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.

During an acute and severe manic episode, a doctor is likely to treat mania more aggressively, perhaps by taking the following steps:

• Prescribing substantial doses of medications such as Abilify or Seroquel.
• Using loading doses of Depakote to reduce acute mania more rapidly. A loading dose is a higher initial dose than normally prescribed. Loading doses are used to ramp up a medication to a therapeutic level more rapidly.

These more aggressive interventions for mania are often performed in hospital. When providing outpatient treatment, doctors usually ramp up these medications more slowly to reduce side effects. Lamictal, which is used to prevent mood cycles, requires many weeks to reach a therapeutic level because of the risk of a skin condition that is much lower if the doses are increased very slowly.

Antidepressants are another story. Routinely, patients are told that they won’t be likely to experience any benefits from their antidepressants for at least a few weeks. Sometimes it can take much longer, and doctors rarely, if ever, suggest what to do in the meantime. Patients are often expected to tough it out. And if the person complains, the doctor often advises them to “BE PATIENT.” Easier said than done in the midst of debilitating depression.

In his recent blog post “How Many Psychiatric Medications Did You Say You Take?” Eugene Rubin, M.D., Ph.D., Professor and Vice-Chair for Education in the Department of Psychiatry at Washington University in St. Louis – School of Medicine, expresses his concern over the pervasiveness of “polypharmacy” (the simultaneous use of large numbers of medications) in treating psychiatric disorders.

Romy103 Asks…

My 21-year old daughter is diagnosed with Bipolar II. After being on Welbutrin and Lamictal, for awhile and doing well, she thought she was okay and decided to stop her medications. She relapsed, and the meds didn’t work as well when she went back on them. So Prozac and Lamictal were tried I believe, then Cymbalta – neither seemed to help. Now a new psychiatrist is prescribing the extended release form of lithium. So far not getting any results, but not up to therapeutic dose yet. While I understand the good things about lithium, I have a few concerns/questions about it:

People are pretty vocal about what they perceive to be the dangers of diagnosing and medicating children who have psychiatric disorders, and you can find plenty of horror stories, including the case of Rebecca Riley, but what about the dangers of not medicating children who fail to respond to non-medication interventions and could really benefit with the right diagnosis and medications?

When I was a medical student we used to have “Liver Rounds” at the hospital on Friday afternoons – a happy hour, keg, and pizza party, compliments of some pharmaceutical companies. Variations of this continued throughout my internship and residency. Later, as a practicing psychiatrist, I would see drug reps in the office and used their pens and pads and ate their lunches. Colleagues and I would often remind ourselves that we needed to see the reps because they gave us samples of medications we could give to our patients. We reassured ourselves that we wouldn’t change our prescribing habits based on the gifts we received.

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on medications that can help you sleep.

Over the past year or so, this sort-of-biweekly series has shined the spotlight on a host of medications used to treat the two poles of bipolar disorder. The medications and medication classes we have covered so far include lithium, anti-seizure medications (including Depakote and Lamictal), antipsychotics and atypical antipsychotics (including Zyprexa and Seroquel), SSRI antidepressants (including Prozac and Paxil), SSNRI antidepressants (including Cymbalta and Effexor), and the older Tricyclics and MAOI’s for treating depression.

This week, we shift gears to start our coverage of medications not exactly designed for treating mania or depression but that nevertheless may come in very handy for treating symptoms that often accompany bipolar disorder and may contribute to its severity – symptoms such as anxiety and sleeplessness. Today, we examine anxiolytics (pronounced ang-zee-oh-li-tiks), sometimes referred to as tranquilizers – medications used to alleviate anxiety and calm the nerves. The main family of anxiolytics is made up of the benzodiazepines – commonly referred to as ” benzos.”

Robert Asks…

Do you think a combination of different herbs can cure any form of bipolar disorder and if so what are those herbs?

Dr. Fink Answers…

In Chapter 9 of Bipolar Disorder For Dummies, we discuss a host of alternative treatments for bipolar disorder, including ECT (electroconvulsive therapy), light therapy, vitamins & minerals, and herbs, used alone and in conjunction with traditional forms of medicines and therapies. For example, some people claim that St. John’s Wort is useful for treating the depressive pole in bipolar disorder. (Of course, unfortunately, like most other antidepressants, St. John’s Wort also increases the risk of triggering mania, especially in someone who has bipolar disorder.)