Bipolar Disorders and Mood Stabilizers (Filtz)

Question 1

Bipolar Disorder

Answer 1

Cycles of depression and mania | Manic phase typically lasts 1 week but many be proceeded by weeks or months of hypomanic activity

Depression phase may last much longer

*rapid cyclers are difficult to treat and stabilize

Question 2

Bipolar Disorder Patients

Answer 2

Recurrent illness affecting 1-2% of adult population

Men and women equally | onset typically 18-45 years | has genetic component | high mortality from suicide (usually at end of depressive phase)

Question 3

Mood stabilizers

Answer 3

Different treatments for unipolar depression and bipolar disorder

Lithium carbonate:
>inorganic cation, excreted in urine unmetabolized
>most effective treatment for bipolar (effective in 80% of manic attacks within 1-2 weeks; problems with toxicity)
>no effect in normal subjects
>used prophylactically to prevent mood swings and cycling into manic phase
>MOA is still poorly understood

Question 4

Adverse effects of Lithium

Answer 4

Lithium substitutes for sodium and magnesium, but is less efficient (accumulates in excitable cells and disrupts action potentials; low therapeutic index)

Adverse effects that decrease over time include nausea, vomiting, muscle weakness and fatigue

Persistent adverse effects: Forgetfulness, mental slowing, hand tremor, polydipsia and polyuria

Question 5

Toxic Effects of Li

Answer 5

Hypothydroidism

Toxicity at slightly higher doses (ataxia, slurred speech, confusion, disorientation, hypotension)

Overdose toxicity (seizure, muscle rigidity, deep tremor, cardiac arrhythmias, coma and death)

Question 6

Anti-convulsant Mood Stabilizers

Answer 6

• not as effective as lithium, not toxic, faster onset
• *problems may include weight gain, sleepiness, inability to concentrate, diaphragmatic depression

Valproic Acid, divalproex, and clonazepam

Carbamazepine, Oxcarbazepine

Topiramate (fewer problems with weight gain, may induce rare type of closed angle glaucoma)

Question 7

VPA and CBZ block __________.

Li blocks ____________ and _____________-

Answer 7

Myo-inositol transporter

IMPase and IPPase

Question 8

Other Mania treatments

Answer 8

Antipsychotics (used as mood stabilizers, dose for bipolar often much less than schizophrenia, MOA may be related to inhibition of serotonin receptors)

Benzodiazepine sedatives (rapidly effective, not a long term option)

Vitamin B12 (consider supplementation with OCD)