Bipolar Disorder

Article

Equetro: New Name, Old Drug

Topics: Bipolar Disorder

Okay, we’ll lay our cards on the table right away. Rarely has TCR been as annoyed by the launch of a new medication as we are by the launch of Equetro. The last time the pharmaceutical industry embarrassed itself this much was when Eli Lilly launched “Sarafem,” calling it a “new” medication for PMDD when it was simply Prozac with a new name an

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Article

Antidepressants in Bipolar Disorder: The Controversy Continues

Topics: Antidepressants | Bipolar Disorder

There is a battle underway in the genteel circles of academic psychiatry. The disputed question is: Are antidepressants (ADs) good or bad for patients with bipolar disorder? The major figureheads in this drama are respected psychiatrists on opposite coasts. In the pro-AD corner, weighing in with an endowed chair and full professorship at UCLA, we hav

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Article

Lab Monitoring with Mood Stabilizers: Let’s Get Real

Topics: Bipolar Disorder

“Be careful, doctor. Don’t order lab tests that you don’t really need. You’re asking for trouble.” No, that’s not TCR talking. That’s none other than George Lundberg, M.D., former editor of JAMA. He made that statement in an editorial webcast in January 2005 on Medscape, where Dr. Lundberg is Editor-in-Chief (http://www.medscape. com/vi

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Expert Q&A

Ivan Goldberg, M.D., on Treating Bipolar Depression

Topics: Bipolar Disorder

TCR: Dr. Goldberg, I know you’ve spent a lot of time thinking about and treating bipolar disorder over the years, beginning when you were a researcher at NIMH, then on the faculty of Columbia University, and most recently in your private practice and your managing of Depression Central. I was hoping we could begin by discussing some of the tricky aspe

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Tales from the History of Psychiatry

A Sad and Strange Chapter

Topics: Bipolar Disorder

There have been many misguided treatments for bipolar disorder and other major mental illnesses throughout the history of psychiatry, but perhaps none has been as misguided--and as damaging--as the one practiced by Henry Aloysius Cotton, M.D. Once a student of Adolf Meyer, Emil Kraepelin, and Alois Alzheimer, he headed the New Jersey State Hospital in T

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Article

Atypicals for Bipolar: And Then There Were Five

Topics: Bipolar Disorder

We knew it was about to happen. We just didn’t know it would happen all at once. Between July and September of 2004, Seroquel, Geodon, and Abilify sequentially won approval for the treatment of manic episodes in bipolar disorder. Which means that now all of the newer atypical antipsychotics have been admitted to the bipolar club, which until December

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Article

Trileptal: Everyone’s Using It!

Topics: Bipolar Disorder

Suddenly, we all have a colleague who is prescribing Trileptal (oxcarbazepine) for bipolar disorder, and who is claiming to have fabulous success. Rarely has a medication generated so much enthusiasm on so little data. The reason is that Trileptal is blessed with extraordinary intuitive appeal. Approved by the FDA for epilepsy in 2000, it is such a c

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Expert Q&A

Dr. Claudia Baldassano on Interviewing Tips in Bipolar Disorder

Topics: Bipolar Disorder | Practice Tools and Tips

TCR: Dr. Baldassano, as the Director of the Bipolar Outpatient Clinic of U Penn, how many patients with bipolar disorder do you typically evaluate in a given week? Dr. Baldassano: About 80 patients a week, and that would include consultations, patients referred directly to me, and patients that I see in supervision with U Penn residents. TCR: Are mo

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Article

Bipolar Confusion: Diagnosis Hints

Topics: Bipolar Disorder

Suddenly, it seems that everybody and their cousin is asking us if they have bipolar disorder. A few years ago, bipolar disorder was the ignored orphan diagnosis in psychiatry. However, now that various patented molecules have been proven effective, industry money is flying into efforts to publicize the diagnosis, and it's clearly working. We are get

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Article

Antipsychotic Maintenance: How Long is Enough?

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Deprescribing | Depression | Depressive Disorder | Mania | Metabolic syndrome | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Risperidone | Side Effects | Tardive dyskinesia

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

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Expert Q&A

The Psychopharmacology Algorithm Project

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Bupropion | Depression | Depressive Disorder | Escitalopram | Lamictal | Lamotrigine | Lithium | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Wellbutrin

TCPR: What would be the biggest change in practice if psychiatrists followed your algorithms?Dr. Osser: One area is bipolar depression. This is a disorder where there is an exceptionally large deviation between what the evidence says and what people are doing, especially when it comes to antidepressants. They are still being used rampantly, even in pati

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Clinical Update

Oxcarbazepine: Close, but no Cigar

Topics: Bipolar Disorder | Carbamazepine | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

You are selecting a mood stabilizer for a 29-year-old woman with mania. If it works, she’ll need to take it long term, but with adherence rates hovering around 50% in this illness, that’s not a likely prospect. The FDA-approved options are not very high on tolerability, but what about oxcarbazepine? Oxcarbazepine (Trileptal) is often used in bipola

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Expert Q&A

Psychopharmacology in Bipolar II

Topics: Bipolar Disorder | Hypomania | Mania | Mixed Features | Mood Stabilizers

TCPR: You’ve carved out a unique practice with difficult-to-treat bipolar disorders. Tell us about the patients you see. Dr. Kelly: I see a lot of bipolar II and “softer bipolar.” Clinically these patients have chronic depression, often mixed with hypomanic symptoms. Nearly all have tried multiple antidepressants that didn’t work, stopped worki

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Highlights

Highlight From This Issue

Topics: Bipolar Disorder | Carbamazepine | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

In bipolar disorder, oxcarbazepine is slightly better tolerated than carbamazepine, but less effective. While its medical risks are different, they are by no means safer than carbamazepine’s. Its drug interactions can be a problem as well. On average, higher doses of second-generation antidepressants do not bring greater recoveries in major depress

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Clinical Update

A Practical Guide to Light Therapy

Topics: Alternative treatments | Bipolar Disorder | Complementary treatments | Depression | Depressive Disorder | Light and Dark Therapy | Light therapy | Lightbox | natural treatments | Seasonal Affective Disorder

Outdoor living, morning light, evening darkness, and regular rhythms of sleep and waking all have one thing in common: They prevent depression. That’s the conclusion of many large epidemiologic studies, but for people who work indoors and wake up to dark winter mornings, this isn’t good news (Asai Y et al, J Affect Disord 2018;241:235–240). Here

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News of Note

A New Treatment for Bipolar Depression

Topics: Antipsychotics | Atypical Antipsychotics | Bipolar Depression | Bipolar Disorder | Depression | News of Note | Pharmacology | Psychopharmacology

On May 28, 2019, cariprazine (Vraylar) became the fourth atypical antipsychotic to receive FDA approval for bipolar depression. The approval was based on two randomized controlled trials involving 1,051 patients and lasting 6–8 weeks. These studies grouped patients into fixed doses from 0.75–3 mg/day. The sweet spot seems to be 1.5 mg/day, which was

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Research Update

Mood Stabilizers and Stroke Risk in Bipolar Disorder

Topics: Bipolar Disorder | Lithium | Medical Comorbidities | Mood Stabilizers | Pharmacology

Review of: Chen PH et al, Br J Psychiatry 2018;1–6. doi:10.1192/bjp.2018.203 Study Type: Case-crossover study People living with bipolar disorder already have a decreased life expectancy of 10+ years compared to the general population (Crump C et al, JAMA Psychiatry 2013;70:931–939). Most of these years of lost life have been attributed to cardiov

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Expert Q&A

Light and Darkness in Bipolar Disorder

Topics: Bipolar Disorder

Dr. Jim Phelps is the author of a textbook on bipolar spectrum disorders, A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management (W. W. Norton & Company) as well as two self-help books on bipolar disorder. He conducted some of the early studies on dark therapy out of his private practice in Oregon, and we ca

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Article

Does Mania Follow the Sun?

Topics: Bipolar Disorder | Free Articles | Mania

TABLE : SPRINGTIME MANIA Click here for the full PDF table showing sunlight peaks.   If dark nights can treat mania, can too much sunshine destabilize it? Yes and no. Mania is linked to rapid changes in sunlight, but not to the amount of light itself. Mania peaks in early spring when there’s a steep rise in sunlight. By the time the longe

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Article

Evaluating and Treating Co-Occurring ADHD and Bipolar Disorder

Topics: ADHD | Bipolar Disorder | Child Psychiatry

Early into the evaluation of a 10-year-old boy, you note the following symptoms: inattention, hyperactivity, impulsivity, sleep problems, racing thoughts, and moodiness. The boy’s parents came to your office convinced that their son has ADHD, but thinking through the case, you recognize that the same symptoms could signal bipolar disorder (BD). You ha

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