MEDICATIONS
by CLASSIFICATION

One thing you learn quickly when you become involved in any bipolar on-line or face to face support group is: We are all similar and have similar experiences, but, we are all different.  This holds most true when it comes to our medications!  There is NO right medication mix for each and every one of us.  This page will attempt  to give you some general information on the many medications used to treat bipolar disorder.  If you are taking a medication, and do not find it listed here please contact Bipolar World, so we can add it.

It is beneficial to have a basic understanding of how the brain works to have a good appreciation of how medications are thought to work.  I recommend visiting Dr Phelps' site ( http://www.psycheducation.org )  and reviewing three articles: The Brain Chemistry of Depression: Inside Cells;  The Brain Chemistry of Depression: Stress Hormones; and Brain Tours.

There are several sources available on the web for more detailed information about medications.  My favorite one is http://www.rxlist.com .  It is the site that is available on our main medication page as well.  If you go to that page http://www.bipolarworld.net/Meds_Trt/Medications/medications.htm  and scroll to the bottom of the page, you will find a search engine.  Just enter the generic or brand name of your medication and you can access complete information about your medication. (this will link you directly to the rxlist.com site)

Mood Stabilizers/Anti-Seizures

Names (generic) & brand

Action

Dosage Range

Major Cautions

(valproic acid, divalproex sodium) Depakote, Depakene. Epival,             increased concentrations of gamma-aminobutyric acid (GABA) in the brain, GABA blocks impulses from one nerve cell to another and prevents mania 2

in plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

divided n 2 - 3 doses

children = 15-20mg/kg

adults =250-1000mg per day although higher doses have been used successfully, lab tests should be done on a frequent basis to monitor for toxicity

be sure to speak to your pharmacist or physician for a listing of prescription and over-the counter medication interactions
(clonazepam) Klonopin enhances the activity of GABA

in plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

divided in 2 - 3 doses

children = 0.01 - 0.03 mg/kg/day

adults = 0.75 - 4 mg per day

benzodiazepine derivative with side effects similar to valium
(lithium carbonate) Lithobid, Carbolith, Duralith, Eskalith, Eskalith CR, Lithane,  Lithonate, Lithotabs, Cibalith, PMS-Lithium Carbonate, Lithium Citrate alters sodium transport in nerve and muscle cells which in turn decreases catecholamine levels 1

in plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

individualized according to blood levels

generally in adults 300-600mg three times a day or 600-900mg of slow release twice a day

dosage ranges have not been established in children younger than 12

initial blood work and daily blood work until therapeutic serum blood levels are determined

then periodic blood levels every 3-6 months

toxic levels can develop quickly notify MD immediately if severe side effects occur

(lamotrigine) Lamictal inhibits sodium voltage channels 1

in plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

increasing doses over a 4 week period in 2 divided daily doses

children 2 - 12 = wk 1 & 2: 0.6mg/kg/day; 
wk 3 - 4: 1.2mg/kg/day
maintenance: 5 - 10mg/kg/day to maximum of 400 mg/day

adults = wk 1 & 2: 50 mg/day; wk 3 & 4: 100mg/day; maintenance 300 - 500mg/ day

report any rashes IMMEDIATELY to your doctor
(gabapentin) Neurontin although it is related to GABA, it's exact action is unknown 1 (check out the rxlist.com site for further information) 900 to 1800 mg/day and given in divided doses (three times a day) using 300- or 400-mg capsules

dosage ranges have not been established in children younger than 12

Dosages up to 2400 mg/day have been well tolerated in long-term clinical studies. Doses of 3600 mg/day have also been administered to a small number of patients for a relatively short duration, and have been well tolerated.
(carbamazepine) Tegretol, Epitol, Mazepine, Novocarbamaz, Apo-Carbamazepine reducing polysynaptic response and blocking the post-tetanic potentiation. Carbamazepine greatly reduces or abolishes pain induced by stimulation of the infraorbital nerve in cats and rats. It depresses thalmic potential and bulbar and polysynaptic reflexes, including the linguomandibular reflex.1

in plain English: prevents over-activity of the brain nerve cells

divided doses 2 - 4 times a day and increased slowly

children under 6 = 10 - 20mg/kg/day not to exceed 400mg/day

children 6-12 = 200 - 1000mg/day

children 2-15 = 1000mg/day maximum

adults = 400 - 1200mg/day

be sure to speak to your pharmacist or physician for a listing of prescription and over-the counter medication interactions
(oxcarbazepine) Trileptal inhibits voltage sensitive sodium channels resulting in stabilization of hyper-excited neural membranes, inhibition of repetitive neuronal firing, and diminution of propagation of synaptic impulses.1

In plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

initial 8 - 10mg/kg per day in divided doses

maintenance doses 

20 - 29kg = 900mg/day

29.1 - 39kg = 1200mg/day

above 39kg = 1800mg/day

most patients were unable to tolerate doses of 2400mg/day

can deplete blood sodium levels,  blood levels should be taken on a regular basis

(topiramate) Topamax First, action potentials elicited repetitively by a sustained depolarization of the neurons are blocked by topiramate in a time-dependent manner, suggestive of a state-dependent sodium channel blocking action. Second, topiramate increases the frequency at which g-aminobutyrate (GABA) activates GABA A receptors, and enhances the ability of GABA to induce a flux of chloride ions into neurons, suggesting that topiramate potentiates the activity of this inhibitory neurotransmitter. This effect was not blocked by flumazenil, a benzodiazepine antagonist, nor did topiramate increase the duration of the channel open time, differentiating topiramate from barbiturates that modulate GABA A receptors. Third, topiramate antagonizes the ability of kainate to activate the kainate/AMPA a-amino-3-hydroxy-5-methylisoxazole-4-propionic acid non-NMDA subtype of excitatory amino acid (glutamate) receptor, but has no apparent effect on the activity of N-methyl-D-aspartate (NMDA) at the NMDA receptor subtype.1

In plain English: Makes the brain slow down and thus prevents mania by preventing over-activity of the brain nerve cells

increasing doses over an 8 week period check out the rxlist.com link below for detailed information

http://www.rxlist.com/cgi/generic2/topiram_ids.htm 

can increase pressure in the eye, report vision problems immediately
NOTE: Not all anti-seizure medications are used for the treatment of bipolar disorder 
or other mental illness.
Never take any medication or come off medications without your doctor's approval
   

 

Anti-Psychotics

Names (generic) & brand

Action

Dosage Range

Major Cautions

       
       

 

Anti-Depressants

Names (generic) & brand

Action

Dosage Range

Major Cautions

       
       

 

Anti-Anxiety

Names (generic) & brand

Action

Dosage Range

Major Cautions

       
       

Updates on 
Recent medication
Trials 

M100907 produced by the Aventis Corporation.  Development was discontinued based on phase III trial results.  www.hmrpharma.com/hmrir/news/develop799.htm   

ORG522 produced by the Organon USA Inc.  It was in phase II of pharmaceutical studies in 2000.  The classification was anti-psychotic.  I can not find any further information on clinical trials.  (Currently the only mental health medication that Organon is producing is Remeron and RemeronSolTabs, antidepressants.)

More on
clinical trials

Clinical trials are an exciting aspect on treating BP and other mental illness.  Many trials involve testing "new" medications, others are testing existing medications for "new" classification. (i.e.: many anti-seizure medications are now being tested for efficacy in controlling BP and other illness. 

http://www.centerwatch.com/cgi-bin/cl.pl?p=patient/studies/cat20.html 

Resources

1.  http://www.rxlist.com

2.  http://micro.magnet.fsu.edu/aminoacids/pages/gaba.html 

 

 

 

 

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