Serotonin and Noradrenaline Reuptake Inhibitors (SNRI)
SNRIs are similar to SSRIs, but also limit the reabsorption of noradrenaline in addition to that of serotonin. SNRIs became available in the 1990s, and are not as widely used as SSRIs. Common SSRIs include:
- Desvenlafaxine (Pristiq)
- Duloxetine (Cymbalta)
- Levomilnacipran (Fetzima)
- Milnacipran (Ixel, Savella)
- Tofenacin (Elamol, Tofacine)
- Venlafaxine (Effexor)
Noradrenaline Reuptake Inhibitors
NRIs work by blocking the action of the norepinephrine transporter (NET). Norepinephrine is also a neurotransmitter, like serotonin. This blockage allows for increased concentrations of norepinephrine outside of the cells.
- Reboxetine (Edronax)
- Viloxazine (Vivalan)
These are a new class of antidepressants that came in the last ten years. The drugs are the result of an accidental discovery of a synthetic melatonin and its effect on serotonergic receptors. This led to a more thorough investigation where the serotonin benefits were documented. Options include:
- Agomelatine (Valdoxan, Melitor, Thymanax)
Atypical Antipsychotic Drugs
Although these drugs are primarily used to control mania, they have demonstrated effectiveness in managing depression:
- Latuda (Lurasidone)
- Seroquel (Quetiapine)
- Abilify (Aripiprazole)
Antipsychotics are used to inhibit bipolar mania. Those diagnosed with schizophrenia also uses many of these drugs.
In the past 30 years a new class of antipsychotic medications was developed; because they were different from the original drugs, they became known as atypical antipsychotics.
Atypical antipsychotics are so named because they treat the symptoms in a manner that is not like its predecessors. The chemistry of these drugs involves neurotransmitters but is more complicated as the drug attacks specific sites of the cell, relying upon particular receptors.
Just like anti-depressants, anti-psychotics work on the brain chemistry. Also affecting the serotonin and noradrenaline, these drugs also affect the dopamine levels. If your doctor has prescribed an antipsychotic it is likely one of these medicines:
- Aripiprazole (Abilify)
- Asenapine (Saphris)
- Clozapine (Clozaril)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Lurasidone (Latuda)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Commonly prescribed typical antipsychotics are listed below:
- Chlorpromazine (Thorazine)
- Haloperidol (Haldol)
Thorazine was introduced in the 1950s, and Halodol came in the 1970s. While it is possible for your doctor to prescribe one of these medications temporarily, it is unlikely you will be on any of these drugs for the long term.
The newer atypical antipsychotic drugs represent significant advancement, leaving little need for the original antipsychotics.
Side Effects of Antipsychotic drugs
Common side effects of antipsychotic medications may include:
- Blurred vision
- Dry mouth
- Muscle spasms or tremors
- Weight gain
If these side effects escalate or if you experience different side effects, see a physician immediately.
It is important to note that several atypical antipsychotic drugs have been linked to increases in blood sugar and diabetes. When taking these medications be sure to watch your intake of carbohydrates and have your blood sugar levels checked regularly.
Finding the Right Bipolar Medication for You
As you start your journey with bipolar medication, remember that most people try many different drug combinations before they find one that is effective.
Even after an effective bipolar medication regimen is achieved, it will often need occasional, “tweaking.” Again, keep a brief journal of your mood and your side effects to assist your doctor in making the best choices for you. Don’t be afraid to do your own research to understand how the medications work.
Also, if you have a first-degree relative (e.g., parent or sibling) who has bipolar disorder and has found success with a specific drug, there is a chance that this drug will work well for you. I discovered this because my mother also has bipolar disorder and on several occasions, my doctors successfully put me on a medication that she was using.
On a final note always remember that bipolar medication represents only a part of your treatment journey. Proper nutrition, exercise, and self-care will make any medication regimen much more effective!