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Bipolar Disorder Treatment - Antipsychotic Medications and Omega-3 fatty acids

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

Antipsychotic Medications

open medication bottle Antipsychotic medications were developed for the treatment of psychosis and schizophrenia symptoms, including hallucinations and delusions and periods of agitation. These are now sometimes used to stabilize mood and as preventative medications against bipolar disorder relapses.

Antipsychotics are divided into two categories: first-generation, also known as "typical" drugs, and second-generation, also known as "atypical" drugs. Typical antipsychotics are the first family of drugs discovered to have antipsychotic properties. Some examples of "typical" antipsychotic medications are: chlorpromazine, fluphenazine, haloperidol, molindone, thiothixene, thoridazine, trifluoperazine, and loxapine.

Atypical antipsychotic drugs were developed later and named to distinguish them from the earlier "typical" drugs. Some examples of "atypical" antipsychotic medications include: clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. In addition to denoting when a given drug was introduced into the market (e.g., recently for atypicals, or in the past for typicals), the category names were also distinguished to highlight differences in how these classes of drugs were thought to work. Typical bipolar disorder medications were originally thought to work primarily by affecting levels of the neurotransmitter dopamine. Atypical drugs were thought to work through other neurotransmitter systems. However, research now suggests that all of these drugs mainly affect dopamine systems.

Atypical antipsychotic drugs are potentially vital in the treatment of bipolar disease because they may have the combined properties of antimanic, antidepressant, and mood stabilizing drugs. These medications are usually quite well tolerated. This is important because mood stabilizers, for the most part, are medications that a patient with bipolar disorder will take indefinitely. In addition, atypical medications seem to produce less cognitive trouble and fewer physical symptoms (such as body stiffness, tremor, slowed movement, loss of capability for facial expression, and restlessness) than atypical antipsychiotics. They also produce less involuntary tic-like body movements, such as mouth and facial twitching.

Some antipsychotics that have been used for the treatment of bipolar disorder are clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). In the future, other antipsychotics are likely to be used in bipolar treatment as more studies become available.

Omega-3 fatty acids

Omega-3 essential fatty acids (oils), which include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are found primarily in fish (such as mackerel, lake trout, herring, sardines, albacore tuna, and salmon) and some plants. While they are necessary for the proper functioning of our bodies, the levels necessary for health benefits are more than can readily be achieved through diet alone. These oils are used as supplemental treatments for an array of conditions including heart disease, diabetes, and arthritis. These oils also play a role in brain development and function.

Population studies have suggested that people who consume a large amount of seafood high in EPA/DHA have low rates of bipolar disorder. However, controlled clinical research with people who are taking EPA/DHA as a supplement to treat bipolar disorder are almost non-existent.

Although the optimal dosage and duration for bipolar treatment is not clear at this time, even at high doses, there are few negative side effects (typically stomach upset, nosebleeds and loose stools). This type of mood therapy might be most useful for women who are pregnant or breastfeeding, as pharmaceuticals may have harmful side effects. At this time, more research is needed to clarify the proper role of omega-3 fatty acids in the treatment of bipolar disorders.