Second generation antipsychotics have developed a reputation for being more effective for treating a number of the symptoms of schizophrenia than their first generation counterparts, even if research doesn’t always back up this claim.
Since antidepressants and psychotherapy are about equally effective for mild to moderate depression, how do we decide which to use for a given patient?
Currently, lithium is FDA approved for both acute mania and for maintenance bipolar treatment, but not for bipolar depression. Lithium is dirt-cheap and the size of its database for efficacy in bipolar disorder is unmatched by any other medication, although many of these studies are old.
In my experience, there are five common reactions from patients with a new diagnosis of bipolar disorder, and here are some suggestions for how to respond constructively.
Ross Baldessarini, MD
Professor of psychiatry and neuroscience, Harvard Medical School, Boston, MA; Director, psychopharmacology program & International Consortium for Bipolar Disorder Research, McLean Hospital, Belmont, MA
Dr. Baldessarini has disclosed that he has recently been a paid consultant to Alkermes, Inc., a comarketer of Risperdal Consta and VIVITROL (a monthly injectable form of naloxone for alcohol and opioid dependence). Dr. Carlat reviewed this article and found that there is no evidence of commercial bias in this educational activity.
Some patients complain bitterly about depression and dysphoria, but they don’t tell you anything about the other half of their lives—the upswings of mood and energy—so you may not realize the need to suspect bipolar illness.
More than a decade ago, researchers introduced the concept of “vascular depression,” a specific type of depression associated with cerebrovascular disease and loss of blood to the brain in older adults.
The treatment of bipolar depression remains challenging. Only two medications are FDA approved for the condition—quetiapine (Seroquel) and olanzapine (Zyprexa)/fluoxetine (Prozac) combination—both of which cause weight gain and sedation, among other side effects.
Kelly Gable, PharmD, BCPP
Assistant professor of pharmacy practice Southern Illinois University, Edwardsville, School of Pharmacy
Daniel Carlat, MD
Editor-in-chief, The Carlat Psychiatry Report
They used to be called “depot” antipsychotics, but the powers that be have renamed them “long acting injectables” (LAIs), presumably to help remove some of the stigma associated with their use. But no matter what you call them, suddenly every drug company is racing to introduce its own LAI neuroleptic.