Bipolar Flashcards
What is Bipolar Disorder?
Bipolar 1: Mania + bouts of intense depression. May be psychotic/delusional and may require hospitalization.
Bipolar 2: Hypomania + bouts of major depressive disorder - functioning patients and does not affect social/work life.
What is Mania?
Symptoms:
- Inflated self-esteem
- Sleeping less
- Talkative
- Jumping from one topic to the next
- Increase in goal-oriented activity
- Easily distracted
What is the goal of treatment?
To stabilize mood without inducing mania or depression.
What are the medications to treat Bipolar?
1) Lithium
2) Valproate
3) Lamotrigine
4) Carbamazepine
5) Antipsychotics (SGA preferred since they are able to stabilize the mood without inducing depression)
Antidepressants can induce a manic episode and are not generally recommended unless the patient is on a mood stabilizer.
Acute Treatment of Mania Symptoms
1) Valproate
2) Lithium
+ an antipsychotic
Acute treatment of Bipolar Depression
1) Lithium
2) Lamotrigine
3) sometimes Carbamazepine
*Lurasidone and Olanzapine/Fluoxetine (Symbyax) are approved for bipolar depression.
-The most serious issue with lamotrigine (Lamictal) is rash formation
Pregnancy and Bipolar Disorder
NO Valproate use in Pregnancy
NO Carbamazepine use in Pregnancy
NO Lithium use in Pregnancy
Can use Lamotrigine and SG-Antipsychotics
What are the SG-Antipsychotics used in Bipolar Depression?
1) Aripiprazole (Abilify)
2) Olanzapine/Fluoxetine (Symbyax)
3) Olanzapine (Zyprexa)
4) Quetiapine (Seroquel)
5) Risperidone (Risperdal)
6) Ziprasidone (Geodon)
7) Asenapine (Saphris)
8) Lurasidone (Latuda)
9) Cariprazine (Vraylar)
-These can be used with/without Lithium or Valproate.
Brand-name for Lithium
Lithobid ( XR is twice daily dosing)
Dosing of Lithium
Start at 150-900 mg/day (TID divided)
MAX 900-1800 mg/day divided TID or QID
ER is BID
Therapeutic Range of Lithium
0.6-1.2 mEq/L (trough)
Common Side Effects of Lithium
- GI Upset
- Cognitive effects (slowed thinking)
- Cogwheel rigidity
- Weight gain
- Polyuria/polydipsia
- Hypothyroidism
Toxicity of Lithium
> 1.5 (hand tremor, vomiting, persistent diarrhea, confusion, ataxia)
2.5 (CNS depression, arrhythmias, seizures, irreversible brain damage, coma)
Monitoring of Lithium
1) Serum lithium levels
2) Renal function (100% renally excreted)
3) Thyroid function
4) Calcium
5) ECG
6) Electrolytes
Relationship between Lithium and Salt
Our kidneys have a hard time distinguishing between Na and Li. As such, when we eat a high salt food and our body is trying to get rid of the excess salt, it can also get rid of the Lithium, and the person can become manic.
