Psychopharmacology

There are currently four drugs which have been FDA approved for the treatment of bipolar disorder. They include: lithium, chlorpromazine, divalproex sodium, and olanzapine.

Among these four, lithium has the most evidence for its efficacy. Lithium was introduced in the 1949 by John Cade who used it for long-term treatment for mania (Baldessarini, 2002). Similar to lithium, chloropromazine was also first used for treatment in the 1950s. The lithium treatment technique has spanned 50 years as no modern drug has yet to overtake it as the most effective long-term mood stabilizer and recurrence-preventing drug during all phases of the disorder. In addition, several studies have shown that a bipolar patient on the lithium treatment is at reduced risk for attempting and succeeding with suicide (Goodwin, et al., 2003). As a result of bipolar disorder being a lifelong disorder once it manifests, the treatment is also lifelong. Consequently, once a patient starts lithium treatment, it is in their best interest to continue. Studies have found that once a patient ceases the use of lithium, within a 10 week period they will suffer a manic or depressive episode (Suppes, Baldessarini, Faedda, & Tohen, 1991).

Divalproex sodium and olanzapine are two of the more modern drugs. These two drugs have been approved to treat acute mania in comparison with lithium which is a long-term treatment drug. Although divalproex has only been approved for short term treatment of manic states, it dominates the playing field in terms of treatment drugs for bipolar disorder in the United States (Baldessarini, 2002). Its popularity is due to successful marketing coupled with the appeal of not having to be constantly monitored, as is the case with lithium. Divalproex and olanzapine have been shown to be relatively similar in effectiveness but treatment using divalproex has been found to produce less adverse effects. In a comparison of the two drugs, no statistically significant differences were found in treatment, but olanzapine was found to produce more weight gain, slurred speech, edema, and rhinitis among its users (Zajecka, 2002).

Despite the fact that there are only 4 FDA approved pharmacological treatments for bipolar disorder, other drugs are still used to treat the disorder. A plethora of antipsychotic, antimanic, antidepressant, and anxiolytic drugs are utilized; many patients being put on a regiment of two of more drugs (Baldessarini, 2002). Furthermore, bipolar disorder patients are being prescribed drugs which have only been approved to be used to treat other disorders such as schizophrenia and epilepsy (Baldessarini, 2002). Even with a larger and greater variety of drugs being given to patients, these drug combinations have not been shown to effective or safe (Baldessarini, 2002).