Many patients with depression are n...

Many patients with depression are now recognized as having bipolar disorder, a chronic biphasic temper disorder with episodes of as well-as; not only-but also; not only-but; not alone-but depression and mania or hypomania. prosperous management of bipolar disorder requires suppression of acute mania, treatment of acute depression, and prevention of relapse into either condition. No single medication can achieve all of these objectives. McIntyre and colleagues examined evidence supporting the efficacy of each of the medications commonly used to treat bipolar disorder. Their review article stresse the ne for individualization of therapy and adaptation to the changing emergencys of each patient over time.

Lithium was the earliest mood-stabilizing medication and still is used extensively. The efficacy of lithium is well established in patients who are in manic states, and it is known to mould the rates of suicide. Lithium is most numerous effective in patients who have little comorbidity and do not period rapidly. Patients who are likely not to correspond well to lithium include those with usual previous episodes, rapid cycling, depressive and anxious symptoms during the manic phase, substance abuse, and medical conditions.

The second-generation antiepileptic medicines divalproex and carbamazepine are highly effective in patients with acute mania, on the other hand have less effect in patients with depression and in the prevention of symptom the having recourse These drugs are useful in patients who do not be agreeable to to lithium, but their use is limited by means of side effects such as weight gain and sedation, as well as multiple drug-drug interactions and the ne to monitor line levels of the drug along with hepatic and hematologic indexes.

reciprocally the third-generation antiepileptic drug lamotrigine is effective in the treatment of depression and the prevention of return and does not require descendants monitoring. The major problem with lamotrigine is a rash that bring outs in up to 10 percent of patients and can progres to Stevens-Johnson syndrome Fewer data are available about other third-generation antiepileptic medicines Gabapentin is useful for anxiety symptoms, and topiramate may improve depressive states. Oxcarbazepine may provide many of the antimania and antidepressant purports of carbamazepine with fewer side general intents and drug interactions.

The conventional antipsychotic agents, of that kind as haloperidol, have been used to treat acute mania, further their use is limited from dysphoria, tardive dyskinesia, and extrapy-ramidal purports The novel antipsychotics, such as olanzapine, risperidone, and quetiapine, have direct antidepressant drifts and are highly effective against mania. These actions appear to be independent of the anti-psychotic issues of these drugs, and in the greatest degree bipolar patients benefit at gentle dosages (e.g., 10 to 15 mg of olanzapine, 2 to 4 mg of risperidone, 400 to 800 mg of quetiapine). This clump of drugs may be particularly effective as adjunctive therapy with antidepressants in patients with bipolar depression and in maintenance therapy, when combined with lithium or divalproex. The biggest disadvantage of the novel antipsychotics is weight gain; lipid and diabetic sugar abnormalities also occur.

Although evidence is limited, antidepressants are commonly used for short periods (up to pair months) to treat patients in the reduceed phase of bipolar disorder. The danger of precipitating mania is reported to be greatest with tricyclic agents.

The authors deduce that a combination of medical and psychosocial strategies is required for auspicious treatment of bipolar disorder. Patients not rarely have problems adhering to therapy and require education and assistance with lifestyle issues to cope with this lifelong condition.

McIntyre R et al. Treating bipolar disorder. Evidence-based guidelines for family medicine. Can Fam Physician March 2004;50:388-94

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