Pharmacologic Treatment of Bipolar Disorder - Lithium
Anticonvulsants
Second generation antipsychotics
Unipolar depression - major depressive disorder (MDD)
one of the most common mental disorders
-Approximately 7.1% of adults in the U.S. had episode in last year, prevalence highest (13.1%) among
individuals aged 18-25
S/S
-depressed mood
-loss of interest or pleasure in daily activities
-irritability
-withdrawal
-problems with sleep, eating, energy, concentration, or self-worth
-severe depression: may experience thoughts of suicide or psychotic symptoms.
Bipolar disorder (BD) - Chronic condition characterized by extreme fluctuations in mood, energy, and
ability to function
-Moods may be manic, hypomanic, or depressed and may include mixed mood or psychotic features
-many have only experienced only one manic episode in their lifetime
-Mood fluctuations may be separated by periods of high stability or may cycle rapidly
-diagnosed when a client has one or more episodes of mania or hypomania with a history of one or
more major depressive episodes
-high risk for suicide
mania - characterized by a persistently elevated, expansive, or irritable mood. Related symptoms may
include inflated self-esteem, increased goal-directed activity or energy, including grandiosity, decreased
,need for sleep, excessive talkativeness, racing thoughts, flight of ideas (FOI), distractibility, psychomotor
agitation, and a propensity to be involved in high-risk activities. Mania leads to significant functional
impairment and may include psychotic features or necessitate hospitalization
Bipolar Type I: - requires at least one episode of mania for at least one week (or any duration if
hospitalization due to symptoms is required)
Bipolar Type II: - diagnosis requires a current or past hypomanic episode and a current or past major
depressive episode. Symptoms last for at least 4 days but fewer than seven.
-Hypomanic symptoms are not of sufficient duration or severity to cause significant functional
impairment, psychosis, or hospitalization.
-Anger and irritability are common.
-Clients often enjoy the elevation of mood and are reluctant to report these symptoms, making bipolar
more difficult to diagnose if the client presents in the depression phase.
Cyclothymia: - involves the chronic presentation of hypomanic and depressive symptoms that do not
meet the diagnostic criteria for a major depressive or manic/hypomanic episode.
If bipolar depression is mistaken for MDD: - antidepressant therapy may precipitate a manic episode or
induce rapid-cycling bipolar depression
-may contribute to the increased incidence of death by suicide in children and adults younger than 25
Antidepressants are used cautiously in clients with bipolar disorder and never as ________________. -
monotherapy
-Antidepressants should be combined with a mood stabilizer to prevent the onset of a hypomanic or
manic episode
DA, NE Dysfunction causes what mood related symptoms - Decreased positive affect:
depressed mood
loss of joy
lack of interest
loss of energy
,decreased alertness
decreased self-confidence
appetite changes
5HT, NE Dysfunction causes what mood related symptoms - Increased negative affect:
depressed mood
guilt
fear/anxiety
hostility
irritability
loneliness
appetite changes
monoamine hypothesis of depression - -depression occurs as a result of a deficiency of one or all three
monoamine transmitters
• Serotonin Antagonist and Reuptake Inhibitors (SARIs)
SSRI's - Mechanism of action
• inhibit 5-HT reuptake
Adverse effects
-diarrhea
-headache
, -weight gain
-sexual side effects
SNRI's - Mechanism of action
• inhibit 5-HT reuptake
• inhibit NE reuptake (increase energy, focus)
• increase DA in prefrontal cortex (increase cognition)
Adverse effects
-elevated blood pressure
-anxiety
-insomnia
-constipation
NDRI's - Mechanism of action
• inhibit DA reuptake (increase alertness, motivation)
• inhibit NE reuptake (increase energy)
Adverse effects
-agitation
-headache
-dry mouth
-constipation
-weight loss
SSRI Prescribing Pearls: med with mild antihistamine effects - citalopram (Celexa)
SSRI Prescribing Pearls: med with no known drug interactions - escitalopram (Lexapro)
SSRI Prescribing Pearls: med with longest half-life - fluoxetine (Prozac)
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