Drugs can cause manic episodes
Medicines are just one building block
However, drugs are only one component among several in the therapy of bipolar disorder. Psychotherapy is at least as important. From the point of view of the patient who is to take the preparations over the long term, pharmacotherapy focuses not only on effectiveness but also on the expected side effects. "Every time someone new comes to the self-help group, that's an issue again," says Wegener. Almost everyone suffers from one side effect: Almost everyone in the group has "the typical drug bulb belly".
Wegener criticized the fact that studies with psychotropic drugs are often too short to allow statements about the advantages and disadvantages of the substances in long-term use. Even methodologically well-executed studies are therefore often not relevant for the patients. Professor Dr. Georg Juckel, Medical Director of the Clinic for Psychiatry, Psychotherapy and Preventive Medicine at the Ruhr University Bochum. “Many studies in psychiatry deliver highly significant results because they do not exceed a period of four to five weeks and test against placebo. Under these conditions, however, it is relatively easy for a drug to prove its effectiveness, ”says the psychiatrist.
Pronounced placebo effect
In addition, there is a pronounced placebo effect in the therapy of acute mania. Overall, monotherapy with a psychotropic drug leads to an at least 50 percent improvement in manic symptoms on average in 56 percent of cases. Placebo therapy is just as successful in 30 percent of the cases. "The effect of psychotropic drugs in acute mania is therefore only moderate," says Juckel. By combining an atypical neuroleptic with a mood stabilizer, it can be increased by 10 to 20 percent. This additional effect is often bought through more side effects.
In the case of atypical drugs such as aripiprazole, olanzapine, risperidone and others, the main undesirable effect is weight gain, in addition to which there may be a prolongation of the QT time, an increase in prolactin or motor restlessness (akathisia). With the classic neuroleptics, for example haloperidol, especially extrapyramidal motor disorders are feared. »Bipolar patients are particularly sensitive to this side effect. Tardive dyskinesias are up to three times as common in them as in patients with schizophrenia, ”Juckel informed. This fact was not known for a long time, but now actually prohibits the use of drugs such as haloperidol in this patient group.
Patients take responsibility
Mood stabilizers such as lithium and valproate also have the very stressful side effect of weight gain for the patient. Valproate can also cause masculinization with hair loss and oligomenorrhea in female patients. "Effect and possible side effects must therefore be weighed against each other in each individual case," emphasized Juckel. In consultation with the practitioner, those affected should also be given the opportunity to adapt their therapy individually. Since patients often have no insight into the disease, especially in manic phases, written agreements on the administration of emergency medication are an important tool. /
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