Posted by med_empowered on December 13, 2006, at 11:00:24
In reply to Atypical antipsychotics as mood stabilizers?, posted by chess on December 13, 2006, at 10:28:38
atypical antipsychotics are actually very much like the old antipsychotics--low-to-moderate doses of low-to-intermediate potency conventional (old school) antipsychotics (example would include Trilafon) are about as effective and cause about as many side effects and standard doses of these "atypical" agents.
In your brain, they dampen dopamine and serotonin, and some, like zyprexa, go all over the place and do things no one quite understands yet. These drugs, and the drugs that came before them, are tranquilizers. They reduce emotional arousal and vitality, reduce locomotor activity in lab animals (and humans--trust me) and overall serve as sedatives, albeit sedatives that sometimes prove useful in psychosis (although, judging by disconitnuation rates and suicide rates, they're really not *that great* for schizophrenia, either).
In the US, Thorazine hit the scene before Lithium did. Thorazine was a common treatment for mania and also sometimes for depression, anxiety, agitation, etc...it was known as a "chemical lobotomy," and for good reason.
"Mood stabilizers" redcue the frequency of mania/depression and lengthen the time spent not in a mood episode. So, if you usually have 2 depressions and 1 fit of mania a year, on a mood stabilizer you could be looking at 1 depression and no mania or (more likely) 2 depressions and no mania, since most "mood stabilizers" are more effective against mania than against depression--probably b/c any sedative can help with mania (barbiturates, opiates, antipsychotics, benzos, etc.)
Atypical antipsychotics are seen as better for depression in bipolar and the "negative symptoms" of schizophrenia than their predecessors. I find this to be more of an assumption than a fact. For along time, antipsychotic doses were very high, and high-potency agents were all the rage. These 2 factors would increase the rate of EPS (including subjective akathisia and neuroleptic-induced dysphoria), which could make negative symptoms worse (or cause them) and make depression worse (or cause it). The most striking thing about the new neuroleptics is their tendency to not cause obvious EPS, so I think you're able to get dopamine blockage w/o as many awful side effects..that doesn't make them wonder drugs; a lot of the problems with old drugs were a result of super-high dosages and poor patient selection.
Basically, the new antipsychotics can reduce frequency/intensity of mania (although they can also induce mania) and they can help with depression(although some people, including myself, find depression getting *worse* on "atypials). ALso, there's a risk of tardive dyskinesia--when these drugs first came out, the assumption was TD was a thing of the past, or it would now be very rare. Case reports have piled up for every available neuroleptic indicating TD; given that only a small percentage of any sort of adverse reactions will ever be reported+ the tendency of shrinks to blame TD on prior treatments or on "the illness" itself, my guess would be that the TD rates for the "atypicals" probably AREN'T that much better than for the older drugs, especially at higher doses, with other meds (such as lithium), and in high-risk groups (young people, older women).
That said...some people derive benefit. Personally, I'd try an anticonvulsant, lithium, benzos, or...anything before an atypical.
poster:med_empowered
thread:713233
URL: http://www.dr-bob.org/babble/20061212/msgs/713243.html