Anti-manic Drugs

Question 1

Bipolar Syndrome

Answer 1

Episodes of Mania and Depression
Manic episodes are characterized by euphoria, hyperactivity, and talkativeness
Overactive NE/5-HT pathways
Intervention when mood swings are severe, disrupt life of the patient and/or family
4 % population prevalence

Question 2

Lithium salts (Lithium Carbonate, Lithium Citrate)

Answer 2

Widely recommended treatment for Bipolar Disorder
60-80% success in reducing acute manic and hypomanic states
Used as adjunct to other antidepressants to treat resistant cases of depression
However… issues in non-compliance to take medication, side effects, and relapse rate with its use are being examined in terms of being the best option

Since its discovery, Lithium has been found to be superior to placebo
In recent years though, efficacy is being questioned:
-Long term results not as good as expected
-28% discontinue use, 38% experience
relapse on the drug
*Even so, it is widely prescribed, demonstrates considerable efficacy, and reduction in mortality risks

Question 3

Pharmacokinetics

Answer 3

Peak blood levels reached in 3 hrs, fully absorbed in 8 hrs
Absorbed rapidly and completely orally
Efficacy correlates with blood levels
Crosses blood-brain barrier slowly and incompletely
Usually taken as a single daily dose

Question 4

Importance of anti-manic drugs

Answer 4

Because of its resemblance to table salt, when Na+ intake is lowered or loss of excessive amounts of fluid occurs, blood levels may rise and create intoxication

Question 5

Pharmacodynamics

Answer 5

No psychotropic effect on non-Bipolars
Affects nerve membranes, multiple receptor systems and intracellular 2nd messenger impulse transduction systems.
Interacts with serotonin
Potential to regulate CNS gene expression, stabilizing neurons with associated multiple gene expression change

Question 6

Side Effects and Toxicity

Answer 6

Relate to plasma concentration levels, so constant monitoring is key
Higher concentrations ( 1.0 mEq/L and up produce bothersome effects, higher than 2 mEq/L can be serious or fatal
Symptoms can be neurological, gastrointestinal, enlarged thyroid, rash, weight gain, memory difficulty, kidney dysfunction, cardiovascular
Not advised to take during pregnancy, affects fetal heart development

Question 7

Combination Therapy

Answer 7

Combination therapy with Lithium and anti-epileptics may demonstrate better protection against relapse, greater therapeutic efficacy, and studies support this as a rule vs. an exception
Antiepileptics used include VPA, carbamazepine, lamotrigine

Question 8

Considerations in Rehabilitation

Answer 8

Positive
Beneficial in terms of improving patient’s outlook
More optimistic about the future and show interest in rehab process
Enhanced participation during rehabilitation
Therapist may be the first person to notice a change in posture, balance, or involuntary movements
Patients are more relaxed after taking an antianxiety drug

-Negative
Side effects – sedation, lethargy, and muscle weakness (problem when patient’s active participation is required
It takes time for drugs to work (1 month or more) – watch for signs that a patient is becoming more depressed and possibly suicidal esp. in early weeks of therapy
Watch for orthostatic hypotension esp. during first few days of initiation of antipsychotics as well as for extrapyramidal motor effects => bring to attention of medical staff