We've moved away from lithium.
Research published in American Journal of Psychiatry Examining data collected over a 20-year period from 1997 to 2016, the researchers found that today's patients are much more likely to be prescribed antipsychotics and antidepressants than mood stabilizers like lithium. There was found.There is no doubt that lithium is an important drug
It is very effective when it comes to bipolar disorder. However, it comes with a risk of side effects, including both kidney and thyroid disease, especially at high doses. For many years, I worked with patients who took lithium and ultimately required kidney transplants. The good news is that today we know more about lithium and how it works, so when we do need to use lithium, we prescribe much lower doses.
Over the past few decades, some anticonvulsants, such as carbamazepine, lamotrigine, and valproic acid, have also been found to be effective ways to treat the manic episodes of bipolar disorder. At the same time, a group of drugs known as second-generation antipsychotics also became available. These drugs, which include aripiprazole, cariprazine, lumateperone, olanzapine, quetiapine, and risperidone, have a lower risk of side effects than older antipsychotics. These side effects include weight gain, increased cholesterol and blood sugar levels, and tardive dyskinesia (stiff, jerky movements of the face and body).
Many more have been approved. Some appear to have a much lower risk of side effects such as weight gain and increased cholesterol and blood sugar levels. Additionally, some drugs seem to be less likely to interact with other drugs, which is something I worry about every day as a prescriber.
There are more long-term medications available.
Another important advance is the availability of long-acting atypical antipsychotics. These drugs play an important role in the treatment of bipolar disorder because noncompliance rates are often high. However, drugs such as aripiprazole monohydrate and risperidone are now available as long-acting injectables that are given in the doctor's office every two weeks or once a month. This is much more acceptable to people with bipolar disorder, especially those who are active and don't want to think about taking pills every day. Studies have shown that these long-term injectables improve recovery outcomes. People are more likely to stay on treatment and get their symptoms under control. I hope to see more of them in the future.
We are moving into gene therapy.
We know that there are certain genes that are associated with the risk of developing bipolar disorder. Just last year, the largest genetic study of bipolar disorder to date was able to identify 64 different spots on the genome that increase the odds of bipolar disorder. However, we have not yet reached the point where modifying a specific gene can cure a disease. The hope is that eventually so-called precision medicine will be able to be applied to bipolar disorder. Ideally, we would analyze a patient's genes to determine which targeted treatments or therapies would be most effective, just as we do for patients with other diseases such as breast cancer.
There are medications that treat unwanted side effects.
One reason people don't stick to their medication regimen is because of side effects, such as weight gain and tardive dyskinesia. However, we are learning that there are other drugs that can be administered to counter these side effects. For example, we now often use metformin to reduce elevated blood sugar levels, or the anticonvulsant drug topiramate to offset weight gain. Although it is never advisable to give patients too many prescriptions, these drugs can avoid some of the side effects that make antipsychotics difficult for some people to take long-term. Ultimately, the hope is that pharmacies will be able to combine two or three different drugs to maximize treatment efficacy and reduce the risk of side effects.
Non-drug treatments are on the rise.
Electroconvulsive therapy may be effective for bipolar disorder that has not responded to medications. That's when electrical current is sent to the brain to cause a controlled seizure. However, it requires general anesthesia and has side effects such as confusion, headache, and nausea. Researchers are currently studying whether transcranial magnetic stimulation (TMS), a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain, is effective. Early research is promising, especially regarding the depressive phase of bipolar disorder.