4 - Bipolar Disorder Flashcards
Bipolar 1
more mania
Bipolar 2
more depression
Pharmacological for Mania:
If on antidepressant, what do you do?
discontinue antidepressant immediately!
Pharmacological for Mania:
What are 1st line agents?
lithium, divalproex, SGA
Pharmacological for Mania:
If they’re already on a 1st line agent (lithium, divalproex, SGA) what do you do?
dose adjustments can be made after checking blood levels where appropriate, or add on another medication
Pharmacological for Mania:
Can you start 2 of the 1st line agents at once?
yes - but only for severe cases
Pharmacological for Mania:
How long do you monitor for efficacy?
2 weeks at therapeutic dose before assessing need for change
Lithium conc for mania?
0.8-1.0 mmol/L
Lithium conc for maintenance?
0.6-0.8 mmol/L
Pharmacological for Depression:
What do you do for an unmedicated patient?
NOT AN ANTIDEPRESSANT - bc it can provoke mania
- lithium
- lamotrigine
- lurasidone
- quetiapine
- these can all be used as monotherapy
*if severe, start on 2 agents
Pharmacological for Depression:
How long do you treat for before assessing efficacy?
2-4 weeks
Pharmacological for Depression:
Which antidepressants have limited ability to provoke mania?
SSRIs and bupropion
Maintenance Therapy:
How long do you have to have no or minimum symptoms to be considered in “remission” ?
2 months
Maintenance Therapy:
gold standard?
lithium
Maintenance Therapy:
What are some talking points about lithium ?
- ppl need to maintain usual salt and caffeine intake and monitor fluid intake and output
- NSAIDs, ACEi, ARB, and diuretics increase lithium levels
- caffeine decreases lithium levels
