Bipolar & Depression...Serious Treatment Options
Q: When treating patients with bipolar depression, Zajecka described a
number of issues to be
considered by the clinician: defining the type of bipolar disorder;
choice of treatment; duration of
treatment; association between antidepressant treatment and affective
cycling; and managing
depression in rapid-cycling bipolar and treatment-refractory patients.
A:The ideal treatment option, according to Zajecka, is a mood stabilizer
which could be used to treat
both phases of the illness, and the different forms of bipolar disorder,
without having to utilize
antidepressants that often cause or exacerbate cycle acceleration or
"precipitate a rapid-cycling
episode."
"In the old days, lithium was our only approved treatment, but now we
have divalproex sodium
(Depakote) approved for use for bipolar disorder, so we have really the
two gold standards," he said.
"And we have quite a bit of information about carbamazepine (Tegretol),
although not as much
compared to the former two. The atypical neuroleptics also are playing
more of an important role,
not only in acute treatment but also in long-term treatment.
Additionally, some newcomers, including
lamotrigine