The depressive episodes that accompany bipolar disorder have often perplexed both people who have bipolar disorder and the professionals who want to help treat them. People with ordinary clinical depression — at one time called unipolar depression — often have a few treatment options to choose from, usually starting with psychotherapy or antidepressants.
But using antidepressants in the treatment of depression of someone who has bipolar disorder can have unexpected — and unwanted — effects. Studies of antidepressant use in bipolar disorder have been decidedly mixed.
So it’s always welcome news when a new medication — or a new use for an existing medication — has been approved. Such is the case with Latuda (lurasidone).
Bipolar depression is a frustrating component of bipolar disorder to treat. The most recent meta-analytic study on the use of antidepressants to treat bipolar depression found little support for their use. Two previous meta-analyses came to contradictory conclusions.
The usefulness of antidepressants in bipolar depression therefore remains controversial. Current guidelines generally recommend the cautious antidepressant use in combination with mood stabilizers to reduce the risk of mood elevation or cycle acceleration.
With the arrival of atypical antipsychotic medications, people with bipolar disorder now have an additional treatment choice to help with the alleviation of depression symptoms.
Latuda (lurasidone) is one such atypical antipsychotic. It was first approved for the treatment of schizophrenia in late 2010; in the summer of 2013, its approved use was extended to help in the treatment of bipolar depression by the U.S. Food and Drug Administration. In schizophrenia, dosing usually starts at 40 mg/daily, but for bipolar depression treatment, 20 mg/daily is recommended. The dose can be increased if needed, but shouldn’t exceed 120 mg/day (160 mg/day in schizophrenia).
Like other atypical antipsychotics, it should be taken with food and it shouldn’t be used in people with liver disease, heart disease, heart problems or a history of heart attacks, or people with high cholesterol.
Latuda is well-tolerated by most people who take it. The most common side effects reported while taking Latuda are somnolence — a strong desire to sleep — (22%) and akathisia — a feeling of inner restlessness that makes it difficult for a person to be able to sit or stay still for long periods of time — (15%). Both of these are dose-related, and can often be controlled by changing the dosing.
Fasting glucose increased — higher blood sugar — (10-14%) and nausea (12%) have also been reported as common side effects. Some people complained of muscle stiffness, or muscle twitching, uncontrollable movements of your eyes, lips, tongue, face, arms, or legs, but these were less common.
Most people who take Latuda are going to start seeing improvement of their symptoms in 3 to 4 weeks. Like all psychiatric medications, Latuda may or may not work for your bipolar depression symptoms. A doctor can’t tell you if it’s going to work for you ahead of time; the only way to know is to try it.
While you are taking Latuda, you may be more sensitive to temperature extremes — so you should avoid getting too cold, or becoming overheated or dehydrated. Drink plenty of fluids, especially in hot weather and during exercise.
The biggest downside to Latuda? Well, because it’s new and still patented, it’s expensive. However, I noticed they do have a savings program that can significantly reduce your co-pay if you qualify.
It’s good to have treatment options, so in that respect, I’m glad to see Latuda is available as one more option to help in the treatment of bipolar depression.