Bipolar disorder has previously been linked to chronic pain, affecting almost 30% of patients. Treatment for chronic pain often includes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (paracetamol). Because people with bipolar disorder already often take more than one medication for the disorder alone, it is important to note any drug interactions from additional medications that may affect treatment. A group of researchers recently set out to see if NSAIDs and/or acetaminophen have negative effects on frequently-used bipolar disorder medications.

Previous studies have shown selective serotonin reuptake inhibitors (SSRIs) to be less effective when used in conjunction with NSAIDs and/or acetaminophen. The use of SSRIs is not generally recommended due to the potential for triggering mania or hypomania, but they are still used, often with additional use of mood stabilizers and antipsychotics.

Since mood stabilizers and antipsychotics are the most frequently prescribed medications for bipolar disorder, it is important to know whether or not their effectiveness may also be diminished by the use of NSAIDs and/or acetaminophen. Dr. Ole Köhler-Forsberg of University Hospital, Risskov, Denmark and his team recently surveyed 482 bipolar disorder patients taking lithium or quetiapine (Seroquel) to see if this is the case.

The participants in this study were surveyed over six months and tested on their symptom levels along with the use of NSAIDs and/or paracetamol. Since the pain relievers were often only used for short periods, they were able to assess any changes in mood during those periods as compared to when the pain relievers were not used in conjunction with a mood stabilizer or antipsychotic.

During the course of the study, the researchers found no difference between patients taking NSAIDs and/or paracetamol and those who were not. This led to the conclusion that taking pain relieving medication had no negative interference with the use of lithium or quetiapine. They did find that those who were taking pain relieving medication were more likely to be female and have hypertension.

It’s important to note that there are many different types of over-the-counter pain relieving medications, all of which have different chemical formulations. The most popular are:

  • Acetaminophen (Tylenol)
  • Paracetamol (Panadol)
  • Aspirin (Bayer or Bufferin)
  • Ibuprofen (Advil or Motrin)
  • Naproxen (Aleve)
  • Celecoxib (Celebrex)

Similarly, there are also many different types of mood stabilizers and antipsychotics. The most popular mood stabilizers are:

  • Lithium
  • Valproate (Depakote)
  • Carbamazepine (Tegretol)
  • Gabapentin (Neurontin)
  • Topiramate (Topamax)
  • Oxcarbazepine (Trileptal)
  • Lamotrigine (Lamictal)

Some of the most used antipsychotics include:

  • Quetiapine (Seroquel)
  • Clozapine (Clozaril)
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
  • Olanzapine (Zyprexa)
  • Ziprasidone (Geodon).

All of these medications also have different chemical formulations, which is why there are often long periods of time spent finding the most effective for the individual. Because there is so much variation on the exact chemical makeup of the drugs, it is important to note that the findings of the study are limited and must be replicated. Finding that lithium and quetiapine do not seem to be negatively affected by NSAIDs or paracetamol does not necessarily mean that finding can be assumed to extend to all other medications as well.

 

 

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Image credit: Michelle Tribe