While it is diagnostically convenient to group Major Depressive Disorder (MDD) and Bipolar Affective Disorder (BPAD) together, their variance in the recommended pharmacotherapy belies their diagnostic similarities. It is necessary to know the diagnostic features of a depressive episode to diagnose both disorders, and the treatment goal of MDD and BPAD is restoration to euthymic state. The purpose of this paper is to summarize the different medications used with each disorder to achieve that goal. Additionally, this paper will point out the side effects, signs, and symptoms therapists should be aware of during the treatment processes.
Medications Treating MDD
There is a plethora of antidepressants available to treat MDD. Antidepressants vary in the neurotransmitter influenced and the mechanism that produces the effect. For example, Monoamine Oxidase Inhibitors (MAOIs) and Selective Serotonin Reuptake Inhibitors (SSRIs) elevate serotonin levels, but as their respective names suggest do so via different processes. Selection of one of these medications is the first part of the pharmacotherapy process, and it involves understanding prior attempted treatments, family history, number of present symptoms, costs, and medication safety (Kelsey, Newport, & Nemeroff, 2006, pp. 62-63). Once a client begins an antidepressant regimen, therapists should be aware of the selected cautions and side effects. For example, SSRIs offer fewer side effects than MAOIs and Tricyclic Antidepressants (TCAs); however, the initial serotonin increase produced by these drugs may result in increased anxiety symptoms (Kelsey et al., 2006, p. 134). MAOIs operate by inhibiting MAO enzyme metabolization that necessitates dietary restrictions to avoid toxic levels of compounds metabolized by MAO enzymes. TCAs operate on a number of neuronal receptors that enable TCAs to treat a host of medical and psychological disorders. However, TCAs also produce a host of side effects including potentially fatal cardiac symptoms. Typically, MDD is treatable by using a single medication and practitioners can treat unresponsive patients by switching to a different antidepressant. BPAD, in contrast, frequently requires a combination of medications to manage manic and depressive episodes. BPAD pharmacotherapy is the focus of the next section.
Medications Treating BPAD
The number of proven antidepressants used to treat MDD far exceeds the number of effective mood stabilizers available to treat MDD. The most effective and most often used medication is lithium (Lambert, Kelly & Kinsley, & Craig, 2005). Unlike MAOIs or SSRIs that have well-defined operating mechanisms, lithium’s biological basis for alleviating symptoms of BPAD is not well-understood (Lambert et al., 2005, p. 307). It also carries with it a host of side effects due to the closeness of therapeutic and toxic levels of the drug. However, due to lithium’s protective qualities against future manic and depressive episodes it is one of the...