To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: DG DISPATCH - APA MEETING: Overview Of Treatment For Bipolar Disorder URL: http://www.pslgroup.com/dg/100EDE.htm Doctor's Guide May 27, 1999
By John L. Moore Special to DG News WASHINGTON, DC -- May 27, 1999 -- Initiating of therapy for bipolar disorder must be approached with caution, particularly in patients with a history of manic episodes or euphoria, explained Dr. Gary Sachs, of Massachusetts General Hospital. Patients diagnosed with bipolar disorder will generally seek treatment during the depressive course of their affliction. However, prescription of antidepressants at this stage, in view of the presenting symptoms, is associated with an increased risk of provoking iatrogenic mania, Dr. Sachs explained. Therefore, careful attention must be paid to the patient's psychiatric history and evidence of past manic episodes, he added. Results of clinical trials indicate that initial treatment with mood stabilisers and or anticonvulsants affords a much better outcome than with antidepressants, Dr. Sachs said. Treatment with the mood stabiliser lithium carbonate, and one or both of divalproex-sodium or carbamazepine, anticonvulsants, generally results in improvement within three to four weeks after the initial dose. The prognosis tends to be far better for patients treated in this fashion after their first episode compared to patients who have breakthrough episodes associated with a refractory form of the disorder. Lamotrigene, a recent addition, has been associated with statistically significant improvement in patients with bipolar disorder when used at doses of either 50 mg or 200 mg. The major drawback with this drug is the increased risk of Stevens-Johnson Syndrome, a potentially fatal rash. Adjunctive treatment with gabapentin does result in improvement, but the drug is not recommended as first-line therapy for mood stabilisation. Topiramate is the newest anticonvulsant. It has been associated with significant secondary weight loss and should therefore not be prescribed in some patients, Dr. Sachs said. Yet to be established is the comparative efficacy of supplementing first-line mood-stabilising therapy with either an anticonvulsant or an antidepressant, he added. --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. P\S\L shall not be liable for any errors, omissions or delays in this content or any other content on its sites, newsletters or other publications, nor for any decisions or actions taken in reliance on such content. --------------------------------------------------------------------------------------------- This news story was printed from *Doctor's Guide to the Internet* located at http://www.docguide.com --------------------------------------------------------------------------------------- Return to News Story Page This site is maintained by webmaster@pslgroup.com Please contact us with any comments, problems or bugs. All contents Copyright (c) 1998 P\S\L Consulting Group Inc. All rights reserved.