Depression, Bipolar & Grief Counselling Blog

Role of second-generation antipsychotic for maintenance therapy of Bipolar Disorder

Lee Hopkins - counsellor and photographer

The International Journal of Bipolar Disorders has published an article on the potential use of second-generation antipsychotics in place of the gold standard Lithium.

Although the trials were low in quality and few in number, drugs such as aripiprazole, olanzapine, quetiapine, ziprasidone, and risperidone long-acting injection (RLAI) showed benefits compared to a placebo when taken in place of lithium.

Reasons why someone might not want to take lithium include the following side effects (WebMD shows that side effects in minor doses occur in 75% of cases)

  • Hand tremor (If tremors are particularly bothersome, dosages can sometimes be reduced, or an additional medication can help.)
  • Increased thirst
  • Increased urination
  • Diarrhea
  • Vomiting
  • Weight gain
  • Impaired memory
  • Poor concentration
  • Drowsiness
  • Muscle weakness
  • Hair loss
  • Acne
  • Decreased thyroid function (which can be treated with thyroid hormone)

But the second-generation antipsychotics don’t come without side effects of their own, which include:

  • weight gain (15% compared to lithium’s 7%),
  • effects on glucose metabolism, cholesterol and prolactin,
  • sedation,
  • sexual dysfunction.

It should be noted that with weight gain, additional interventions exist that can be taken to reduce the gain effect (Young et al. 2015; Maayan et al. 2010). My physician prescribed Metformin for me.

Conclusion
Monotherapies in the second-generation bracket include long-release injections, which are helpful for people who have problems with adherence to their more usual tablet regimen, or are intolerant of lithium.

More research is needed into the use of second-generation antipsychotic therapies, in lieu of the use of lithium, the gold standard of treatment for bipolar disorders.


Source article: https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-019-0145-0
Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Please see my medical disclaimer.

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