Medications for Depression & Bipolar | Robert D. McMullen, MD

Robert D. McMullen, MD about Medications for Depression & Bipolar
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Medications for treatment of Depression & Bipolar disorders
Major depressive disorder is also known as major depression, clinical depression, or unipolar depression. The term unipolar refers to the presence of one pole, or one extreme of mood- depressed mood. This may be compared with bipolar depression which has the two poles of depressed mood and mania (i.e., euphoria, heightened emotion and activity).
Bipolar disorder (also known as manic depression) causes serious shifts in mood, energy, thinking, and behavior-from the highs of mania on one extreme, to the lows of depression on the other
These are of 2 types
• Bipolar I disorder involves periods of severe mood episodes from mania to depression. The highs may even require hospitalization of the person.
• Bipolar II disorder is a milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression
The depression that people with bipolar disorder experience is generally of a melancholic or psychotic type and therefore more biological in its nature. The depression found in these bipolar patients can be difficult to treat than unipolar depression as the antidepressants can cause them to have greater mood swings. These patients need to be on mood-stabilizing drugs. The antidepressants alone can actually increase the manic episodes and worsen the disorder.
Antidepressants: divided into three main classes:
• Selective serotonin reuptake inhibitors (SSRIs) - were developed in the 1980's and are the most common prescribed today. They are sold under brand names such as Prozac, Paxil, Prozac, Luvox, Zoloft, Celexa
• Monoamine oxidase inhibitors (MAOIs) There are three types of MAOIs, phenelzine,(Nardil) isocarboxazid and tranylcypromine, ( Parnate) and moclobemide.)
• Tricyclic drugs (TCAs). (sold as Amitriptyline, Imipramine)
For effective control and to limit the side effects a combination can be used such as Wellbutrin (or bupropion). Mechanisms of action are different hence lower doses of both help control side effects. The combination of Zoloft and wellbutruim earned the popular name Welloft.
The MAO inhibitors are more effective than the SSRI drugs. But can cause severe weight gain and therefore patients need to work on diet control, else the spike in blood pressure can be dangerous. They are contraindicated with drugs that work on serotonin.
Lamictal (or Lamotrigine) was FDA approved for treating depression in 2003.The main advantage being, no sexual dysfunction, no sexual side effects and no weight gain. There is no sedative effect and dosage is generally much less than used for seizures.
If any of the above mentioned combinations are ineffective in controlling depression, the thyroid hormone replacement drug Cytopan or Cytomel or Synthroid can be added to any of the above drug.
Atypical anti-psychotics such as low doses of Zyprexa, or Abilify, or Seroquel, and the latest Quetiapine can also be prescribed. 150 mg of Lithium, normally prescribe for Bipolar at much higher doses, can be used safely without having to get regular blood checks.
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