Chapter 36: Drugs for Bipolar Disorder

Question 1

What are the typical manifestations and clinical course of bipolar disorder (BPD)?

Answer 1

BPD is a chronic, cyclic disorder marked by recurring mood episodes—pure mania, hypomania, major depression, or mixed episodes—requiring lifelong treatment.

Question 2

What classes of drugs are used to manage bipolar disorder and how are they used?

Answer 2

Mood Stabilizers (e.g., lithium, valproate): Relieve symptoms and prevent recurrence.

Antipsychotics (e.g., olanzapine, quetiapine): Treat acute mania and aid long-term stabilization.

Antidepressants (e.g., bupropion, SSRIs): Used in depression but always with a mood stabilizer to avoid triggering mania.

Question 3

What is the typical drug strategy for managing short-term mania in BPD?

Answer 3

Use lithium and/or valproate, often combined with an atypical antipsychotic.

Question 4

What is the typical drug strategy for managing short-term depression in BPD?

Answer 4

Use a mood stabilizer alone or in combination with an antipsychotic or antidepressant. Antidepressants are never used alone

Question 5

What is the typical drug strategy for long-term prevention in BPD?

Answer 5

Use one or more mood stabilizers, sometimes combined with antipsychotics.

Question 6

Why is sodium balance important in maintaining stable lithium levels?

Answer 6

The kidneys handle lithium like sodium; low sodium causes lithium retention, raising levels and risk of toxicity. Normal sodium intake helps prevent this.

Question 7

How can diet and other drugs affect lithium levels in the body?

Answer 7

Low sodium diet increases lithium levels and toxicity risk.

Diuretics (e.g., furosemide) increase lithium levels by promoting sodium loss.

NSAIDs (e.g., sulindac) increase lithium reabsorption, raising levels.