Bipolar - 3 Flashcards
Line 0 - A patient comes in with Bipolar Depression
Offer evidence based psychological intervention -specific for bipolar
or
Offer a high intensity psychological intervention in line with Nice recommendations for depression
What are hi intensity psychological options for depression (NICE)
CBT
Interpersonal therapy
Behavioural couple therapy
Line 1- patients come in with moderate to severe Bipolar depression who is not on any bipolar treatments
Offer olan + fluoxentine
or
Quetiapine
What if patients did not want fluoxetine in Line 1
Offer Olan alone or Lamotrigine alone
What if patient in line 1 did not respond to olan+ fluoxetine or quetiapine?
Offer Lamotrigine alone
Line 2
what if patients with bipolar epression already are on lithium
-Check lithium level to optimize
-if necessary add combined olan +fluoxetine (fluox is optional for patient)
or
add quetiapin
What if patient in line 2 did not respond to que and olan addition
Add lamotrigine
Line 3
what if a patiet comes in with bipolar depression on valproate
_ increase dose to max
if no response
_add fluoxetine + olan (fluox optional) or quetiapine
What if patients in line 3 still did not improve
Add lamotrigine to valproate
Is lamotrigine level routinely checked
No
Target dose for lamotrigine
200 mg
(some might need 400 mg)
Mechanism of action Lamotrigine
Blocks calcium channel ==> inhibition of excitatory
Starting dose for lamotrigine
25 mg
start low and go slow
Titration for lamotrigine
In-patients —-25 mg / day until reach 100 mg then 50 mg /day
outpaitients —25 mg/2 weeks
Line 0 For long term biplar depression
Offer psychological interventions which prevent relapse
(indiviual, damily or group)
