It is well known that some people with bipolar disorder experience a variety of neuro-cognitive deficits (problems in areas such as attention, learning, and memory) in addition to their emotional and behavioral symptoms.

Because many of the medications used to treat bipolar disorder can cause cognitive problems as a side effect, psychiatrists have often debated whether these problems with learning and thinking are due to medications or are related to the underlying brain changes found in bipolar disorder. It seems likely that both factors are at play.

Some ongoing studies are looking at a medication called galantamine (Razadyne is the trade name), which is FDA approved for treating the cognitive deficits in Alzheimer’s disease.

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.

On August 4, 2010, the American Academy of Child and Adolescent Psychiatry (AACAP) released its new Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents.

“Medication decisions for children with bipolar disorder are complex and difficult for many parents. AACAP’s Parents’ Medication Guide for Bipolar Disorder in Children & Adolescents compiles the very best information and helps parents decipher the daunting decision-making process. I consider it required reading for any parent of a child with bipolar disorder.”
— Susan Resko, Executive Director Child & Adolescent Bipolar Foundation

This is another resource that parents of children and adolescents who have been diagnosed as having bipolar disorder may want to investigate.

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.

Many people wonder whether brand name medications are any better or even any different than their generic equivalents. After all, if two medications contain the same amount of the same active ingredient, theoretically, they should be equally effective.

Short Answer

The answer to this question is most often yes. The vast majority of generic medications contain the same active chemical found in the name brand product. When you buy generic acetaminophen instead of Tylenol, you’re getting the same active chemical and typically the same effect. Similarly with generic Prozac (fluoxetine), for example, the products are almost identical, and the effects are almost always very similar.

A recent study published in the Archives of General Psychiatry by researchers at National Institute of Mental Health showed that the medication Ketamine, given intravenously to a small group of people with bipolar depression, caused a rapid antidepressant response in a high percentage of those patients. Their responses were much better than patients given a placebo IV solution.

It may often seem that doctors don’t trust their patients regarding management of their medications, particularly controlled substances, including tranquilizers and stimulants. This is a dilemma that I face all the time in my practice. Some medications are powerful and excellent at treating specific symptoms, such as Xanax for anxiety, but they carry significant risk of dependency and misuse as recreational drugs.

I am a strong believer in using the right medication and not being fearful of using these medications when they are indicated, as long my patient and I engage in ongoing conversations about the risks and that we both carefully monitor their usage.

We often discuss the potential risks to a fetus when the mother is taking psychiatric medications, but we rarely if ever consider the potential risks of a prospective father taking psychiatric medications. One of our readers posted a question addressing this issue.

Heidi asks…

Hi there, my husband started taking Depakote for bipolar disorder several months ago. We are talking about having another baby and are wondering whether it’s safe for us to conceive while he is on Depakote? Any advice is helpful, thanks.

Over the last several years, a number of studies have found a relationship between decreased bone mineral density – bone strength – and long-term use of SSRI antidepressants. The theory behind this association is that serotonin is part of the system that regulates signaling in bone cells and that medicines that affect the serotonin system could change bone metabolism.

At the American Psychiatric Association meeting in May of this year, researchers from Canada (Bolton, et al. 2010) presented a large, well done study that provides even more evidence that bone density can be reduced in people taking SSRI’s for long periods of time. Following are additional details from the study:

I recently noticed an article on the Web entitled “Psychotropic drugs can cause birth defects.” The article reports that “Researchers at the University of Copenhagen (UC) have documented the serious side-effects that can be associated with these types of medications.”

The trouble with articles like this is that they often cause unnecessary anguish and can be counterproductive in managing a healthy pregnancy while effectively treating psychiatric conditions of the expectant mother.