Medication for Mixed States of Bipolar Disorder

Some patients with bipolar disorder may experience a condition called mixed states, where symptoms of clinical depression and mania occur at the same time. In psychiatric terms, the presentation of mixed states is called a mixed affective episode. As an example, a bipolar patient feeling very sad and depressed, but extremely energetic simultaneously, would be experiencing a mixed state episode.

Danger of Antidepressants

• Antidepressants used alone by bipolar patients may bring on a mixed state episode. Most physicians coprescribe a mood stabilizer, such as lithium or an anticonvulsant, to minimize the risk of mixed states.

Depakote

• In persons experiencing mixed states as part of their bipolar condition, the anticonvulsant Depakote is commonly prescribed.

Atypical Antipsychotics, Off-label Use

• Zyprexa, Seroquel and Clozaril have been shown effective in off-label studies to minimize mixed affective episodes. However, as of May 2009, the U.S. Food and Drug Administration (FDA) had not yet approved these drugs for the treatment of mixed states in bipolar patients.

Atypical Antipsychotics Approved by the FDA

• The atypical antipsychotic drugs Abilify and Geodon have been approved by the FDA for the treatment of bipolar patients experiencing mixed states.

Nonpharmaceutical Treatment

• In severe and debilitating cases of bipolar mixed states, electroconvulsive therapy (ECT) may prove therapeutic and may stabilize a patient not responding adequately to drug therapy. ECT may also be used when the use of drugs is too risky, such as in the case of pregnant women.