thera final bipolar

• 1) abnormal depressed mood
• 2) abnormal loss of all interest and pleasure
• 3) if < 18 yo, abnormal irritable mood

at least 1 of the above that occurs most of the day, nearly every day for at least 2 weeks

5 of the following with at least 1 being depressed mood or loss of interest/pleasure

• depressed mood
• marked loss of interest/pleasure
• appetite or weight disturbance
• sleep disturbances
• activity disturbances
• abnormal fatigue
• abnormal feelings of worthlessness or guilt
• abnormal concentration
• abnormal morbid thoughts of death

3 or more of the following

• inflated self esteem
• decreased need for sleep
• more talkative
• flight of ideas
• distractibility
• increase in goal-directed activity
• excessive involvement in activities that have a high potential for painful consequences

• lithium
• with AP or Benzo to reach steady state (1 wk)

0.6 - 1.2 mEq/L

renal function

• early
•   polydipsia
•   polyuria
•   confusion
•   decreased concentraton

• late
•   DI
•   hypothyroidism
•   hypokalemia

• gold standard
• use for > 50 years
• effective in mania and hypomania
• cheap

• narrow therapeutic window
• slow onset
• not as effective in mixed or rapid cycling bipolar disorder

50-125 mcg/mL

• GI
• tremor
• sedation

• less frequent
•   wt gain
•   lethargy

• quick onset
• titrated quickly
• effective in mixed states or rapid cycling
• effective in some lithium refractory pts

• monitoring
• inhibitor of cytochrome enzyme (2D6)
• expensive

4-12 mcg/mL

• drowsiness/dizziness
• fatigue
• clumsiness/confusion
• hyponatremia
• blurred vision

• effective in bipolar subtypes
• cheap

• DI - CYP 450 enzymes
• monitoring

decrease dose by 50% of lamotrigine

• effective in depressive episode
• no blood level monitoring
• decreases relapse
• ODT formulation available

• rash
• long titration period
• 2nd agent needed for acute mania

• lithium + AP (Seroquel)
•   VPA + AP

• lithium
• VPA (preferred of lithium in mixed)

• lithium
• quetiapine
• lamotrigine

lithium + antidepressant

• taper antidepressant if possible
• lithium VPA

• lithium
• lamotrigine
• olanzapine
• aripiprazole