Bipolar Disorder

Question 1

Valproic Acid

Stavzor, Depakote

Answer 1

Bipolar Disorder
Indications
- *Bipolar disorder, seizure disorders, and migraine
• *Good choice in mania and hypomania
- *mood stabilizer
MOA
- unknown, but thought to enhance GABA and blocks Na channels
ADE
• *Transient: GI effects, sedation, dizziness, tremor, thrombocytopenia
• *Weight gain, polycystic ovary syndrome (PCOS), menstrual changes, mild alopecia
• Rare: agranulocytosis, hepatotoxicity, pancreatitis, SJS
D/I
• *Pregnancy Category D
• Quite a few P450 interactions, weak inhibitor
• May displace highly protein bound drugs

Question 2

Lamotrigine (Lamictal®)

Answer 2

Bipolar Disorder
INDICATIONS
- *Bipolar disorder and various seizure disorders
- *mood stabilizer
MOA
- unknown, but thought to be related to glutamate inhibition
ADE
• *Nausea and headache
• *Somnolence and fatigue
• Rash; SJS (rare
D/I
• *Pregnancy Category C
- *anticonvulsants

Question 3

Carbamazepine (Tegretol®)

Answer 3

Bipolar Disorder
INDICATIONS
- *Bipolar disorder, epilepsy, and trigeminal neuralgia
• Good for *mania/hypomania
- *mood stabilizer
MOA
• Affects Na channels
• May affect aspartate and glutamate
• Similar structure to TCAs 
 ADE
• *Somnolence, confusion, dizziness, blurred vision, GI effects, diplopia, SIADH
• Rare: SJS/TENS, blood dyscrasias, hepatic failure
D/I
• *Pregnancy Category D
• *Avoid with MAOIs
• *Need 2nd form of birth control

Question 4

Oxcarbazepine

Trileptal®

Answer 4

Bipolar Disorder
INDICATIONS
- Epilepsy (but NOT for bipolar)
- *mood stabilizer
MOA
• Prodrug of 10,11-epoxycarbamazepine 
ADE
• Similar to carbamazepine, but less blood cell effects and more SIADH
D/I
• Many due to 3A4 induction, but it is NOT an autoinducer
• Avoid with MAOIs
• *2nd form of birth control

Question 5

Symbyax® (olanzapine + fluoxetine)

Answer 5

Bipolar Disorder
Antipsychotics
• Indication: Bipolar depression

Question 6

Lorazepam (Ativan)

Answer 6

Bipolar Disorder
Benzodiazepines
• Acute management of agitation/mania

Question 7

Lithium

Eskalith, Lithobid

Answer 7

Bipolar Disorder
INDICATIONS
- Bipolar disorder
MOA
• *Alters Na transport
• Alters metabolism of neurotransmitters
• *May affect *2nd messenger systems like IP3 and DAG
ADE
- nausea, diarrhea, polyuria, polydipsia, weight gain, tremor, fatigue, confusion, somnolence (often dose related)
• Hypothyroidism, skin reactions, leukocytosis, cardiac abnormalities, diabetes insipid us
D/I
• Renal and electrolyte related = increased levels
o *NSAIDS, diuretics, ACE-I or ARBs