Monday, February 9, 2009

Mood Stabilisers

There are many. This article concentrates on lithium and lamotrigine, particularly as a combination therapy for Bipolar Disorders.

Bipolar patients often present in the depressed state and are incorrectly diagnosed with depressive disorder. This can lead to problems in pharmacological treatment since anti-depressants can cause manic episodes in bipolar patients. For this reason, mood stabilisers are often prescribed in conjunction with an anti-depressant. However, there is evidence that this combination has little positive effect on bipolar symptoms and the mood stabiliser may not be enough to prevent the anti-depressant causing a manic episode.

Yet, anti-depressant therapy is necessary in BP disorders since the majority of symptomatic time is dominated by depressive symptoms (about 1/3 of time overall, including asymptomatic states, is reported as depression) and BPII patients experience significantly more depression (about 90% of time is dominated by depression).

There is growing evidence that a lithium-lamotrigine combination therapy is well-tolerated and effective in the treatment of both poles of BP disorders. Lithium is more effective for attenuating mania, while lamotrigine works better at the depressive end of the scale. As well, lamotrigine has proved beneficial in rapid-cycling bipolar disorder. There is also evidence that lamotrigine monotherapy may be beneficial in the treatment of manic episodes.

The rash side effect of lamotrigine is not more likely to occur in the lithium combination therapy, nor does lamotrigine interfere with the functioning of lithium. (There is some evidence, in 3 case reports, that lamotrigine may induce mania.)

Also, quietipine has been shown to have anti-depressant effects in BP patients. As well, its anti-psychotic properties may prove beneficial in manic states. As such, it may be beneficial as a further adjunct to the lithium-lamotrigine combination therapy.

Valproate, another favourite in BP treatment, has also shown positive effects for treating mania when used in combination with lithium, especially for rapid-cycling, and has been shown to have similar effectiveness as a monotherapy BP treatment as lithium, but less so with depressive symptoms. There doesn’t seem to be much information on the effectiveness of valproate in BP depression.

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