Return to list of medications for bipolar disorder. Return to information page on bipolar. Return to Home Spanish version.

From the NAMI National web site.

New Treatment Options For Bipolar Disorder

Compared to the glut of new medications developed in recent years for the treatment of such serious mental illnesses as schizophrenia and depression, the lack of advances in new drug options for those with bipolar disorder (manic depression) has proven increasingly frustrating and disappointing. Currently, the mood stabilizers available for those with manic depression are limited to the old standby lithium (Eskalith, Cibalith-S, Lithobid) and the newer divalproex sodium (Depakote). While these medications have proven helpful for many, there is a substantial group of those with bipolar disorder who have either not benefited from these options or experience problematic side effects. Furthermore, some feel that lithium and Depakote are better at treating mania than depression, and using antidepressants with these drugs has been known to trigger mania or rapid cycling-conventional antidepressants may not be as effective in treating depressive episodes related to bipolar disorder as they are for treating such episodes in those with unipolar depression. For such reasons, many clinicians have begun to experiment with drugs that are indicated for the treatment of other illnesses, but have proven effective in the treatment of those with bipolar disorder in some studies. This type of medication usage is known as "off label."

Note: It is important to recognize that "off label" usage is generally considered an option only after all traditional treatment methods have failed. Like all medications, these new drugs work differently for different people and each has its own unique side effects. Although the discovery of the effectiveness of these medications in some cases points to a future filled with newer and better options for those with bipolar disorder, many more controlled studies need to be conducted. These drugs have not been approved by the Food and Drug Administration (FDA) for the treatment of bipolar disorder.

The type of medication used most often for bipolar disorder in an "off label" capacity is the group known as anticonvulsants. Used primarily for the treatment of epilepsy, several of these drugs have recently shown promise in treating those with manic depression, particularly in helping stabilize mood.

• Tegretol (carbamazepine): Due to its apparent effectiveness as a mood stabilizer, Tegretol has become a first-line treatment option even though it has never received FDA approval for the treatment of bipolar disorder. The most common side effects seen with Tegretol include dry mouth and throat, constipation, impaired urination, decreased sense of taste, dizziness, drowsiness, unsteadiness, loss of appetite, nausea, vomiting, indigestion, and diarrhea. Some individuals may also experience clumsiness, double vision, edema (excess of fluid in tissue or body cavity), skin rash, and cardiovascular complications. Additionally, there is the possibility of such life-threatening adverse effects as suppression of blood cells that fight infection or prevent bleeding. The drug can also have negative interactions with Prozac, Luvox, and lithium. Furthermore, it should not be taken with monoamine oxidase inhibitors (MAOIs) and should not be used by those pregnant or nursing. Lastly, regular blood count monitoring and periodic liver function tests are mandatory-due to the induction of enzymes in the liver by carbamazepine, several adverse interactions can occur when it is combined with other drugs.
• Lamictal (lamotrigine): Several studies (including a randomized, double-blind, placebo-controlled trial presented at the 1998 American Psychiatric Association's annual meeting) indicate that Lamictal may also help stabilize mood in those with bipolar disorder. The drug has been reported as being a more potent antidepressant than Tegretol or Depakote, and it appears to have a low incidence of such side effects as weight gain and hair loss. Although it seems that Lamictal can be taken with MAOIs, taking the drug concurrently with Tegretol may increase the chance of adverse side effects. The most commonly reported side effects are dizziness, headache, double vision, unsteadiness, nausea, blurred vision, sleepiness, rash, and vomiting. Special attention should be paid to skin rashes, which in some extreme cases have developed into the severe disorder known as Stevens-Johnson syndrome or caused death. Any noticed rash should be reported immediately to a doctor. The concurrent use of Depakote increases the risk of developing a rash.
• Neurontin (gabapentin): Also proven effective as a mood stabilizer for those with bipolar disorder, Neurontin is chemically unrelated to any other anticonvulsant. The drug has been the subject of several studies as well, two of which were presented at this year's APA meeting. Like Lamictal, Neurontin has exhibited a lower incidence of side effects (weight gain, hair loss) than lithium and Depakote. As opposed to Lamictal, Neurontin appears to work more in alleviating mania than depression. It also seems to be a more potent antianxiety agent than both Depakote and Tegretol. Additionally, there have been no reports of Neurontin interacting negatively with MAOIs, lithium, Depakote, or Tegretol. Side effects most often noted include sleepiness, dizziness, unsteadiness, nystagmus (rapid, involuntary fluctuation of the eyeballs), tremor, and double vision. A distinct disadvantage to the drug is that it needs to be taken up to four times a day, compared to twice a day for other anticonvulsants.
• Topamax (topiramate): Yet another anticonvulsant that seems to help regulate mood in those with manic depression, Topamax has been the subject of a few open-label studies. The apparent advantage of this anticonvulsant over the others is that it does not seem to cause weight gain; it may actually help individuals lose weight. On the other hand, Topamax appears to cause more cognitive side effects than the other new drugs. Other commonly reported side effects include sleepiness, dizziness, vision problems, unsteadiness, speech problems, psychomotor slowing, "pins and needles," nervousness, nausea, memory problems, tremor, and confusion. Topamax does not seem to interact negatively with MAOIs, lithium, Lamictal, or Neurontin, but a combination of the drug with Depakote or Tegretol can lower plasma levels of Topamax.
• ABS-103: This drug is currently in preclinical studies evaluating its treatment potential for epilepsy, migraine headaches, and mania. Evidence suggests it may be as effective as Depakote and not cause as many side effects. In fact, ABS-103 might prove safe for women of childbearing age.

The new generation of drugs used to treat schizophrenia, known as atypical antipsychotics, have also been explored in some studies as potential treatment options for individuals with bipolar disorder.

• Zyprexa (olanzapine): Although recently turned down by the FDA to be marketed for the treatment of bipolar disorder, Zyprexa has shown antimanic effectiveness in some trials when used in conjunction with other medication. One adverse effect, excessive weight gain, can be problematic in some patients and may lead to nonadherence.
• Seroquel (quetiapine fumarate): Another atypical antipsychotic currently being investigated for use in those with bipolar disorder.
  (Note: Separate fact sheets on the above two medications and their uses for the treatment of schizophrenia are available from the NAMI HelpLine.)

Substance P-blockers are one other type of newly developed medication that also shows potential promise in helping regulate mood. This class of drugs derives its name from how it works; unlike SSRIs, which work by blocking the brain chemical serotonin, these medications block a brain chemical known as substance P. Substance P was discovered in 1931, and medications designed to work against the chemical have often been used experimentally, but never successfully, in attempts to treat such conditions as chronic pain, migraine headaches, anxiety, and asthma. A recent study of a substance P-blocker called MK-869 found the drug to work as effectively as and cause less of certain sexual side effects than the SSRI Paxil.

Please remember: While all of the medications mentioned above have proven effective in certain studies, there is still quite a way to go in getting approval by the FDA for their use in the treatment of bipolar disorder.

Return to list of medications for bipolar disorder.

Return to information page on bipolar.

Return to Home.

Nuevas opciones para el tratamiento del trastorno bipolar

Nota: Es importante reconocer que usar los medicamentos en forma distinta a la indicada en la etiqueta generalmente se considera como opciÑn sÑlo despu*s de que han fallado todos los m*todos de tratamiento tradicionales. Al igual que todos los medicamentos, estos nuevos fàrmacos funcionan de diferente forma en cada persona y cada uno tiene sus propios y singulares efectos secundarios. Aunque el descubrimiento de la eficacia de estos medicamentos en algunos casos seÐala a un futuro con mejores y nuevas opciones para los que padecen de trastorno bipolar, es necesario realizar muchos màs estudios controlados. Estos fàrmacos no han sido aprobados por la AdministraciÑn de Alimentos y Medicamentos (FDA, siglas en ingl*s) para el tratamiento del trastorno bipolar.

El tipo de medicamento que se utiliza con màs frecuencia para el tratamiento del trastorno bipolar en forma distinta a la indicada en su etiqueta es el grupo conocido como anticonvulsivantes. Ästos se utilizan principalmente para la epilepsia, y recientemente se ha determinado que varios de estos fàrmacos pudieran ser eficaces para el tratamiento de personas con trastorno maniacodepresivo, particularmente para ayudar a estabilizar el humor.

• Carbamazepina (Tegretol): Debido a su aparente eficacia como estabilizador del humor, Tegretol ha pasado a ser la opciÑn de tratamiento de primera lÕnea, a pesar que la FDA nunca lo ha aprobado para el tratamiento del trastorno bipolar. Los efectos secundarios que se observan con màs frecuencia al tomar Tegretol incluyen resequedad de la boca y garganta, estreÐimiento, problemas para orinar, disminuciÑn del sentido del gusto, mareo, somnolencia, inestabilidad motora, falta de apetito, nàusea, vÑmito, indigestiÑn y diarrea. En algunas personas tambi*n se ha observado torpeza, vista doble, exceso de lÕquido en los tejidos o cavidades del cuerpo, erupciones cutàneas y complicaciones cardiovasculares. Ademàs, existe la posibilidad de que se presenten efectos secundarios adversos que pongan en peligro la vida, como la supresiÑn de los glÑbulos sanguÕneos que combaten infecciones y previenen hemorragias. El medicamento tambi*n puede tener interacciones negativas si se usa con Prozac, Luvox y litio. Ademàs, no debe tomarse con inhibidores de la monoaminooxidasa (inhibidores de MAO). No se debe tomar durante el embarazo o lactancia. Por Ïltimo, debe hacerse notar que es obligatorio observar periÑdicamente el conteo sanguÕneo y hacerse pruebas periÑdicas de la funciÑn hepàtica, ya que la carbamazepina induce enzimas en el hÕgado. Cuando se combina con otros fàrmacos pueden ocurrir varias interacciones adversas.
• Lamotrigina (Lamictal): Varios estudios indican que posiblemente Lamictal tambi*n ayude a estabilizar el humor en los que padecen de trastorno bipolar. Se ha demostrado que el fàrmaco es un antidepresivo màs potente que Tegretol o Depakote y parece tener una baja incidencia de efectos secundarios como aumento de peso y p*rdida de cabello. Aunque parece que Lamictal puede tomarse con los inhibidores de MAO, tomar el fàrmaco simultàneamente con Tegretol podrÕa aumentar la probabilidad de que se presenten efectos secundarios adversos. Los efectos secundarios que se reportan con màs frecuencia son mareos, dolor de cabeza, vista doble, inestabilidad motora, nàusea, vista borrosa, somnolencia, erupciones cutàneas y vÑmito. Debe prestarse especial atenciÑn a las erupciones cutàneas, las cuales en casos extremos han avanzado hasta el grado de convertirse en una grave enfermedad conocida como el sÕndrome de Stevens-Johnson o hasta han ocasionado la muerte. Se debe informar al m*dico inmediatamente sobre todas las erupciones cutàneas que aparezcan. La administraciÑn simultànea de Depakote aumenta el riesgo de que se presente una erupciÑn en la piel.
• Gabapentin (Neurontin): Se ha demostrado que tambi*n es eficaz como estabilizador del humor para los que padecen de trastorno bipolar. Neurontin no tiene una relaciÑn quÕmica con ningÏn otro anticonvulsivante. Asimismo, este fàrmaco ha sido sujeto a varios estudios, dos de los cuales se presentaron en la asamblea de este aÐo de la APA. Al igual que Lamictal, se ha demostrado que Neurontin ocasiona una menor incidencia de efectos secundarios (aumento de peso, p*rdida de cabello) que el litio y el Depakote. A diferencia de Lamictal, Neurontin parece funcionar màs para aliviar la manÕa que la depresiÑn y tambi*n parece ser un agente contra la ansiedad màs potente que Depakote y Tegretol. Ademàs, no han habido informes que indiquen que Neurontin interactua negativamente con los inhibidores MAO, el litio, Depakote o Tegretol. Los efectos secundarios que se presentan màs a menudo incluyen somnolencia, mareo, inestabilidad motora, movimiento ràpido e involuntario de los globos oculares, temblores y vista doble. Una clara desventaja del medicamento es que es necesario tomarlo hasta cuatro veces al dÕa, en comparaciÑn con las dos veces al dÕa que se toman otros anticonvulsivantes.
• Topiramato (Topamax): Este es otro anticonvulsivante que parece ayudar a regular el humor en las personas que sufren del trastorno maniacodepresivo. Topamax tambi*n se ha sometido a varios estudios. La ventaja aparente de este anticonvulsivante sobre otros es que no parece ocasionar aumento de peso sino que màs bien podrÕa ayudar a disminuirlo. Por otro lado, Topamax parece ocasionar màs efectos secundarios cognitivos que los demàs medicamentos nuevos. Otros efectos secundarios que se presentan comÏnmente incluyen somnolencia, mareo, problemas de la vista, inestabilidad motora, problemas del habla, aletargamiento psicomotor, hormigueo, nerviosismo, nàusea, problemas con la memoria, temblores y confusiÑn. El Topamax no parece interactuar negativamente con los inhibidores MAO, el litio, Lamictal o Neurontin, pero combinado con Depakote o Tegretol, puede reducir los niveles de Topamax en el plasma.
• ABS-103: Actualmente, este fàrmaco se està sometiendo a estudios preclÕnicos para evaluar su potencial como tratamiento para epilepsia, migraÐas y manÕa. La evidencia sugiere que puede ser tan eficaz como Depakote, pero sin ocasionar tantos efectos secundarios. De hecho, podrÕa ser que ABS-103 fuera seguro para las mujeres en edad de concebir.

La nueva generaciÑn de fàrmacos que se utilizan para tratar la esquizofrenia, conocidos como antipsicÑticos atÕpicos tambi*n se han investigado en ciertos estudios como posibles opciones de tratamiento para el trastorno maniacodepresivo.

• Olanzapina (Zyprexa): Aunque recientemente la FDA negÑ la autorizaciÑn para su comercializaciÑn para el tratamiento del trastorno bipolar, en algunas pruebas Zyprexa ha demostrado ser eficaz para tratar la manÕa cuando se usa junto con otros medicamentos. Un efecto adverso, el aumento excesivo de peso, puede ser problemàtico para algunos pacientes y puede conllevar a que no se cumpla con el r*gimen.
• Fumarato de quetiapina (Seroquel): Otro antipsicÑtico atÕpico que actualmente se està investigando para usarse en el tratamiento del trastorno bipolar.

Los bloqueadores de la sustancia P son otro tipo de medicamentos reci*n creados que tambi*n podrÕan ser eficaces para ayudar a regular el humor. Esta clase de fàrmacos toma su nombre de la forma en que funcionan: a diferencia de los SSRI (inhibidores selectivos de la absorciÑn de serotonina), que funcionan bloqueando la substancia quÕmica del cerebro llamada serotonina, estos medicamentos bloquean una substancia quÕmica cerebral llamada sustancia P. Esta sustancia se descubriÑ en 1931 y los medicamentos diseÐados para funcionar contra dicha sustancia a menudo se han usado en forma experimental, pero nunca con *xito, en intentos de tratar padecimientos como neuralgia crÑnica, migraÐas, ansiedad y asma. En un estudio reciente de un bloqueador de sustancia P denominado MK-869 se determinÑ que el fàrmaco funciona tan eficazmente como el SSRI Paxil y ocasiona menos de los efectos secundarios que afectan la funciÑn sexual.

Por favor recuerde: Aunque todos los medicamentos mencionados anteriormente han demostrado ser eficaces en ciertos estudios, todavÕa falta mucho para obtener la aprobaciÑn de la FDA para usarlos en el tratamiento del trastorno bipolar.

Return to list of medications for bipolar disorder.

Return to information page on bipolar.

Return to Home.