I’ve been taking medication for bipolar illness for the past nine years. It seems to work fairly well, but occasionally, symptoms reappear for a short time. What sort of new medications are available or likely to be approved in the near future?

Studies of bipolar disorder strongly suggest that this illness requires more than one medication for sustained mood management. Hence, combination medication strategies are the standard of care. One promising area of study is the use of anticonvulsant medications in bipolar disorder. Historically, valproic acid (Depakote or Depakene) and carbamazepine (Tegretol) have been tried first in treating bipolar illness, either by themselves or in conjunction with other drugs (e.g., Lithium). Several recent studies have suggested that lamotrigine (Lamictal), may be particularly effective in treating bipolar depression in conjunction with the patient’s existing medications. Another agent, topiramate (Topamax), has shown promise in reducing manic symptoms. Carbamazepine (Tegretol), although a first line agent, carries with it numerous side effects, including a potentially fatal bone marrow abnormality (rare) and severe sedation. Additionally, it can adversely interact with the patient's other medications. An anticonvulsant medication that is related to carbamazepine, oxcarbazepine (Trileptal), has emerged as a possible combination agent for bipolar disorder. Oxcarbazepine may have the mood stabilizing properties of carbamazepine WITHOUT the side effects and drug interactions. Oxcarbazepine is currently being studied in bipolar disorder at Saint Louis University School of Medicine. We are currently enrolling bipolar (manic-depressive) subjects ages 18 to 65 who experience incomplete or partial remission of their illness. Subjects are reimbursed for travel and time. If you know of someone who you believe meets these criteria, please contact Katherine at 314-577-8000, extension 3417.

Charles R. Conway, M.D.
Director, Adult Inpatient Psychiatric Unit
St. Louis University School of Medicine

Bipolar Disorder is a disorder of affect (mood) that results in periods of depression, as well as episodes of euphoria, or elevated, irritable mood changes. The mood stabilizers that are approved by the Food and Drug Administration (FDA) for treating Bipolar Disorder are limited to Lithium (Eskalith, Cibalith-S, Lithobid) and the newer (1995) divalproex sodium, also known as valproic acid (Depacine, Depakene, Depakote, Epival, Epilim, and Valproate). Lithium is usually the first drug utilized because of its overall success rate. Individuals with less frequent and more intense mood swings respond best to Lithium, while those with more than four mood swings per year tend to respond best to the anticonvulsant mood stabilizers. Anticonvulsants, such as carbamazepine (Tegretol), clonazepam (Klonopin), gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), tiagabine, (Gabitril), topiramate (Topamax) and verapamil (Calan), have recently shown promise in treating those with Bipolar Disorder. New anticonvulsants currently available include zonisamide (Zonegran) and levetiracetam (Keppra). Antipsychotic medications such as quetiapine (Seroquel), risperidone (Risperdal), and olanzapine (Zyprexa, which is now FDA-approved to treat Bipolar Disorder), have also been successfully used to treat mania. New atypical antipsychotic medications that may be helpful in the future include iloperidone (Zomaril) and aripiprazole (Abilitat). Treatment choices depend on the type and phase of the illness.

Asif Habib, MD
Mid-America Psychiatric Consultants
St. Louis, MO
314-569-6295
314-268-6195

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