A study published last week entitled “Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis” (Cipriani et al The Lancet 17 Aug 2011) reviewed many previous trials of medications for mania. It looked at results for any of the following medications: Aripiprazole (Abilify) , asenapine (Saphris), carbamazepine (Tegretol) , valproate (Depakote) , gabapentin (Neurontin), haloperidol (Haldol), Lamotrigine (Lamictal), lithium, Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) , topiramate (Topamax), and Ziprasidone (Geodon).

At a recent meeting of the American Psychiatric Association, researchers presented a study suggesting that ziprasidone (Geodon) was less effective in treating acute mania in people with obesity or hyperglycemia (very high blood sugar level). The study was funded by Pfizer, which makes Geodon, and was done by looking at pooled data from previous studies performed by Pfizer looking at this medication’s effectiveness.

The lead author of the study, Roger S. McIntyre, Associate Professor of Psychiatry and Pharmacology at the University of Toronto, indicated that while the findings could be related to a need for higher doses in people with higher body mass indexes, it could also be that these differences in body mass and blood sugar could reduce the effectiveness of the drug at any dose. While this type of study is apparently uncommon in psychiatric research, it is actually quite important in helping us understand patterns of effectiveness in various medications used to treat bipolar disorder.

Abilify (aripiprazole) is an atypical antipsychotic medication commonly used to treat schizophrenia and acute mania. In 2005, the Food and Drug Administration (FDA) approved its use in the maintenance treatment of bipolar disorder – to prevent the recurrence of mood episodes. Unfortunately, evidence proving the effectiveness of Abilify as a maintenance medication for bipolar disorder is scarce and questionable.

Exposing the Truth

An article published this week in the open access journal PLoS Medicine (Tsai et al) looks critically at the scientific evidence that supports such widespread use of this medicine for maintenance treatment of bipolar disorder.

Until recently, doctors and researchers had believed that brain volume loss in schizophrenia was caused primarily by the disease itself. One recent study, however, questions this long-held belief and identifies antipsychotics, the medications most commonly used to treat schizophrenia, as the more likely culprits.

With the increased long-term use of antipsychotics to treat schizophrenia and other forms of mental illness, especially bipolar mania, it’s important to determine whether the illness or the medication (or both) contribute to the potential loss of brain volume.

In an article published in the Archives of General Psychiatry (February, 2011) entitled “Long-term Antipsychotic Treatment and Brain Volumes,” Beng-Choon Ho, MRCPsych, et al. conclude the following:

The U.S. Food and Drug Administration (FDA) is informing healthcare professionals that it has updated the Pregnancy section of drug labels for the entire class of antipsychotic drugs. The new drug labels now contain more and consistent information about the potential risk for abnormal muscle movements (extrapyramidal signs or EPS) and withdrawal symptoms in newborns whose mothers were treated with these drugs during the third trimester of pregnancy.

For details, see http://www.fda.gov/Drugs/DrugSafety/ucm243903.htm

Important: Do not stop taking your antipsychotic medication if you become pregnant. Consult your healthcare professional before making any changes to your medication. Abruptly stopping antipsychotic medication can cause significant complications in your treatment.

Photo by Frank de Kleine, available under a Creative Commons attribution license.

Genetic Engineering & Biotechnology News recently ran a brief article entitled “EU Sanctions Merck & Co.’s Sublingual Bipolar Disorder Drug Sycrest.” Sycrest was first approved in the U.S. in 2009 where Merck markets it as Saphris. Sycrest/Saphris is a “sublingual asenapine drug for treating moderate to severe manic episodes in adult patients with bipolar I disorder” and for treating schizophrenia. When used in treating bipolar disorder mania, it is most effective when used with other anti-manic medications, including lithium and Depakote.

Saphris/asenapine is the newest member of the class of drugs called atypical antipsychotics. It works in the same general manner – affecting primarily dopamine receptors. It also carries the same potential risks that we describe in our initial post on atypical antipsychotics. It is approved for use in schizophrenia and Bipolar I disorder for acute mania. It comes in a sublingual form (under the tongue), which some patients prefer, but which many people don’t like.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past several weeks, we covered five commonly used atypical antipsychotics, including Zyprexa (olanzapine) and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past several weeks, we covered four commonly used atypical antipsychotics, including Zyprexa (olanzapine) and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past couple weeks, we covered three commonly used atypical antipsychotics – Zyprexa (olanzapine), Risperdal (risperidone), and Seroquel (quetiapine). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. Over the past couple weeks, we covered two commonly used atypical antipsychotics – Zyprexa (olanzapine) and Risperdal (risperidone). Because the Zyprexa post contains a great deal of information that applies to the atypical antipsychotics as a group, we encourage you to read it first.