Treatment of depression with normotimics in the context of bipolar disorder
The drugs of choice in the treatment of depression are normotimics . This group of pharmacological drugs consists of:
· Lamotrigine ;
· Sodium valproate ;
· Lithium carbonate;
· Carbamezepine .
These drugs have an antidepressant effect, but they are inferior in effect to antidepressants. Normotimics prevent phase inversion caused by antidepressants.
The normotimics should be applied continuously from the beginning of the diagnosis throughout the life.
Lithium salts have long been used in the treatment of depression in bipolar disorder. 50 years of use have proven their effectiveness. This drug should be given first in the treatment of bipolar disorder.
The antidepressant activity of lithium is low, but it has antimanic and anti – suicidal effects. The antidepressant effect of the drug depends on its concentration in the blood. A monotherapy with lithium has proved its effectiveness. The disadvantages of lithium are the slow development of the antidepressant effect.
When prescribing a drug, it is necessary to determine the concentration of the drug in the blood, since it has a large number of side effects. The therapeutic window for the drug is 0.6-0.8 mmol / L.
The study of valproate in the treatment of bipolar depression has just begun. There is conflicting evidence on its effectiveness. But data from GS Malhi, see co-authors, proved its antidepressant properties and fewer side effects.
Carbamazepine is also not well understood, but the effect was observed in patients with recurrent and bipolar depression in 56% and 44% of cases. The antidepressant effect of carbamazepine is lower than that of valproate and lithium, but the anti – manic properties are stronger. Additional study of carbamazepine and valproate is needed using placebo-controlled studies in a large sample of patients.
Lamotrigine ( Lamictal ) also has an antidepressant effect, as proven by Calabrese JR et al. The effect of lamotrigine is dose dependent. It does not induce phase inversion and can be used as monotherapy . The drug is well tolerated by patients, which distinguishes it from other normotimics . The only serious side effect of lamotrigine is a rash.
Thus, normotimics can be used in the treatment of bipolar depression in patients with no suicidal tendencies.
In other cases, treatment of depression in the context of bipolar disorder should be carried out with a combination of normotimics and antidepressants.