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Antipsychotic Treatment in Bipolar Disorder

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Living with bipolar disorder is a challenging journey that requires specific treatment to manage the symptoms. Among all treatment options for bipolar disorder, medication is one of the most effective methods. Medications typically include mood stabilizers, antipsychotics, and atypical antipsychotics. 

Bipolar disorder is a chronic mood disorder that has symptoms like unusual mood shifts, energy levels, and thinking patterns. Individuals with this disorder experience distinct periods of mania or hypomania and periods of depression. It significantly impacts their daily lives. 

What is Antipsychotics? 

Antipsychotics are a form of medication used to treat various mental health conditions. It provides short or long-term treatment for bipolar disorder that helps manage the symptoms of the disorder. The symptoms of acute mania or severe depression include hallucinations, delusions, or other symptoms of mania. Some antipsychotics are also given as sedatives to deal with insomnia, anxiety, or agitation. The drug helps regulate normal brain functioning.

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Types of Antipsychotics Used in Bipolar Disorder 

Antipsychotics are widely divided into two categories: typical antipsychotics and atypical antipsychotics. Typical antipsychotics were developed first and, to date, continue to help when the newer medications are ineffective. Atypical antipsychotics are the second degenerative drug that has less severe side effects compared to typical drugs.  

Overview of Atypical Antipsychotics 

The term atypical means they are differentiated from typical antipsychotics based on their clinical profile. It is also known as second-generation antipsychotics, which mainly treat acute psychoses. The side effects of this drug are comparatively fewer than those of typical antipsychotics. It has changed the treatment course of psychoses as it is prescribed for the management of affective disorders and geriatric agitation.  

Typical vs. Atypical Antipsychotics 

Typical antipsychotics, or first-generation antipsychotics, were developed in the 1950s and primarily block dopamine receptors in the brain. It was used to treat symptoms of psychosis, such as delusions and hallucinations. The side effects were severe, such as tardive dyskinesia, where an individual would experience involuntary, repetitive movements of the face, tongue, or limbs.  

Atypical antipsychotics or second-generation antipsychotics were developed in the 1990s, which also blocked dopamine receptors, but to a lesser extent than typical drugs, and also interacted with serotonin receptors. It is proven to be more effective in treating symptoms of psychosis and has a lower risk of severe side effects, like a less effective raising of prolactin levels.  

How do they work? 

With all the advantages of typical antipsychotics, like blocking dopamine signals, atypical antipsychotics also affect serotonin levels. Bipolar disorder causes an imbalance in dopamine, serotonin, and glutamate levels in the brain. These drugs are crucial for mood regulation, thinking, and behavior. Antipsychotics block dopamine receptors and manage the symptoms of bipolar disorder, like mood stabilization. They also increase serotonin levels, which contributes to mood improvement and emotional regulation. Overall, antipsychotics help to re-balance the activity of these neurotransmitters, leading to reduced manic symptoms.  

Efficacy of Atypical Antipsychotics in Bipolar Disorder 

The efficacy of atypical antipsychotics for bipolar disorder entirely depends on the type of drug used and the effect it has on the symptoms. With medication, bipolar disorder treatment also includes therapy and self-care modulation. Research also suggests that these medications may be less effective in helping depressive episodes than manic episodes.  

Treating Manic Episodes 

Psychiatrists generally prescribe antipsychotics to reduce the symptoms of manic episodes like agitation, impulsivity, and psychosis. It stabilizes the mood by affecting neurotransmitters like dopamine receptors in the brain. The blocking of dopamine calms down the intensive activities associated with mania. Two types of antipsychotics help in treating mania, but atypical antipsychotics are often prescribed as the side effects are fewer compared to typical drugs.  

Treating Depressive Episodes 

Using antipsychotics for depressive episodes is uncommon, as it’s considered a second-line treatment option because of the ineffectiveness of other treatments. Medical professionals can prescribe off-label antipsychotics to help manage episodes but only based on an individual’s assessment of specific symptoms and medical history. Antipsychotics are given alone or along with antidepressants or psychotherapy.  

Maintenance Therapy 

Continuous treatment is vital even though symptoms and signs are well-managed, making sure the control of any lingering issues is maintained and preserving typical well-being. Long-term use can also lead to side effects that require continuous monitoring and implementing changes. Maintenance therapy involves everyday compliance with mental health professionals to provide useful resources, reveal improvement, and address any worrying conditions that might arise at some point during treatment.  

Common Antipsychotics Prescribed for Bipolar Disorder 

Aripiprazole (Abilify) is used to balance the dopamine and serotonin levels in the brain.  

Asenapine (Saphris) helps to restore the balance of natural substances in the brain.  

Cariprazine (Vraylar) also helps balance the neurotransmitters in the brain.  

Clozapine (Clozaril): it treats depressive behaviors like suicide in bipolar disorder.  

Lumateperone (Caplyta) is used to treat depressive episodes  

Lurasidone (Latuda) blocks the receptors for dopamine and serotonin, which helps to balance brain activity.  

Olanzapine (Zyprexa) regulates the brain regions responsible for mood, behaviors, and thoughts.  

Quetiapine (Seroquel) helps regulate temper, behavior, and mind. 

Risperdal (Risperidone): this medication manages the hormone level in the brain.  

Ziprasidone (Geodon) helps by altering the chemicals associated with psychotic disorders. 

Side Effects and Considerations 

Antipsychotics aid immensely in the treatment of mental disorders like schizophrenia and bipolar disorder. While they can be effective, they also cause several side effects. In addition to these side effects, there are other considerations to keep in mind when taking antipsychotics.  

Common Side Effects 

Blurred Vision: Some antipsychotics block chemicals in the brain (acetylcholine), which can lead to blurred vision. This effect is usually temporary and improves over time.  

Dry Mouth: The chemical causes neurotransmitters to block the production of saliva, which leads to a dry mouth.  

Drowsiness: Blocking dopamine and serotonin makes it difficult for an individual to concentrate, stay awake, and perform daily tasks.  

Muscle spasms or tremors: First-generation antipsychotics can cause movement disorders that involve involuntary and repetitive movements. 

Weight Gain: Medications can block histamine receptors, leading to increased appetite and slowing down the metabolism process.  

Serious but less common Side Effects 

  • Neuroleptic malignant syndrome is a life-threatening reaction to antipsychotics with symptoms like high fever, muscle rigidity, and rapid heart rate. 
  • The effects on the central nervous system can cause dementia, amnesia, and memory loss. 
  • Antipsychotic effects on the cardiovascular system include palpitations, chest pain, and arrhythmias.  
  • Heart attack is an uncommon side effect of the drug that affects 1% of individuals. 
  • Sexual dysfunction like impotence, priapism, and premature ejaculation have also been reported.  

Managing Side Effects 

The success of treatment significantly depends on managing the side effects of antipsychotics. Communicate with your doctor about each side effect you have been struggling with. They may adjust your medication or prescribe additional drugs to manage the symptoms. Physical therapy or occupational therapy can also help manage the effects. Make changes to your lifestyle, engage in regular physical activity, and maintain a healthy diet plan. Consult with a therapist to discuss the psychological complexities caused by the medication. These changes can ensure effective holistic recovery while managing the adversities of antipsychotics.  

Enhancing Antipsychotic Treatment for Bipolar Disorder with Cadabams 

Antipsychotics are one of the most effective treatments for various mental health disorders, including bipolar disorder. These medications need to be prescribed with the utmost precaution.  If you are searching for a solution to your problem, Cadabam’s Rehabilitation Centre and Hospitals can help you with its team of specialized experts. Cadabams has been helping people with mental health issues for more than 30 years, We have experienced psychiatrists, psychologists, and therapists working tirelessly to deliver personalized treatment plans for bipolar disorder. We leverage evidence-based approaches and holistic treatment methods to help individuals effectively manage the disorder. Get in touch with us today. You can call us at +91 96111 94949.  

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1. Which antipsychotic is best for bipolar disorder? 

A psychiatrist can truly judge the best antipsychotic to manage your symptoms of bipolar disorder. Research suggests that atypical antipsychotics like clozapine, risperidone, olanzapine, and quetiapine effectively work for bipolar disorder treatment with fewer severe side effects. Medication needs to be taken under a doctor’s supervision, with frequent monitoring its effects.  

2. What do antipsychotics do to someone with bipolar? 

Antipsychotics are given to manage manic or mixed episodes of bipolar disorder. It blocks dopamine receptors and affects serotine levels in the brain. It helps stabilize the mood and decrease hyperactivity. Symptoms like hallucinations and delusions can be lessened with medication. Long-term use of the drugs can help prevent future manic or depressive episodes.  

3. How can I treat bipolar disorder on my own? 

Bipolar disorder is a serious mental health disorder that needs professional help and support. Self-treating is not recommended as it can worsen the condition. The illness requires a comprehensive treatment plan developed by an experienced mental health personnel. Treatment involves medication, therapy, and ongoing support.  

4. What is the most serious side effect of antipsychotics? 

There isn’t one serious side effect of antipsychotics, as the severity can vary depending on the individual and prescribed medication. Neuroleptic malignant syndrome is a rare but life-threatening side effect of the drugs. Its symptoms include a high fever, muscle rigidity, confusion, and a rapid heart rate. Tardive dyskinesia is another serious effect that develops after long-term use of medication. It causes tremors in the body.  

5. What is the strongest antipsychotic? 

The effect of an antipsychotic depends on its potency. High-potency drugs have stronger effects at relatively low doses. They can cause various neurological side effects compared to low-potency drugs. Clozapine has the highest potency and can be considered the strongest antipsychotic. 

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