Employing Pharmacologic Treatment of Bipolar Disorder to Greatest Effect
J Clin Psychiatry 2004;65(suppl 15):15-20
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Mechanisms of action, onset and duration of action, and interactions with other medications—all
of these pharmacokinetic properties of pharmacologic agents affect the efficacy and safety of therapeutic
regimens for bipolar disorder. For example, antiglutamatergic agents such as lamotrigine may
relieve depression but have no impact on mania. Atypical antipsychotics with the dual effect of blocking
dopamine and serotonin receptors in the brain decrease psychosis, mania, and, according to some
preliminary indications, possibly depression. The impact of these properties has been borne out in
clinical studies. Mood stabilizers such as lithium and valproate stabilize mood by significantly
decreasing the manic and hypomanic symptoms of bipolar disorder, although they can have effects on
depressive symptoms too. Lamotrigine stabilizes mood by reducing depression. The atypical antipsychotics
have been shown to be effective either as monotherapy or in combination with mood