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| |  DG DISPATCH - APA MEETING: Overview Of Treatment For Bipolar Disorder By John L. Moore Special to DG News WASHINGTON, DC -- May 27, 1999 -- Initiating of therapy for bipolar disorder must be approached with caution, particularly in patients with a history of manic episodes or euphoria, explained Dr. Gary Sachs, of Massachusetts General Hospital. Patients diagnosed with bipolar disorder will generally seek treatment during the depressive course of their affliction. However, prescription of antidepressants at this stage, in view of the presenting symptoms, is associated with an increased risk of provoking iatrogenic mania, Dr. Sachs explained. Therefore, careful attention must be paid to the patient’s psychiatric history and evidence of past manic episodes, he added. Results of clinical trials indicate that initial treatment with mood stabilisers and or anticonvulsants affords a much better outcome than with antidepressants, Dr. Sachs said. Treatment with the mood stabiliser lithium carbonate, and one or both of divalproex-sodium or carbamazepine, anticonvulsants, generally results in improvement within three to four weeks after the initial dose. The prognosis tends to be far better for patients treated in this fashion after their first episode compared to patients who have breakthrough episodes associated with a refractory form of the disorder. Lamotrigene, a recent addition, has been associated with statistically significant improvement in patients with bipolar disorder when used at doses of either 50 mg or 200 mg. The major drawback with this drug is the increased risk of Stevens-Johnson Syndrome, a potentially fatal rash. Adjunctive treatment with gabapentin does result in improvement, but the drug is not recommended as first-line therapy for mood stabilisation. Topiramate is the newest anticonvulsant. It has been associated with significant secondary weight loss and should therefore not be prescribed in some patients, Dr. Sachs said. Yet to be established is the comparative efficacy of supplementing first-line mood-stabilising therapy with either an anticonvulsant or an antidepressant, he added.
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