Bipolar disorder: a review of current U.S. Food and Drug Administration approved pharmacotherapy.

Bipolar disorder (BD) is a chronic disorder which usually has its onset in early adulthood. At one end of the spectrum is depression and at other is mania. Like many psychiatric illnesses, it is not treatable but its symptoms are completely manageable with medications. Commonly used drugs are mood stabilizers and atypical antipsychotics along with adjunctive medications such as anxiolytics and antidepressants. In general, a combination of these drugs is used for treatment. These drugs have significant adverse effects which add to the burden of the disease. Presently, there are 11 US Food and Drug Administration - approved drugs for management of acute mania, 3 for bipolar depression and 7 for bipolar maintenance. This review article details the use of these drugs in BD.

Ephedrine: direct, indirect or mixed acting sympathomimetic.

Ephedrine is the principal alkaloid that is responsible for the physiological effects of herb ephedra. This herb is found in literature of India and China since ancient times because of its effectiveness as an anti-asthmatic. Ephedrine is classified as sympathomimetic drug. Despite extensive work in this field, the mechanism of action of ephedrine remains controversial. Initial studies classified ephedrine as indirectly acting sympathomimetic, subsequent studies showed ephedrine acts by mixed action by releasing noradrenaline and by acting directly on receptors. However, few recent studies on rat have shown predominant direct action on adrenergic receptors. Hence, there is marked controversy existing whether ephedrine is directly, indirectly or mixed acting drug.