Bipolar Disorder

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Part of ch 16: Drugs for emotional, mood, and behavior disorders
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Olivia McRitchie
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Olivia McRitchie
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Resource summary

Bipolar Disorder
  1. Characteristics
    1. Depression looks like typical major depression
      1. 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.
        1. Must be present for at least 1 wk.
          1. Hypomania is same symptoms, less severe.
            1. Excess of excitatory neurotransmitter or deficiency of inhibitory neurotransmitters
        2. Medications
          1. Sometimes called mood stabilizers.
            1. Lithium, antiseizure drugs, and atypical antipsychotics.
              1. Lithium (Eskalith)
                1. Effective for purely manic or purely depressive episodes.
                  1. Narrow therapeutic range; monitored by serum levels every 4-5 days, then 5 days after every dose change.
                    1. Must remain within 0.6-1.5 mEq/L
                      1. Close monitoring encourages compliance and helps prevent toxicity.
                      2. Acts like sodium in body, so when sodium is greatly reduced, chance of lithium toxicity increases.
                        1. Necessary to monitor sodium levels
                          1. Overdose treated w/hemodialysis and supportive care.
                            1. Baseline for renal, electrolyte, cardiac, and thyroid status is indicated.
                              1. Polypharmacy is not unusual for this drug.
                                1. Lithium +TCA or bupropion (atypical antidepressant): Good for depressive episodes.
                                  1. Lithium +benzo= Good for manic episodes.
                                    1. If serious agitation, delusion, or hallucination happens: Lithium + antipsychotic.
                    2. Valproic acid (Depakene/Depakote), carbamazepine (Tegretol), and lamotrigine (Lamictal)
                      1. Antiseizure drugs that can be used for rapidly cycling and mixed states of bipolar.
                      2. Gabapentin (Neurontin), oxcarbazepine (Trileptal), topiramate (Topamax, and zonisamide (Zonegran)
                        1. Aripiprazole (Abilify), asenapine (Saphris), olanzapine (Zyprexia), qurtiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon)
                          1. Atypical antipsychotics that treat extreme mania and bipolar disorder.
                            1. Black box warning: don't use for patients w/dementia-related psychosis
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