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.

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.

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. We will keep you notified about any changes in status.

Reviewed by David J. Kupfer, M.D., Thomas Detre professor and chair for the Department of Psychiatry and director of research at Western Psychiatric Institute and Clinic