Bipolar Disorder

Bipolar Disorder

1. Characteristics

   • Depression looks like typical major depression
   • 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

2. 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)
   • Aripiprazole (Abilify), asenapine (Saphris), olanzapine (Zyprexia), qurtiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon)
     • Atypical antipsychotics that treat extreme mania and bipolar disorder.
       • Black box warning: don't use for patients w/dementia-related psychosis