Pharmacology for Bipolar Dxo

[epijunky]

I have a question about psychopharmacology for Bipolar dxo. I understand there are medications for the depression part of Bipolar, and the manic part. The depression part is treated with TCAs, SSRIs, MAOIs, and SNRIs. The mania is treated with Lithium, anticonvulsants and antipsychotics. My question...is the patient on both year around? Or do they take the TCAs during their depression phase and the Lithium during their manic phase? If so, who decides when they take what? I am confused. Please help clear this up for me.

[mentalhealthRN]

I have seen mostly continuous use of all the meds, but it would depend on the particular patient and what the doc feels in needed. In general you don't stop in start anti-depressants. They take 3-6 weeks to be effective, build up in the body, so you don't stop and start. The idea is to try to PREVENT the extremes of mood, not treat once they are there--as best as possible. So I would say, in general patients are on their meds continuously but not being a doc I can't say that is the case 100% of the time.

[Davey Do]

There are those medications known as the so-called Mood Stabilizers: e.g Lithium, Depakote, Tegretol, Lamictal. The others you mentioned are often used in conjunction with, or instead of, are the antidepressants and antipsychotics.

I've known of one patient in my 27 years of Nursing that was treated with Monoamine Oxidase Inhibitors. There are just far too many side effects and interactions with them. Tricyclic Antidepressant use is rather rare these days, for similar reasons. Selective Seritonin Reuptake Inhibitors and Selective Norepinephrine Inhibitors are used with Bipolar d/o, but can run the risk of throwing the Patient into a manic phase.

Dave

[mathis1965]

Usually the goal is to prevent the mania and depression, so the meds are used year round. Some only require one medication to stabilize the mood like depakote, and some require multiple medications.

[Smitty08]

Agree with above posters. Often adding an anti-depressant can activate (encourage hypomania/mania) in someone with bipolar. Others with bipolar seem to need an anti-depressant, but I am not 100% convinced this is wise. I just love it when I can stabilize a patient on ONE mood stabilizer. My personal choice is Lamictal/Lamotrigine which has strong anti-depressant properties as well. LICO3 works well too, but is in some ways riskier and more troublesome. I personally LOVE treating bipolar, it is so interesting! And when treated well, quality of life can really return for a patient!