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Bipolar Disorder

 

  1. It mental condition marked by alternating periods of elation (mania) and depression.
  2. Bipolar disorder, once known as manic-depressive illness, was conceived of as a psychotic disorder distinct from schizophrenia at the end of the 19th century. Before that both of these disorders were considered part of a continuum. 

Mood Stabilizing Drugs:

  1. Lithium
    1. Monovalent Ion                    
    2. Discovered by James Cade’ 1949
    3. Obtained from soil              
    4. Measured by flame photometer  

MAO

  1. Inhibits Phospho-Inositol Phosphate-2 recycling
  2. Stabilizes neurotransmission
  3. Inhibits neurotransmitters uptake
  4. Probably responsible for antidepressant action

P/K

  1. Well absorbed orally; food increases absorption    
  2. 90% protein bound
  3. Not metabolized                                   
  4. Eliminated unchanged          
  5. Vd=0.5L
  1. t1/2=20 hours
  2. Takes 5 days to achieve steady state
  3. Haloperidol/diazepam are given in beginning

Uses

  • DOC:
  1. Acute mania
  2. Prophylaxis of bipolar disoder (Bipolar-II)
  3. Used in cyclical neutropenia/cancer chemotherapy induced neutropenia

Side effects

  1. Gastrointestinal upset              
  2. Tremors (Coarse-overdose, fine-therapeutic dose)
  3. Weight gain                     
  4. Neutrophilia     
  5. Slurring of speech/dysarthria
  6. Folliculitis                 
  7. Hypothyroidism
    1. More common in obese
    2. Rapid cycling more common
    3. Use valproate/carbamazepine in these patients
    4. Thyroid hormone supplements may be needed
  8. Hyperthyroidism
    1. Antithryoid drugs may be needed
  9. Nephrogenic diabetes insipidous-Rx-thiazides/amiloride
  10. ST & T wave abnormality
  11. Ebstein’s anomaly if given in pregnancy
  12. Hyperkalemia

Monitoring:

  1. 0.6-0.8 meq/liter      (Prophylactic)
  2. 0.8-1.2 meq/liter      (Therapeutic)
  3. >1.2 meq/liter (Toxic)
  4. >1.5 meq/liter (Established toxicity)
  5. >2.5 meq/liter (Haemodialysis)

Drug interactions

  • Plasma levels increased by (TAN):
  1. Thiazides            
  2. Tetracyclins         
  3. ACE inhibitors              
  4. NSAIDS

C/I

  • Sick Sinus syndrome

Other drugs for Bipolar disorders

  1. For Mania
    1. Sodium valproate, Topiramate
    2. BDZ”s
    3. Atypical antipsychotic
  2. For Depression
    1. Lamotrigine, Carbamazepine
    2. Atypical antipsychotic

Newer Drugs

Duloxetine (SNRI/SSRI)

Major depressive disorder (MDD)

Aripiprazole (D1 partial agonist)

Schizophrenia (also has anti-anxiety properties)

Escitalopram (SSRI)

Major depressive disorder

Atomoxetine (SNRI)

Attention deficit hyperkinetic disorder

Ziprasidone (D1 & 5- HT2A partial agonist)

Acute exacerbations of schizophrenia

Atomoxetine (Reuptake inhibitor)

ADHD

Asenapine (D4/5-HT2 blocker)

Schizophrenia

Iloperidone ((D4/5-HT2 blocker)

Schizophrenia

Palliperidone (D4/5-HT 2 blocker)

Schizophrenia

Lurasidone (5HT2 antagonist)

Schizophrenia

 





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