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Bipolar disorder - Highlights

Description

An in-depth report on the causes, diagnosis, and treatment of bipolar disorder.

Alternative Names

Manic depression

Highlights:

Drug Approval

In 2008, the FDA approved the atypical antipsychotic aripiprazole (Abilify) for the acute treatment of manic and mixed episodes of bipolar I disorder in children ages 10 - 17. Aripiprazole is the second atypical antipsychotic drug to be approved for short-treatment of older children with bipolar I disorder.

Drug Warning

In 2008, the FDA warned that antiseizure drugs can increase the risk for suicidal thoughts and behavior as soon as 1 week after starting drug therapy. The risk for suicidality can continue for at least 6 months. All patients who take these drugs should be monitored for worsening depression or unusual changes in behavior.

Antiseizure drugs are sometimes used as a treatment for bipolar disorder. These drugs include valproate (Depakote, Stavzor),lamotrigine (Lamictal), carbamazepine (Epitol,Tegretol), gabapentin (Neurontin), zonisamide (Zonegran) and topiramate (Topamax).

Treatment of Bipolar Disorder During Pregnancy

In 2008, the American College of Obstetricians and Gynecologists (ACOG) released guidelines for the use of psychiatric medications during pregnancy. For treatment of pregnant patients with bipolar disorder, ACOG recommends:

Lithium is associated with a small increased risk for heart and other birth defects. When possible, the drug should be gradually discontinued before conception. Women who are at moderate risk for relapse should stop taking lithium until the fetus� ' organ development is complete.
If lithium does need to be taken during the entire pregnancy, women should stop the drug a few days before delivery. Fetuses exposed to lithium during the first trimester should receive an echocardiography to evaluate heart condition.
Women who take lithium should not breastfeed because this drug is concentrated in breast milk.
The antiseizure drugs valproate and carbamazepine should not be used during pregnancy due to a high risk for birth defects. Lamotrigine is a safer choice.
For atypical antipsychotics, there is limited data on safety.

Resources

www.nimh.nih.gov -- National Institute of Mental Health
www.bpkids.org -- Child & Adolescent Bipolar Foundation
www.dbsalliance.org -- Depression and Bipolar Support Alliance
www.nami.org -- National Alliance on Mental Illness
www.nmha.org -- Mental Health America
www.aabt.org -- Association for Behavioral and Cognitive Therapies
www.psych.org -- The American Psychiatric Association
www.aacap.org -- American Academy of Child and Adolescent Psychiatry

References

ACOG Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists number 92, April 2008 (replaces practice bulletin number 87, November 2007). Use of psychiatric medications during pregnancy and lactation. Obstet Gynecol. 2008 Apr;111(4):1001-20.

Benazzi F. Bipolar disorder -- focus on bipolar II disorder and mixed depression. Lancet. 2007 Mar 17;369(9565):935-45.

Frans EM, Sandin S, Reichenberg A, Lichtenstein P, Langström N, Hultman CM. Advancing paternal age and bipolar disorder. Arch Gen Psychiatry. 2008 Sep;65(9):1034-40.

Geller B, Tillman R, Bolhofner K, Zimerman B. Child bipolar I disorder: prospective continuity with adult bipolar I disorder; characteristics of second and third episodes; predictors of 8-year outcome. Arch Gen Psychiatry. 2008 Oct;65(10):1125-33.

Gentile S. Extrapyramidal adverse events associated with atypical antipsychotic treatment of bipolar disorder. J Clin Psychopharmacol. 2007 Feb;27(1):35-45.

Jarema M. Atypical antipsychotics in the treatment of mood disorders. Curr Opin Psychiatry. 2007 Jan;20(1):23-9.

McClellan J, Kowatch R, Findling RL; Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007 Jan;46(1):107-25.

Merikangas KR, Akiskal HS, Angst J, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry. 2007 May;64(5):543-52.

Miklowitz DJ, Otto MW, Frank E, et al. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry. 2007 Apr;64(4):419-26.

Montgomery P, Richardson AJ. Omega-3 fatty acids for bipolar disorder. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005169.

Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007 Sep;64(9):1032-9.

Morriss RK, Faizal MA, Jones AP, Williamson PR, Bolton C, McCarthy JP. Interventions for helping people recognise early signs of recurrence in bipolar disorder. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD004854.

Sachs GS, Nierenberg AA, Calabrese JR, et al. Effectiveness of adjunctive antidepressant treatment for bipolar depression. N Engl J Med. 2007 Apr 26;356(17):1711-22. Epub 2007 Mar 28.

Scherk H, Pajonk FG, Leucht S. Second-generation antipsychotic agents in the treatment of acute mania: a systematic review and meta-analysis of randomized controlled trials. Arch Gen Psychiatry. 2007 Apr;64(4):442-55.

Smith LA, Cornelius V, Warnock A, Bell A, Young AH. Effectiveness of mood stabilizers and antipsychotics in the maintenance phase of bipolar disorder: a systematic review of randomized controlled trials. Bipolar Disord. 2007 Jun;9(4):394-412.

Reviewed last on: 1/22/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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