Preventing Relapse and Choosing Medication in Bipolar Disorder Treatment

Join Jonathan Meyer, MD, a voluntary clinical professor of psychiatry at the University of California, San Diego, as he unveils the evidence gaps and medications to avoid in bipolar disorder treatment. In this video clip from the 2023 Psych Congress NP-Institute in Boston, Massachusetts, Dr Meyer discusses anticonvulsants like gabapentin and topiramate, deemed ineffective, as well as effective mood stabilizers, shedding light on lithium, divalproex, and carbamazepine for bipolar 1 patients. Watch this video to gain valuable advice on patient communication and shared decision-making, empowering clinicians to navigate the complex world of mood stabilizers effectively.

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Read the Transcript: 

Psych Congress Network: In what instances does the evidence lack or not support the use of certain medications in treating patients with bipolar spectrum disorders and what medications should be avoided?

Jonathan Meyer, MD: I think over the years we've come and realize that certain anticonvulsants, which have been studied for bipolar disorder are simply ineffective, and that would be gabapentin and topiramate in particular. Oxcarbazepine has some data for anti-manic properties, but very weak data for maintenance and no data for suicide protection, so for any individual with a history of mania, it's probably medication best avoided.

For those who are bipolar 1 in particular, our only effective mood stabilizers are agents such as lithium divalproex, if appropriate, or carbamazepine. For maintenance, there's a drug called lamotrigine whose niche is mitigation of future depressive episodes, and that also can be useful in some patients.

PCN: What advice do you have for clinicians talking to their patients about mood stabilizers such as shared decision-making, informing, communicating, and educating?

Dr Meyer: A big part of working with bipolar spectrum patients is talking about the fact that relapse risks are much higher when there's a prior history of mania if they don't take a mood stabilizer. Now unfortunately, drugs like lithium require ongoing blood monitoring. Many patients are reluctant to do that, but they have to be at least educated about the risks of making that decision. It's not my preference that they end up on second-generation monotherapy, but if that's what they choose, they have to understand.

A big part of educating people is finding out what matters to them. Some patients are reluctant to take medicines which may control their mood. Some people don't like certain types of side effects. Some people may have misperceptions about medications from what they've read on the internet. All one can do is communicate, try to understand their perspective and try to come to the best solution for that person at the particular stage in their illness.

Jonathan Meyer, MD, is a voluntary clinical professor of psychiatry at University of California, San Diego, and a distinguished life fellow of the American Psychiatric Association. Dr Meyer is a graduate of Stanford University and Harvard Medical School, finished his adult psychiatry residency at LA County-USC Medical Center and completed fellowships there in Consultation/Liaison Psychiatry and Psychopharmacology Research. Dr Meyer has teaching duties at UC San Diego and the Balboa Naval Medical Center in San Diego, and is a consultant to the first episode psychosis program at Balboa NMC.