People with bipolar disorder 2 spend 35 times more time depressed than hypomanic. As a person with bipolar type 2, I can tell you how true this is. Bipolar type 2 is more like a depressive disorder than a bipolar one. However, this doesn’t mean bipolar disorder 2 can just be treated like unipolar depression. If only life were that simple.
Bipolar disorder type 2 depression treatments must not induce hypomania or mania, and antidepressants used alone often do that. For this reason bipolar 2 depression treatment is generally like happy hour (full of cocktails). And many of us are very frustrated with the fact no new medications are being developed for our mental illness.
So here’s some hope. Here are five bipolar depression treatment areas you probably don’t know about.
Note: I don’t have to tell you this, but these are research areas some of which some clinicians are using and some of which they are not. Don’t even think about trying this at home. Talk to a doctor.
FDA-Approved Bipolar Depression Medication
For those of you wondering, only quetiapine and a fluoxetine/olanzapine combination are FDA-approved for the treatment of bipolar depression. (That’s an antipsychotic and an antidepressant/antipsychotic combination. It’s odd that lamotrigine isn’t on the list because it’s one of the biggies for treating bipolar depression.)
Two psychiatric medications. Just two. Chocolate and vanilla. Heaven help you if you like rocky road.
Glutamate and Bipolar Depression
Everyone has heard of serotonin and dopamine – two neurotransmitters antidepressants commonly target. Glutamate is another neurotransmitter, this one of the amino acid variety. Glutamate is essential in things like learning and memory.
Glutamate fact of the day – nicotine affects glutamate in the brain and may be one reason why so many people with a mental illness smoke.
Genetic and other abnormalities in the glutamate receptor complex have been found in people with bipolar disorder. Two medications targeting the glutamate receptor complex appear to have antidepressants effects: riluzole and ketamine. Both of these drugs are FDA approved for other uses.
Riluzole appears to have very early and small-scale evidence of an antidepressant effect in bipolar depression while there has been significant interest and study of ketamine and depression.
Ketamine is an anesthetic (and a street drug), but when used at lower doses, appears to alleviate bipolar depression extremely quickly – like 40 minutes kind of quickly (when used with lithium or valproic acid). However, the effects only last for three days, the administration is intravenous and there is that issue of it being an anesthetic and producing dissociative type side effects.
If I had to guess, I’d say glutamate will be big in upcoming treatments. I’m very interested to see where this one goes.
Anti-Inflammatory Medication and Bipolar Depression
This area is extremely experimental but basically abnormal function in the inflammatory network has been found in bipolar depression and bipolar mania. One of the things lithium does is modulate the inflammatory network.
One small study shows a non-steroidal anti-inflammatory (NSAID) with an antipsychotic or mood stabilizer, given to people with bipolar 1/2 depression, had statistically significant improvement over placebo after one week. However, this effect was not seen at six weeks.
An additional study found a similar antidepressant effect using aspirin and fluoxetine in depression treatment resistant rats (really).
What I get from this is anti-inflammatories seem to make antidepressants work faster, but are not in and of themselves antidepressants.
More Bipolar Depression Treatments to Come
Next I’ll review metabolic, antioxidant and dopamine modulation treatments.
The information in this article is primarily from: Novel Treatment Avenues for Bipolar Depression By Roger S. McIntyre, MD and Danielle S. Cha. Clinical Psychopharmacology. April 19, 2011.
See the article for all the nitty gritty details about the above.
Psychotropic Drug Brand NamesFluoxetine – Prozac
Fluoxetine and olanzapine combined – Symbax
Lamotrigine – Lamictal
Olanzapine – Zyprexa
Quetiapine – Seroquel
Riluzole – Rilutek
Valproic Acid – Depakote or Epival