Lecture 10 - Bipolar Disorder Flashcards
Drugs used for bipolar disorder?
- lithium
- valproate
- lamotrigine
- atypical antipsychotics
- carbamazepine
List the 3 parts to bipolar disorder
- mania
- hypomania
- depression
Define mania
- distinct period of dramatically elevated, irritable mood lasting 1 week or more and impairing social functioning
- can include: inflated self-esteem, reduced need to sleep, verbosity, racing thoughts, distractibility, risky behaviour
Define hypomania
- briefer duration of manic symptoms
- less severe
- no positive psychotic symptoms
Bipolar is divided into:
Bipolar 1
Bipolar 2
Describe them
Bipolar 1:
- episodes of sustained mania, usually with intervening depressive episodes
- more mania
Bipolar 2:
- major depressive episodes with at least 1 manic episode
- more depression
___% of adults affected by bipolar in north america
1-3
Bipolar 1:
more common in males or females?
equal
Bipolar 1:
average onset
at 21
Bipolar 2:
more common in males or females?
females
Non-pharm treatments for bipolar disorder
adjust sleep, nutrition, exercise, stress, caffeine
Pharmacological treatment for bipolar disorder
Mood stabilizers
-lithium, valproate, lomtrigine, carbamazepine
Atypical antipsychotics
Adjunct therapy with benzodiazepines
What drugs are used to control manic episodes?
lithium carbamazepine valproate antipsychotics benzodiazepines
How effective is lithium for a manic phase?
60-80%
How effective is lithium for maintenance?
60%
Patients with mania possessing psychotic features often receive adjunct ??
SGA (olanzapine)
How much does lithium reduce suicide?
8-10 fold
Does lithium have a fast or slow onset of therapeutic effects?
slow onset
What is the major working hypothesis for the mechanism of action for lithium?
Li+ affects the IP3/DAG second messenger system by blocking inositol recycling
Early adverse effects of lithium
- GI: nausea, vomitting, diarrhea
- muscle weakness/ lethargy
- polydypsia with polyuria/nocturia (excessive urination or urination at night)
- headache, confusion, tremor
- nephrogenic diabetes insipidus (fluid loss due to abnormal kidney fcn)
Long-term adverse effects of lithium
- renal morphology changes
- hypothyroidism and/or goiter
- weight gain > 10 kg
- reduced libido/sexual dysfunction
- edema
- severe acne
- cardiovascular
List 3 other adverse effects of lithium
1 - low therapeutic index
2 - problematic in renal inusfficiency
3 - drug interactions
Describe the drug interactions with Li+
1 - thiazide diuretics, NSAIDS, ACE inhibitors = increase Li
2 - K+-sparing diuretics = reduce Li
3 - loop diuretics, Ca channel blockers = may increase or decrease Li
Carbamazepine is good for?
manic
depression
maintenece
*good for all 3 categories
Carbamazepine is better than Li for ??
rapid cycling between the two phases
Adverse effects of carbamazepine?
nausea vomiting diarrhea hyponatremia rash leukopenia fluid retention drowsiness dizziness lethargy headache
Valproate is approved for?
anti-manic effects
Valproate:
strong efficacy in Patients not responsive to ___
Li
Valproate:
better than Li for ??
rapid cycling between the two phases
Valproate:
is generally well-tolerated but with upward dose titration - can cause?
nausea weight gain diarrhea vomiting hair loss tremour
Antipsychotics are used alone or with a ??
mood stabilizer
Describe benzodiazepines
- used with mood stabilizer
- clonazepam is drug of choice
- limited by abuse potential beyond acute setting
What drugs control depressive episodes?
- lithium
- lamotrigine
- antipsychotics
- antidepressants
Lamotrigine has ____ efficacy for mania
limited
Lamotrigine has ___ control of depressive episodes
good
Lamotrigine is an alternative to lithium for ?
maintenence
Combination of antipsychotics is FDA approved for ?
bipolar depression
Should you use antidepressants in a bipolar patient?
NO
- no quantifiable advantage of mono therapy or combination therapy
- monotherapy of antidepressants may precipitate “switch” to mania
What drugs are used for maintenance therapy?
lithium lamotrigine valproate carbamazepine \+psychotherapy
Lifetime bipolar is diagnosed as ?
3 or more manic episodes or 1 moderate to severe manic episode
Drug efficacy is assessed in 3 categories: what are they?
mania
depression
maintenance
_____ is widely used and has efficacy in all 3 categories, but it is associated with therapeutic lag and considerable adverse effects
Lithium
Alternatives to lithium for manic episodes
Valproate
Carbamazepine
SGAs
benzodiazepines
Alternatives ot lithium for depressive episodes
Lamotrigine
SGAs
Alternatives to lithium for maintenance therapy
Valproate
Carbamazepine
Lamotrigine
