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Antipsychotics
Antipsychotics are very useful in the treatment of bipolar disorder. They are often prescribed temporarily for patients during manic episodes when rapid control of the manic symptoms is needed, or when the patient is experiencing delusions or hallucinations. Antipsychotics are also prescribed for the long-term maintenance of psychotic symptoms in children and adults.
Antipsychotic drugs are typically prescribed in tablet or liquid form and are taken once or twice a a day. Prolixin and Haldol can be given as a long-acting injection that lasts from 2-4 weeks.
Early (and the most common) side effects of most antipsychotic medications are constipation, blurring of vision, clumsiness, nasal congestion, and dry mouth. These typically fade as the person adjusts to the medication.
In recent years newer "atypical" antipsychotic medications have been developed that usually result in fewer short and long term side effects. I will discuss both the traditional antipsychotics and the newer ones briefly below.
Abilify (aripiprazole):
Recently approved by the FDA (Nov, 2002), Abilify appears to be both effective and have a good side effect profile. Those taking this medication should be aware that it does carry a risk of developing orthostatic hypotension. Common side effects include nausea, headache, anxiety and insomnia.
Zyprexa (olanzapine):
It has been proposed that this thienobenzodiazepine's antipsychotic activity is mediated through a combination of dopamine and serotonin type 2 antagonism. Many experts believe it is more effect for the treatment of mania than lithium. Side effects, that may go away during treatment, include dizziness, drowsiness, constipation, weight gain, and restlessness.
Geodon (ziprasidone):
Large clinical trials have shown that ziprasidone is associated with little or no weight gain, thus distinguishing it from most other antipsychotic drugs. The most common side effects reported for ziprasidone are headache, somnolence, drowsiness, dry mouth, and abnormal movements. In some people with heart problems or a slow heartbeat, Geodon can cause serious and potentially fatal heartbeat irregularities. The chance of a problem is greater if you are taking a water pill (diuretic) or a medication that prolongs a part of the heartbeat known as the QT interval. Many of the drugs prescribed for heartbeat irregularities prolong the QT interval and should never be combined with Geodon.
Risperdal (resperidone):
While its exact mechanism of action is not yet understood, Risperdal seems to block the action of serotonin and dopamine, two neurotransmitter chemicals in the brain. Because Risperdal is effective and has relatively few side effects, doctors may consider it one of the first medications to try for patients with bipolar disorder. The most frequent side effects associated with the use of Risperdal include sleepiness, agitation, anxiety, uncontrolled movements, headache, and nasal stuffiness and irritation.
Seroquel (quetiapine fumarate):
One of the great advantages of this medication is that it usually starts working in about one and a half hours, and can therefore be very helpful in treating acute mania. The medication may take longer to exhibit beneficial effects in some people due to symptoms and other factors. Side effects are relatively mild and may include dizziness, drowsiness, constipation, dry mouth, hypotension (abnormally low blood pressure) and indigestion.
Clozaril (clozapine):
Clozaril has been found to improve symptoms in 50-60% of people in which standard antipsychotic medications were ineffective. This medication can, however, cause the serious disorder agranulocytosis. For this reason, a baseline white blood count and differential count are required before treatment can begin. Blood work should also be repeated regularly throughout therapy and for four weeks after discontinuing the medication. The combination of Lithium and Clozapine may cause seizures and confusion. Cigarette smoking may increase the rate at which the liver breaks down Clozapine, altering dosage requirements. Some side effects that may go away during treatment are rapid heartbeat, low blood pressure, dizziness, fainting, drowsiness, salivation, constipation.
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Neuroleptic Malignant Syndrome (NMS):
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure.
The management of NMS should include immediate discontinuation of all antipsychotic drugs including olanzapine, intensive monitoring of symptoms and treatment of any associated medical problems.
Tardive Dyskinesia:
A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown.
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Thorazine (chlorpromazine)
