Mania looks like inflated
self-esteem, decreased
need for sleep, increased
talkativeness, racing
thoughts, distractability,
increased goal-directed
activities, and excessive
involvement in
dangerous but
pleasureable activity.
Must be
present for
at least 1
wk.
Hypomania is
same symptoms,
less severe.
Excess of excitatory
neurotransmitter or
deficiency of
inhibitory
neurotransmitters
Medications
Sometimes
called mood
stabilizers.
Lithium,
antiseizure drugs,
and atypical
antipsychotics.
Lithium (Eskalith)
Effective for purely
manic or purely
depressive
episodes.
Narrow therapeutic
range; monitored by
serum levels every
4-5 days, then 5 days
after every dose
change.
Must remain
within 0.6-1.5
mEq/L
Close monitoring
encourages
compliance and
helps prevent
toxicity.
Acts like sodium in
body, so when sodium
is greatly reduced,
chance of lithium
toxicity increases.
Necessary to monitor
sodium levels
Overdose treated
w/hemodialysis and
supportive care.
Baseline for renal,
electrolyte, cardiac, and
thyroid status is
indicated.
Polypharmacy is
not unusual for this
drug.
Lithium +TCA or bupropion
(atypical antidepressant):
Good for depressive
episodes.
Lithium +benzo= Good for manic
episodes.
If serious agitation, delusion, or
hallucination happens: Lithium +
antipsychotic.
Valproic acid
(Depakene/Depakote),
carbamazepine (Tegretol), and
lamotrigine (Lamictal)
Antiseizure drugs that can be
used for rapidly cycling and
mixed states of bipolar.
Gabapentin (Neurontin),
oxcarbazepine (Trileptal),
topiramate (Topamax,
and zonisamide
(Zonegran)