Bipolar Medications

Question 1

What is the aim of Acute treatment in Bipolar?

Answer 1

To reduce mood in episodes of mania.
To raise mood in episodes of depression.

Question 2

What is the aim of Long term treatment in Bipolar disorder?

Answer 2

To stabilise mood and prevent recurrence of both mania and Depression (prophylaxis)

Question 3

What is the most commonly used Drug in Bipolar Prophylaxis (long term management)?

Answer 3

Lithium (normally given as lithium carbonate)

+ Valproate if primarily manic/Hypomanic.

Question 4

What is the mode of action of lithium?

Answer 4

May block phosphatidylinositol pathway (second messager system)
or
Inhibit Glycogen synthase kinase 3-beta.
or
Modulate NO signalling.

Question 5

What is the monitoring required in Lithium management?

Answer 5

12 hour post-dose blood levels monitored because of narrow therapeutic index.

Target range is 0.4-1.0mmol/l with higher end of range being associated with better response.

Question 6

What are some of the side effects associated with lithium?

Answer 6

• Dry-mouth/ strange taste
• Polydipsia
• tremor
• Hypothyroidism
• Long term reduced renal Function.
• Neprhogenic diabetes insipidus.
• Weight gain.

Question 7

What are some Toxic effects of lithium treatment?

Answer 7

• Vomiting, Diarrhoea
• Ataxia / course tremor.
• Drowsieness / Altered consciousness level.
• Convulsions
• Coma.

Question 8

What happens to the levels of lithium in dehydration?

Answer 8

They increase as Lithium and Sodium ions are indistinguishable to renal tubules. (so both will be retained)

Question 9

What Anticonvulsants can be used as mood stabilisers?

Answer 9

• Valproate
• Carbamazepine
• Lamotrigine.
  All can be used in long term as well if px cant tolerate Lithium.

Question 10

What are some side effects of valproate?

Answer 10

Teratogenicity - NEURAL TUBE DEFECTS (not safe in pregnancy or women)

Also cause -
- Drowsiness, Ataxia, Cardiovascular effects, induces liver enzymes. (Carbamazepine causes these too)

Question 11

What are some side effects of lamotrigine?

Answer 11

very small risk of Steven-johnson syndrome (SJS)

Question 12

What antipsychotics are used as mood stabilisers in Bipolar disorder?

Answer 12

Quetiapine, Aripiprazole, Olanzapine, Lurasidone.

Question 13

What is the mechanism of action of antipsychotics used in Bipolar disorder?

Answer 13

Either Dopamine antagonism or 5-HT antagonism.

Question 14

What is the acute management of Mania and similarly of depression episodes in bipolar?

Answer 14

Atypical Antipsychotic -
- Olanzapine
- Quetiapine
or Respiridone

Question 15

What medications should typically be avoided in the acute management of a depressive bipolar episode?

Answer 15

Antidepressants as they can cause rapid cycling mood.

Question 16

What is a potential complication of long term Lithium use?

Answer 16

Hyperparathyroidism causing Hypercalcaemia. (Low mood, Lower back pain, concentration difficulty, constipation and Headaches)