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    Bipolar Disorder Treatment Overview

    Mania in Bipolar Disorder continued...

    If mania occurs while you are on maintenance therapy, your doctor may simply change your medication dose. Or you may start taking an antipsychotic drug or a second mood stabilizer to lessen symptoms. Also antidepressants should usually be discontinued while someone is manic, because they can worsen the symptoms of mania.

    Non-drug treatments, such as psychotherapy and establishing a well-ordered routine, may help patients in their maintenance phase. This is often suggested along with medication, but non-drug treatments are usually not effective alone.

    Depression in Bipolar Disorder

    Treating bipolar depression is controversial and challenging. Studies have shown that antidepressants may be less effective in treating bipolar depression than they are in treating unipolar depression (that is, major depressive episodes in someone who has never had a previous manic or hypomanic episode). Also using antidepressants alone may trigger a manic or hypomanic episode in some people with bipolar disorder.

    Antidepressants alone also may lead to or prolong rapid cycling. In rapid cycling, a person may recover more quickly from depression but then experience mania followed by another episode of depression. And antidepressants can increase the risk of suicidal thoughts and attempts in children and adolescents with any form of depression.

    Three drugs are FDA-approved for the treatment of bipolar depression: quetiapine (Seroquel) by itself, olanzapine (Zyprexa) when used with fluoxetine (Prozac) (which also comes as a combination pill called Symbyax), and lurasidone (Latuda) used alone or with lithium or valproate (Depakote). The atypical antipsychotic drug caripirazine (Vraylar) has also shown promise in initial studies to treat bipolar depression.

    There are also a number of treatments that have begun to show promise in research studies for treating bipolar depression, including the Parkinson's disease drug pramipexole dihydrpcholoride ( Mirapex), the wakefulness drugs modafinil (Provigil) and armodinifinil (Nuvigil), the nutritional supplement n-acetylcysteine, and the intravenous anesthetic drug ketamine. 

    In April 2002, the American Psychiatric Association suggested using lithium or the anticonvulsant drug lamotrigine (Lamictal) as an initial treatment for people in the acute depressive phase of bipolar disorder who were not already taking a mood-stabilizing drug. Since then, research has shown that Lamictal seems to be more effective at preventing future depression rather than treating current depression in bipolar disorder. Recent studies have shown that Lamictal added to lithium may be a potent treatment for acute bipolar depression.

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