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.
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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.
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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.
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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.
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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.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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