A recent article in the American Journal of Psychiatry sheds light on the vexing challenge of treating depression in individuals who have an underlying bipolar disorder: For many people with bipolar disorder, depression occurs more frequently and damages function more severely than mania, but treating bipolar depression with antidepressants carries the risk of triggering manic symptoms.
Please check out Suelain Moy’s excellent interview of Dr. Fink, “Treating Bipolar Disorder: A Q & A with Dr. Candida Fink, Part 2.” Dr. Fink’s answers cover medication, therapy, self-help, and the benefits of having a strong support network. After reading the interview, please return here and let us know what you think.
Research has long shown an association between low folate levels and depression, particularly depression that’s more severe and less responsive to medical treatment. (Folate is a water-soluble B vitamin in its natural form. Folic acid is the synthetic version found in supplements.)
Folate is critical in the development of the human nervous system, so pregnant women must take folic acid supplements. People who abuse alcohol, people with certain illnesses, and those who take a number of different medications are at risk for folate deficiencies, which can present with a variety of cognitive, emotional, and behavioral symptoms. Doctors may check folate levels as part of an initial workup of depression.
If you’re taking a selective serotonin reuptake inhibitor (an SSRI antidepressant) that doesn’t seem to be working very well and you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain, that NSAID may be the reason why your SSRI isn’t working.
Recently Paul Greengard PhD published a report in an online journal that strongly suggests that treatment with NSAIDs may reduce the antidepressant activity of SSRIs. Their research is based on the theory that depression is at least partially related to the body’s inflammatory responses. This is called the cytokine hypothesis and is based on observations that some chemicals released as part of inflammation – cytokines – are involved in regulating neurotransmitters such as serotonin.
One of the problems with using traditional anti-depressants, especially selective serotonin reuptake inhibitors (SSRI’s) to treat bipolar depression is the potential risk of triggering a switch from depression to mania. Another issue is that traditional anti-depressants may not be effective in treating depression in some patients.
SSRI’s work by inhibiting the reabsorption of the neurotransmitter serotonin, effectively increasing the level of serotonin in the synapses of the brain – the space between the brain cells (neurons). This reduces the symptoms of depression and anxiety in many people.
While insufficient serotonin may be one cause of depression, researchers are exploring another possible cause – dysregulation of glutamate. Glutamate is the most abundant excitatory neurotransmitter in the body. Riluzole (Rilutek), a prescription drug commonly used to treat Lou Gehrig’s disease, amyotrophic lateral sclerosis (ALS), reduces the release of glutamate while increasing its uptake. Some studies have shown that Riluzole is effective in treating acute bipolar depression alone or in combination with other anti-depressants.
As we have noted in several posts, the depressive pole of bipolar disorder is often the more challenging to treat. In most cases, conventional antidepressants may require three to four weeks or even longer to become effective. In addition, most if not all of the most effective antidepressants may push a person with bipolar disorder from a depressive cycle into a mania.
For these reasons and others, researchers are constantly on the lookout for new treatments for depression that provide faster relief and have a more neutral side effect profile. Some medications that show promise are already in use in other medical applications. Back in August of this year, we wrote about one of these promising medications, Ketamine – originally used as an anesthetic.
Another medication that has shown some promise is scopolamine, which traditionally has been used to prevent nausea and vomiting caused by motion sickness.
In a letter to the editor of the Journal of the American Psychiatric Association , printed November 2010, Alan Eppel, M.B., F.R.C.P.C. cites an article published in the July 2010 issue of the journal that examined the use of antidepressants in bipolar II disorder. Mr. Eppel questions the clinical significance of the results of the study and claims the study adds “more fuel to the three-decades old debate between those who advocate minimal use of antidepressants in the treatment of bipolar disorder and those who favor maximal usage.”
Debate continues to swirl among psychiatrists about the risks/benefits of antidepressant use in bipolar. The July article suggests people with bipolar II who take antidepressants as opposed to lithium or placebo have a longer interval before relapsing into a depressive episode.
With this post, we continue our sort-of-biweekly series on medications used to treat bipolar disorder and related symptoms. A few weeks ago, we wrapped up our coverage of SSNRI antidepressants with Cymbalta (Duloxetine). This week, we turn our attention to an antidepressant that’s in a class of its own – Wellbutrin (bupropion), also marketed as Zyban for smoking cessation.
With this post, we continue our sort-of-biweekly series on medications used to treat bipolar disorder and related symptoms. A few weeks ago, we began our coverage of the SSNRI antidepressants with Effexor (venlafaxine).
With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past weeks, we covered several commonly used SSRI antidepressants, including Prozac, Paxil, Zoloft, Celexa, and Lexapro. This week, we turn our attention to another class of antidepressants known as SSNRI’s, the most popular of which are Effexor, Cymbalta, and Pristiq.