p>\n Available as:<\/strong> Oral preparations and Injectable preparations<\/p>\n I. Phenothiazines<\/strong><\/p>\n A. Chlorpromazine<\/strong> B. Trifluoperazine<\/strong><\/p>\n Trifluoperazine Oral<\/strong> Trifluoperazine Injection<\/strong> C. Fluphenazine<\/strong><\/p>\n US-FDA Status:<\/strong> Approved for Bipolar Disorder II. Butyrophenones<\/strong><\/p>\n A. Haloperidol Oral and Injection<\/strong> These are the second-generation, newer anti-psychotic drugs. They have a weak D2 receptor blocking action. However, they block serotonin receptors (medically termed as 5-hydroxytryptamine) and alpha-adrenergic receptors of the brain. These receptors mediate the neurotransmission, i.e. transmission of brain signals. Hence, atypical anti-psychotics are used to manage mood changes in bipolar disorder. Available as:<\/strong> Oral preparations and Injectable preparations<\/p>\n I. Olanzapine<\/strong> II. Risperidone<\/strong> III. Aripiprazole<\/strong> IV. Quetiapine<\/strong> V. Ziprasidone<\/strong> VI. Lurasidone<\/strong> VII. Asenapine<\/strong> This class of drugs is a new generation anti-depressant. It is useful in relieving the depression in bipolar disorder. It acts by inhibiting the Serotonin Transporter (SERT), located in the nerve cell membrane. SERT is necessary for re-uptake of a neurotransmitter, namely serotonin. By inhibiting the re-uptake of this chemical, SSRIs produce an anti-depressant effect. However, it takes few weeks to act and hence, is not used in cases where rapid results are desirable. Available as:<\/strong> Oral preparations<\/p>\n I. Fluoxetine<\/strong> II. Paroxetine<\/strong> III. Sertraline<\/strong> IV. Citalopram<\/strong>Symptoms<\/h2>\n
\n
Treatment Methods and Drugs Used<\/h2>\n
1. Lithium Carbonate<\/h3>\n
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> lithium carbonate
\nBrand name:<\/strong> Lithium Carbonate tablet
\nSide-effects:<\/strong> Thinning or drying of hair, skin itching, lack of coordination, tremors of hand, vomiting, nausea
\nIndicated in Pregnancy:<\/strong> Only when there are no other alternatives, as it can cause cardiac anomalies in fetus, such as Ebstein’s anomaly<\/strong>
\nAlcohol Content:<\/strong> Absent<\/p>\n2. Typical Anti-psychotics<\/h3>\n
\nUS-FDA Status:<\/strong> Unapproved for Bipolar Disorder
\nGeneric name:<\/strong> chlorpromazine hydrochloride (oral)
\nBrand name:<\/strong> Thorazine
\nSide-effects:<\/strong> Dizziness, dry mouth, skin rash, weight gain, extrapyramidal side effects, such as dystonia (abnormal movements and postures), tardive dyskinesia (involuntary movements, such as lip smacking, eye blinking, etc.)
\nIndicated in Pregnancy:<\/strong> Only when there is an absolute need, as there has been evidence of fetal death, prolonged labor and other fetal abnormalities.
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> trifluoperazine hydrochloride
\nBrand name:<\/strong> Trifluoperazine Hydrochloride
\nSide-effects:<\/strong> Dry mouth, skin rash, dizziness, blurred vision, anorexia, muscle weakness, extrapyramidal side-effects (already mentioned above)
\nIndicated in Pregnancy:<\/strong> Only when there is an absolute need, as there has been evidence of fetal death, prolonged labor and other fetal abnormalities.
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Unapproved for Bipolar Disorder
\nGeneric name:<\/strong> trifluoperazine hydrochloride
\nBrand name:<\/strong> Stelazine
\nSide-effects:<\/strong> Same as seen with Oral Trifluoperazine
\nIndicated in Pregnancy:<\/strong> Only when there is an absolute need
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> fluphenazine hydrochloride (oral), fluphenazine decanoate (injection)
\nBrand name:<\/strong> Fluphenazine Hydrochloride (oral), Fluphenazine Decanoate (injection)
\nSide-effects:<\/strong> Depression, cataract, drowsiness, blurred vision, extrapyramidal side-effects (already mentioned above)
\nIndicated in Pregnancy:<\/strong> It can hamper the cerebral and skeletal development of fetus. Thus, it should be administered only when advantages outweigh fetal risk.
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> haloperidol (oral), haloperidol decanoate (injection)
\nBrand name:<\/strong> Haloperidol (oral), haldol (injection)
\nSide-effects:<\/strong> Constipation, weight gain, blurred vision, dry mouth, extrapyramidal side-effects (already mentioned above)
\nIndicated in Pregnancy:<\/strong> It can hamper the cerebral and skeletal development of fetus. Thus, it should be administered only when advantages outweigh fetal risk.
\nAlcohol Content:<\/strong> Absent<\/p>\n3. Atypical Anti-psychotics<\/h3>\n
\nSince typical anti-psychotics have some major side effects, atypical anti-psychotics are preferred.<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> olanzapine (oral), olanzapine pamoate (injection)
\nBrand name:<\/strong> Olanzapine (oral), Zyprexa Relprevv (injection)
\nSide-effects:<\/strong> Drowsiness, extrapyramidal symptoms, weight gain, dry mouth, weakness
\nIndicated in Pregnancy:<\/strong> Not indicated in third trimester as it can cause hypertonia, hypotonia, agitation, tremors, distress and feeding disorders in fetus.
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> risperidone
\nBrand name:<\/strong> Risperidone (oral), Risperdal Consta (injection)
\nSide-effects:<\/strong> Aggression, anxiety, agitation, increase amount of urine, skin rash or itching, memory problems
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated, as cases of stillbirths have been reported
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> aripiprazole
\nBrand name:<\/strong> Abilify (oral), abilify maintena kit (injection)
\nSide-effects:<\/strong> Loss of balance control, speech difficulty, drooling, limbs stiffness, muscle trembling
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated, as it may lead to developmental defects in fetus
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> quetiapine fumarate (oral)
\nBrand name:<\/strong> Seroquel XR
\nSide-effects:<\/strong> Loss of balance control, speech difficulty, drooling, limbs stiffness, muscle trembling
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated, as it may lead to developmental defects in fetus
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> ziprasidone hydrochloride (oral), ziprasidone mesylate (injection)
\nBrand name:<\/strong> Geodon (oral and injection)
\nSide-effects:<\/strong> Fever, drooling, cough, nervousness, loss of balance control
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated, as it may lead to developmental defects in fetus
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> lurasidone hydrochloride (oral)
\nBrand name:<\/strong> Latuda
\nSide-effects:<\/strong> Drooling, difficulty with swallowing, muscle discomfort, inability to sit still
\nIndicated in Pregnancy:<\/strong> Not indiacted in third trimester, as it can cause tremors, agitation, hypotonia, somnolence and respiratory disorder in fetus
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> asenapine maleate (oral)
\nBrand name:<\/strong> Saphris
\nSide-effects:<\/strong> Trouble with breathing, swallowing or speaking, lip puckering or smacking, reduced or abnormal touch sensation, inability to move eyes
\nIndicated in Pregnancy:<\/strong> Usually contraindicated, especially in third trimester
\nAlcohol Content:<\/strong> Absent<\/p>\n4. Selective Serotonin Re-Uptake Inhibitor (SSRI) Anti-depressants<\/h3>\n
\nA notable fact here is that SSRIs are a potent anti-depressant but can worsen the manic episodes. Hence, these are usually combined with a mood stabilizer or anti-psychotic.<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> fluoxetine hydrochloride (oral)
\nBrand name:<\/strong> Sarafem
\nSide-effects:<\/strong> Restlessness, hives, itching, skin rash, inability to sit still
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> paroxetin mesylate (oral)
\nBrand name:<\/strong> Brisdelle
\nSide-effects:<\/strong> Chills, chest pain, chest congestion, agitation, cold sweats
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> sertraline hydrochloride (oral)
\nBrand name:<\/strong> Zoloft
\nSide-effects:<\/strong> Failure to ejaculate (in men), reduced sex drive
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated
\nAlcohol Content:<\/strong> Absent<\/p>\n
\nUS-FDA Status:<\/strong> Approved for Bipolar Disorder
\nAvailability:<\/strong> Prescription only
\nGeneric name:<\/strong> citalopram hydrobromide (oral)
\nBrand name:<\/strong> Celexa
\nSide-effects:<\/strong> Fever, blurred vision, agitation, confusion, loss of memory
\nIndicated in Pregnancy:<\/strong> Only when absolutely indicated and is contraindicated in third trimester
\nAlcohol Content:<\/strong> Absent<\/p>\n