Bipolar meds list
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Comprehensive List of Medications for Bipolar Disorder
Bipolar disorder is a complex and recurrent mental health condition that requires a multifaceted treatment approach. The primary goal of treatment is to manage acute episodes of mania and depression and to prevent relapse. Here, we provide a detailed overview of the medications commonly used in the treatment of bipolar disorder, categorized by their primary use and efficacy.
Mood Stabilizers
Lithium
Lithium has long been considered a first-line treatment for both acute mania and maintenance therapy in bipolar disorder. It is effective in reducing the frequency and severity of manic episodes and has some efficacy in treating bipolar depression1 2 3. However, its use is limited by a narrow therapeutic window and potential side effects such as polyuria, increased thirst, and enuresis1.
Valproate (Valproic Acid, Divalproex)
Valproate is another widely used mood stabilizer, particularly effective in treating acute mania and in maintenance therapy. It is often chosen for patients who do not respond adequately to lithium1 2 3. Valproate is associated with side effects like sedation and infection, but it generally has a better tolerability profile compared to lithium1.
Carbamazepine
Carbamazepine is effective in treating acute mania and has some utility in maintenance therapy. It is particularly useful for patients with rapid cycling bipolar disorder3 6. However, its use is limited by potential drug interactions and side effects such as dizziness and gastrointestinal issues6.
Lamotrigine
Lamotrigine is primarily effective in treating bipolar depression and in maintenance therapy to prevent depressive episodes. It is less effective for acute mania3 4 6. Lamotrigine is generally well-tolerated but requires slow titration to avoid the risk of severe skin reactions3.
Antipsychotics
First-Generation Antipsychotics
First-generation antipsychotics are effective in treating acute mania but are less commonly used due to their side effect profiles, which include extrapyramidal symptoms and tardive dyskinesia3.
Second-Generation (Atypical) Antipsychotics
Atypical antipsychotics are increasingly used in the treatment of bipolar disorder due to their efficacy and more favorable side effect profiles. These include:
- Quetiapine: Effective for both acute mania and bipolar depression, and useful in maintenance therapy2 3 4.
- Olanzapine: Effective for acute mania and maintenance therapy. Often used in combination with fluoxetine for bipolar depression3 4.
- Aripiprazole: Approved for acute mania and maintenance therapy. It is generally well-tolerated and has a favorable side effect profile2 4 6.
- Risperidone: Effective for acute mania and maintenance therapy, available in long-acting injectable form4 6.
- Asenapine: Effective for acute mania and maintenance therapy, often used as adjunctive therapy2 4.
- Cariprazine: Approved for acute mania and bipolar depression, showing promise in maintenance therapy6.
Antidepressants
Antidepressants are generally not recommended as monotherapy in bipolar disorder due to the risk of inducing mania or rapid cycling. They are often used in combination with mood stabilizers or antipsychotics3 4.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs like fluoxetine are sometimes used in combination with antipsychotics or mood stabilizers to treat bipolar depression3 4.
Bupropion
Bupropion is another option for treating bipolar depression, often used in combination with mood stabilizers4.
Non-Conventional Agents
Dopamine Receptor Partial Agonists
Aripiprazole and cariprazine are examples of dopamine receptor partial agonists that have shown efficacy in treating various phases of bipolar disorder6.
Other Agents
Non-conventional agents such as tamoxifen, allopurinol, and methoxyprogesterone have shown some efficacy in specific cases but are not widely used due to limited data and potential side effects9.
Conclusion
The treatment of bipolar disorder involves a variety of pharmacological options, each with its own efficacy and side effect profile. Mood stabilizers like lithium and valproate remain foundational treatments, while atypical antipsychotics are increasingly favored for their efficacy and tolerability. Antidepressants are used cautiously and typically in combination with other agents. Ongoing research continues to refine these treatment options, aiming to improve outcomes for individuals with bipolar disorder.
Sources and full results
Most relevant research papers on this topic
Valproic acid, valproate and divalproex in the maintenance treatment of bipolar disorder.
Valproate is an effective and acceptable long-term treatment for bipolar disorder, preventing episodes and improving patients' general health and social functioning.
Systematic Review
Very Rigorous Journal
Highly CitedCanadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder
The 2018 CANMAT and ISBD Bipolar Treatment Guidelines recommend lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine as first-line treatments for acute mania, bi
Highly CitedTreatment of bipolar disorder: a systematic review of available data and clinical perspectives.
Lithium, antipsychotics, and psychosocial interventions are effective for treating bipolar disorder, but further research and guidelines are needed for better outcomes.
Systematic ReviewHighly CitedThe armamentarium of treatments for bipolar disorder: a review of the literature.
Atypical antipsychotics show a growing role in the treatment of bipolar disorder, with potential benefits for acute mania and maintenance therapy.
Systematic ReviewCanadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.
The 2013 update of CANMAT guidelines maintains the use of lithium, valproate, and various atypical antipsychotic agents for acute mania, while adding asenapine and lurasidone as first-line options for bipolar depression.
Highly CitedDopamine Receptor Partial Agonists for the Treatment of Bipolar Disorder
Aripiprazole and cariprazine are effective and well-tolerated dopamine receptor partial agonists for treating bipolar disorder, while Brexpiprazole shows promising tolerability and warrants further efficacy studies.
Systematic ReviewAnticonvulsants and antipsychotics in the treatment of bipolar disorder.
Valproate and carbamazepine effectively treat acute mania in bipolar disorder patients, while new antipsychotic agents show potential for treating acute mania and bipolar depression, but have not been studied in controlled trials.
Systematic ReviewHighly CitedA History of the Pharmacological Treatment of Bipolar Disorder
Pharmacological treatments for bipolar disorder have progressed from nonspecific sedative agents to the current range of drugs, with socio-sanitary implications also discussed.
Highly Cited[Non-conventional pharmacological agents for the treatment of bipolar disorder: Α systematic review of the evidence].
Non-conventional pharmacological agents show promise in treating acute mania and depression, but most data is negative, highlighting the need for new paradigms and horizons in bipolar disorder treatment.
Systematic ReviewCanadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.
This update maintains the use of lithium, valproate, and atypical antipsychotics for acute mania, with tamoxifen as a third-line augmentation option, and expands on treatment options for bipolar II disorder.
Highly Cited