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Employing Pharmacologic Treatment of Bipolar Disorder to Greatest Effect

Alan F. Schatzberg, MD

Published: November 15, 2004

Article Abstract

Mechanisms of action, onset and duration of action, and interactions with other medications—allof these pharmacokinetic properties of pharmacologic agents affect the efficacy and safety of therapeuticregimens for bipolar disorder. For example, antiglutamatergic agents such as lamotrigine mayrelieve depression but have no impact on mania. Atypical antipsychotics with the dual effect of blockingdopamine and serotonin receptors in the brain decrease psychosis, mania, and, according to somepreliminary indications, possibly depression. The impact of these properties has been borne out inclinical studies. Mood stabilizers such as lithium and valproate stabilize mood by significantlydecreasing the manic and hypomanic symptoms of bipolar disorder, although they can have effects ondepressive symptoms too. Lamotrigine stabilizes mood by reducing depression. The atypical antipsychoticshave been shown to be effective either as monotherapy or in combination with moodstabilizers.

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