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Employing Pharmacologic Treatment of Bipolar Disorder to Greatest Effect

J Clin Psychiatry 2004;65(suppl 15):15-20

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 stabilizers.