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Flashcards in Mood Stabilizers - BP Treatment Deck (16)
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3.3 General Treatment Modalities

Psychotherapies: Cognitive behavioral therapy
Pharmacotherapies: Mood stabilizers, antidepressants, antipsychotics
Somatic therapies: ECT


3 Treatments of Mania

Mood stabilizers like lithium


Lithium Use

Significant reduction in mortality and suicides


Lithium 3 Side Effects and 2 Major Points

Renal problems: polyuria out the ass
Teratogenic effects of tricuspid valve malformations
Heavily dose dependent so you need to find right dose: very narrow therapeutic window
Do pretreatment workup


4 Lithium Mech

Acts through GPCRs
Inhibits inositol 1 phosphatase, affecting inositol triphosphate and decreases firing rate
May alter circadian pacemaker at SCN correcting desynchronization
Augments 5HT function, anti depressive


Lithium Timetable

Antimanic: 5 days
Antidepressive: 6-8wks


Valproate (what it is and mech)

Anticonvulsant effective for rapid cycling and mixed states, not as effective for BPD
May facilitate GABA release and inhibit its degradation


Valproate Side Effects

hepatic failure, teratogenic NTDs


Carbamezapine (uses and mech)

Used to treat seizures before, now approved for mania, rapid cycling, and mixed states. Inactivates Na channels to decrease excitability


Carbamezapine Side Effects (2)

Leukopenia so need to monitor CBCs. Dermatologic rashes like Stevens Johnsons


Stevens Johnsons Syndrome

rash that progresses to sloughing, usually from multiple anti convulsants together


Lamotrigine (Lamictal)

Anticonvulsant used to treat pretty much everything for bipolar, but have to titrate it slowly w/ gradually increasing dose so NOT for acute mania phases. Good at putting off next episodes and has fairly benign side effects and good stability


2nd Gen Antipsychotics

Things like Risperidone and Olanzapine, all have anti-manic activity w/ less PD side effects, but have metabolic syndrome which really increase appetite and weight


General Treatment of Depression in BPD

Mood stabilizers like Li and lamotrigine help, so combo treatment w/ one of these and antidepressant probably pharmacotherapy choice


Switch Risk

Appears lowest w/ Wellbutrin and then Paxil, then other shit. Highest w/ TCAs


6 Steps of Treatment of Depressive Episode w/ BPD

1. Li or lamotrigine
2. That + antidepressant (wellbutrin, paxil for lowest switch risk)
3. Suicidal, may try ECT
4. Add cognitive behavioral therapy
5. Still no response, try bupropion or paroxetine
6. Alternatives include newer antidepressants like SSRIs