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Bipolar Disorder Treatment - Tricyclics, MAOIs, and Other Antidepressants

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Bipolar Medication Options - Tricyclic Antidepressants (TCAs)

pile of pillsAlthough these first generation antidepressant medications also work by inhibiting reuptake of neurotransmitters, they are typically considered second or third choice antidepressant bipolar treatments. Their lack of popularity is not simply marketing pressure (e.g., to use the latest and greatest medications that also happen to be under patent and therefore expensive); TCAs precipitate increased mood cycling and mania compared to SSRI and SNRI bipolar medications. They are also easier to overdose on when someone is suicidal. TCAs may also have weight gain as a side effect. Some common TCAs are imipramine (Tofranil) and maprotiline (Ludiomil).

Bipolar Medication Options - Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidases are enzymes that break down serotonin, norepinephrine, and dopamine. By preventing these enzymes from doing their job, MAOIs help these neurotransmitters to remain in the synaptic gap longer, allowing for greater stimulation at recipient neurons' receptors. More serotonin, norepinephrine, and/or dopamine present in an individual's system can lead to antidepressant effects. This class of drugs is more valuable for bipolar disorder than TCAs since their use is associated with a lower risk of swinging to mania. However, MAOIs come with side effects including insomnia, sleepiness, nervousness, low blood pressure, sweating, weight gain, and sexual dysfunction. These bipolar medications are considered to be second-line therapies.

Bipolar Medication Options - Other Antidepressants

Other antidepressants may include stimulants such as caffeine, thyroid replacement or supplementation in the form of Synthroid, herbal remedies such as St. John's Wort and gingko, and homeopathic remedies customized for specific personality types. Though some of these bipolar medications are available over the counter (e.g., without prescription), this does not mean that these substances are free from side effects or are perfectly safe under all circumstances. As well, most of these remedies (with the possible exception of thyroid replacement) are unlikely to be powerful enough to have an impact on bipolar disorder symptoms. Please keep in mind that, given the dangerousness of the condition and the potential for making mood symptoms worse with improper treatment, self-treatment for bipolar disorder is strongly counter-indicated. Prescription bipolar medications should always been taken under the supervision of a licensed physician. If non-prescription (e.g., alternative) preparations are going to be taken, at the very least, they should be taken under the supervision of a naturopathic physician (e.g., an ND, rather than an MD) for best results.

As should be clear now, the list of medications used for bipolar disorder treatment is extensive and complex, as is the set of medication combinations that are used at different stages of bipolar illness. The addition of individual differences in toleration of different bipolar medications makes the picture still more complex. No doubt, as research illuminates more about the causes and mechanisms underlying the bipolar disorders, and as clinical trials reveal more about how efficiently treatments work in various populations, the list of bipolar medications and medication combinations will grow.