Dr. Saurabh Kumar
MBBS, M.D. (Psychiatry) 15 years experience overall Psychiatrist , Neuropsychiatrist , Sexologist
Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick
Published In: the Indian Journal of Psychological Medicine
About the Indian Journal of Psychological Medicine: The Indian Journal of Psychological Medicine is a reputable, peer-reviewed publication that serves as a platform for cutting-edge research, clinical case studies, and reviews in psychiatry and psychological medicine. The journal is known for its contributions to both academic and clinical advancements in mental health, particularly within the Indian context. It is a valuable resource for mental health professionals seeking to stay updated on the latest therapeutic interventions and mental health care approaches.
Abstract
This article, co-authored by Dr. Saurabh Kumar and his colleagues, examines the use of chlorpromazine (CPZ), a first-generation antipsychotic, in managing treatment-resistant mania in bipolar disorder (BD) that has not responded to both standard pharmacological interventions and electroconvulsive therapy (ECT). Published in the Indian Journal of Psychological Medicine, the article presents a compelling case study that underscores CPZ's efficacy as both an anti-manic agent and a long-term mood stabilizer in a patient with severe, refractory mania.
Key Findings of the Research:
- Chlorpromazine’s Role in Refractory Mania: The article describes the case of a 22-year-old male with a diagnosis of bipolar disorder, who presented with a third episode of mania that proved resistant to multiple therapeutic agents, including olanzapine, haloperidol, and ECT. Upon the introduction of chlorpromazine, the patient experienced a significant reduction in manic symptoms. This highlights chlorpromazine’s potential utility as an anti-manic agent in cases where conventional treatments fail.
- Sustained Efficacy of CPZ: The study further documents that, beyond acute symptom control, chlorpromazine also acted as an effective mood stabilizer during long-term maintenance therapy. The patient maintained remission for eight months, but upon tapering off CPZ, he relapsed. Reinstitution of the drug led to another sustained period of remission, demonstrating CPZ's efficacy in long-term management of treatment-resistant bipolar disorder.
- Comparative Advantages of CPZ: While newer atypical antipsychotics have gained prominence in the treatment of bipolar disorder, the article notes that chlorpromazine’s profile—particularly its impact on serotonin and dopamine receptors—shares similarities with second-generation antipsychotics. This suggests that CPZ may be a valuable alternative for patients who do not respond to more commonly prescribed medications, especially in resource-constrained settings.
- Clinical Implications for Treatment-Resistant Cases: The findings suggest that CPZ, despite being an older medication, offers a reliable and cost-effective option for managing severe, refractory mania in patients with bipolar disorder. The case study highlights the importance of considering alternative, less frequently used medications in complex cases, particularly in situations where first- and second-line treatments have failed.
Applicability to the General Population:
The implications of this research are particularly significant for clinicians managing difficult cases of bipolar disorder in resource-limited settings. Chlorpromazine, which is listed on the World Health Organization’s essential medications list, is widely available and inexpensive, making it an accessible option for patients in low-income regions. The study supports the idea that even older medications, which may have fallen out of favor in modern psychiatry, can offer critical therapeutic value in managing complex psychiatric cases.
For the general population, particularly those affected by treatment-resistant bipolar disorder, this study offers a message of hope—demonstrating that there are still viable treatment options, even in cases where multiple therapies have failed. The findings also encourage a broader discussion about the individualized nature of psychiatric care, where clinicians must weigh the benefits of both newer and older treatments to achieve the best possible outcomes for their patients.
In conclusion, "Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania" adds an important dimension to the understanding of chlorpromazine’s therapeutic potential. By revisiting this “old horse” in the context of modern psychiatry, Dr. Saurabh Kumar and his colleagues provide valuable insights into its role as both an acute treatment and a long-term stabilizer in refractory cases of bipolar disorder. This case study highlights the importance of maintaining an open, flexible approach in psychiatric treatment, particularly when managing challenging and resistant cases.
Author Information: Modak, Tamonud, Saurabh Kumar, Arghya Pal, Rishab Gupta, Raman Deep Pattanayak, and Sudhir Kumar Khandelwal. "Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment-and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick." Indian Journal of Psychological Medicine 39, no. 4 (2017): 539-541.