What are the treatment options for mood disorders?

From the Guidelines

Treatment for mood disorders, particularly bipolar disorder, should primarily involve traditional mood stabilizers such as lithium or valproate, and/or atypical antipsychotic medications, as these are the most effective options based on current evidence. When considering treatment options, it's essential to note that the term "mood stabilizer" may be misleading, as most agents have only demonstrated efficacy for treating acute manic symptoms in adults, making "antimanic" a more accurate description 1.

For bipolar disorder, the primary treatment approach includes:

• Traditional mood stabilizers like lithium (dosage and blood levels should be carefully managed) or valproate
• Atypical antipsychotic medications for acute mania or bipolar depression
• Adjunctive therapy with other psychotropic agents or psychotherapies to address comorbid conditions or problems

It's crucial to recognize that no single agent is approved by the FDA for treating all phases of bipolar disorder, including acute mania, acute depression, and maintenance treatment to prevent new mood episodes 1. Therefore, treatment plans must be tailored to the individual's specific needs and phases of the disorder.

Lifestyle changes, such as maintaining regular sleep patterns, engaging in exercise, practicing stress management techniques, and avoiding alcohol and recreational drugs, are also vital components of managing mood disorders. While the provided evidence primarily focuses on pharmacological interventions, incorporating these lifestyle modifications can significantly impact the overall quality of life and treatment outcomes for individuals with mood disorders.

From the FDA Drug Label

Case reports and epidemiological studies (case-control and cohort design) have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Anxiety and Insomnia — In US placebo–controlled clinical trials for major depressive disorder, 12% to 16% of patients treated with Prozac and 7% to 9% of patients treated with placebo reported anxiety, nervousness, or insomnia. Activation of Mania/Hypomania — In US placebo–controlled clinical trials for major depressive disorder, mania/hypomania was reported in 0.1% of patients treated with Prozac and 0. 1% of patients treated with placebo.

Mood Disorder Treatment with Fluoxetine:

• Fluoxetine may be used to treat mood disorders, including major depressive disorder.
• The medication has been associated with various side effects, including anxiety, insomnia, and activation of mania/hypomania.
• Patients with a history of seizures should be introduced to fluoxetine with care, as the medication may affect seizure risk.
• Caution is advised when using fluoxetine in patients with concomitant illnesses, such as recent myocardial infarction or unstable heart disease.
• Fluoxetine has not been extensively evaluated in patients with these conditions, and its use should be carefully considered on a case-by-case basis 2, 2.
• Key considerations for treatment include:
  • Monitoring for side effects, such as anxiety and insomnia
  • Careful introduction in patients with a history of seizures
  • Caution in patients with concomitant illnesses
  • Regular evaluation of treatment efficacy and safety 2, 2.

From the Research

Mood Disorder Treatment Options

• The treatment of depressive episodes in bipolar disorder remains a challenge for clinicians, and fluoxetine monotherapy has been shown to be efficacious in bipolar depression with a low percentage of mood switch 3.
• Selective serotonin-reuptake inhibitors (SSRIs), including fluoxetine, are an important advance in the pharmacotherapy of mood and other disorders, and are the treatment of choice for many indications, including major depression, dysthymia, and panic disorder 4.
• First-line pharmacotherapies for depression include SSRIs, serotonin and norepinephrine reuptake inhibitors, and norepinephrine-dopamine reuptake inhibitors, and while these medications offer superior tolerability and safety, there remains no universally effective pharmacologic treatment for major depressive disorder (MDD) 5.

Efficacy of Selective Serotonin Reuptake Inhibitors

• SSRIs have been shown to be effective in preventing relapse of major depressive disorder, and continuing SSRIs for 1 year reduces the risk of MDD and relapse 6.
• Escitalopram has been found to be more effective than other SSRIs in terms of response rate, remission rate, and withdrawal rate, and may be a better choice for the treatment of MDD 6, 7.
• A systematic review of systematic reviews found that escitalopram was more effective than other defined SSRIs in terms of response rate, remission rate, and withdrawal rate, and provides a clearer picture for assessing the efficacy of SSRIs 7.

Safety and Tolerability

• SSRIs have a good side-effect profile, tolerability, and safety in overdose, as well as patient compliance, making them a popular choice for the treatment of mood disorders 4.
• Common side effects of SSRIs include gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 4.