Zyprexa Offers Hope in the Treatment of Manic Depression
For the almost 3 million people in the United States diagnosed with manic depression, the announcement earlier this year that the federal Food and Drug Administration had approved a new drug to treat their illness brought cautious optimism. Health spoke to Dr. Stephen G. Hayes, president-elect of the Southern California Psychiatric Society, the local branch of the American Psychiatric Assn.
Hayes is an expert on psychopharmacology and a clinical professor in the department of psychiatry at USC’s medical school. He also works at the Child and Adolescent Program at Metropolitan State Hospital in Norwalk and has a private practice in Pasadena.
Question: Could you start by defining manic depression for us?
Answer: Manic depression, or bipolar disorder, is widely known to run in families. It’s a lifelong mental illness characterized by extreme mood swings--from severe depression to euphoria and agitation known as mania. Patients also manifest irritability with rapid speech and overactive behavior. That alternates with periods of very slow thoughts, terribly depressed moods, oversleeping and excessive self-deprecation. There may be other periods in which the person appears absolutely normal. We’re not sure exactly what the biochemistry of the disease is, and there may be multiple paths to it, which is why individuals respond differently to different medications, even though the symptoms may be similar.
Q: Which brings us to Zyprexa. But it’s not actually a new drug, is it?
A: That’s right. It was approved about four years ago to treat schizophrenia. At the time, we didn’t know that it would work for manic depression too. What’s interesting is that here’s a drug that was originally marketed to treat schizophrenia, but now we’ve found that it’s effective in people who are in depressed or manic states. It has a broad therapeutic spectrum.
Q: How is Zyprexa different from the older drugs used to treat manic depression, such as lithium and Thorazine?
A: Zyprexa is one of a new group of medications called atypical antipsychotics that were first found to be helpful with schizophrenia. But Zyprexa also works as an antidepressant and will bring people out of mania. We used Thorazine for management of mania, but it was never known to have long-term mood or stabilizing effects.
Q: Does Zyprexa have fewer side effects? Is that why it’s being touted as such a breakthrough?
A: Not fewer. Just different. It’s a very serious drug. The major side effects have been sedation--people feel sleepy--and weight gain. Some patients don’t have much trouble with it, but others have gained a lot of weight.
Q: How do these side effects compare with those of other drugs used to treat manic depression, many of which are prescribed by doctors even though they’re not specifically approved by the FDA to treat that particular condition?
A: You can have weight gain with some of the old drugs. Thorazine and Clozapine frequently cause weight gain. Clozapine can knock out your white blood cells and has occasionally caused fatal reactions. Lithium and Tegretol, other drugs used to treat bipolar illness, have side effects too. With all these treatments, you have to look at the risk/benefit ratio.
Q: So it’s no magic bullet?
A: Psychopharmacology is a very complex area. It’s not a good idea to go to a doctor and ask for any specific drug. You may or may not find effective treatment in the first drug or the first six drugs if you have a mood disorder.
Q: But people shouldn’t give up?
A: There are all kinds of options and treatments, and Zyprexa just adds something new. Bipolar disorder is still chronically under-diagnosed and undertreated everywhere in the world, even the United States. Ninety-nine percent of schizophrenics get treated in Finland, for instance; in the United States, it’s a little over one-third. But with the diminishment of the stigma surrounding mental health, we are making progress.
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The Southern California Psychiatric Society can be reached at (310) 815-3650 or https://www.socal psych.org. The American Psychiatric Assn. can be reached at (202) 682-6000 or https://www.psych.org.
