6 hours ago
Bipolar Depression: Choosing the Right Antipsychotic
Major depressive episodes are difficult to treat in patients with bipolar disorder I (BD-I) using traditional antidepressants. However, atypical antipsychotics can be effective in BD-I, and five FDA-approved monotherapies are discussed by Dr Joseph Goldberg, of Icahn School of Medicine at Mount Sinai, New York, NY.
Dr Goldberg reports that traditional antidepressants are not overly effective in the treatment of depression in BD-I, and their use can risk destabilizing mood or exacerbating mixed features. In contrast, atypical antipsychotics have demonstrated efficacy as monotherapy for BD-I.
Dr Goldberg reviews the five FDA-approved atypical antipsychotics for patients with BD-I. He then discusses the specific indications for each therapy and notes their effectiveness in treating particular comorbid features of BD-I. For example, he cites quetiapine as effective in treating anxiety, and cariprazine as beneficial for impulse control.
He notes that antipsychotics, as a class, are associated with increased risk for metabolic changes, including abnormal movement disorders. However, individual agents differ in tolerability and side-effect profiles.
In choosing the most appropriate agent for a given patient, Dr Goldberg advises clinicians to target the symptoms needing control, understand the therapeutic goals important to the patient, and identify the agent that has the greatest potential to meet those endpoints with the lowest risk for side effects.
