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Bipolar Disorder Treatment - Antipsychotic Medications and Omega-3 fatty acids

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Bipolar Disorder Treatment - Antipsychotic Medications

Initially developed for the exclusive treatment of psychosis and schizophrenia, antipsychotic medications are finding new and alternative uses in the treatment of bipolar disease and other mood disorders. In the past, antipsychotic agents were used as treatment for bipolar patients exhibiting psychotic features. However, clinicians are finding that treatment with antipsychotics can help to relieve acutely ill bipolar patients and, as well, prevent recurring episodes. These medications may be useful beyond the acute phases of bipolar disorder, in that they may serve as true mood stabilizers (additional bipolar treatment research and time will tell)

Antipsychotics are divided into two categories: first-generation, also known as "typical" drugs, and second-generation, also known as "atypical" drugs. Typical antipsychotics are so-called because they were the first family of drugs discovered to have antipsychotic properties. Some examples of "typical" antipsychotic medications are: chlorpromazine, fluphenazine, haloperidol, molindone, thiothixene, thoridazine, trifluoperazine, and loxapine. Atypical antipsychotic drugs were developed later and named to as to distinguish them from the earlier "typical" drugs. Some examples of "atypical" antipsychotic medications include: clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. In addition to denoting when a given drug was introduced into the market (e.g., recently for atypicals, or in the past for typicals), the category names were also distinguished so as to highlight differences in how these classes of drugs were thought to work. Typical bipolar disorder medications were originally thought to work primarily by affecting levels of the neurotransmitter dopamine, while atypical drugs were thought to work through other neurotransmitter systems. Recent research suggests that all of these drugs mainly affect dopamine systems, however.

Atypical antipsychotic drugs are potentially vital in the treatment of bipolar disease because they may have the combined properties of antimanic, antidepressant, and mood stabilizing drugs. Furthermore, these bipolar medications are usually quite well tolerated. This is important because mood stabilizers, for the most part, are medications that a patient with bipolar disorder will take indefinitely. In addition, atypical medications seem to produce less functional cognitive impairment, fewer extrapyramidal physical symptoms (such as body stiffness, tremor, slowed movement, loss of capability for facial expression, and restlessness), and less tardive dyskinesia (involuntary tic-like body movements, most often manifesting as mouth and facial twitching) than typical antipsychotic agents (which were known for producing these sorts of side effects).

Some antipsychotics that have been used for the treatment of bipolar disorder are clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). In a recent practice guideline published by the American Psychiatric Association, Zyprexa was given equal first-line treatment status as lithium and valproate. In the future, other antipsychotics are likely to be used in bipolar treatment as more studies become available.

Bipolar Disorder Treatment - Omega-3 fatty acids

Omega-3 fatty acids have been dubbed nature's mood enhancer and wellness molecule. In addition to their positive effects on other diseases such as heart disease, Crohn's disease, rheumatoid arthritis, and cancer, they are also thought to have a mood-enhancing effect. Based on the finding that omega-3 fatty acids, given in the form of fish oil tablets, have intracellular effects similar to those caused by lithium and valproate, studies investigating the mood stabilizing abilities of omega-3 fatty acids have been conducted. Both clinical trials, as well as case reports suggest that omega-3 fatty acids can contribute to the well-being of some bipolar patients. Although the optimal dosage and duration for bipolar treatment is not clear at this time, even at high doses, there are few negative side effects. This type of mood therapy might be most useful for women who are pregnant or breastfeeding, as pharmaceuticals may have harmful side effects. At this time, more research is needed to clarify the proper role of omega-3 fatty acids in the treatment of bipolar disorders.