Bipolar affective disorder manic depression

For patients with bipolar affective disorder (manic-depressive illness) lithium, usually in the form of lithium carbonate, has been the main prophylactic agent for the last forty years. However, during the last ten years certain anticonvulsants (carbamazepine and sodium valproate) have also been found to be effective. 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

Lithium is the simplest therapeutic agent for the treatment of depression and has been used for over 100 years—lithium carbonate and citrate were described in the British Pharmacopoeia of 1885. Lithium therapy went through periods when it was in common use, and periods when it was discouraged. Finally, in 1949, J.J.F. Cade reported that lithium carbonate could reverse the symptoms of patients with bipolar disorder (manic-depression), a chronic disorder that affects between 1% and 2% of the population. The disease is characterized by episodic periods of elevated or depressed mood, severely reduces the patients quality of life and dramatically increases their likelihood of committing suicide. Today, it is the standard treatment, often combined with other drugs, for bipolar disorder and is prescribed in over 50% of bipolar disorder patients. It has clearly been shown to reduce the risk of suicide in mood disorder patients, and its socioeconomic impact is considerable—it is estimated to have saved around 9 billion in the USA alone in 1881. 

Indications include a wide variety of psychiatric disorders, in the first place schizophrenia, organic psychoses and other acute psychotic illnesses. However they are also of use for the manic phase of bipolar affective disorder and for psychotic depression. Under antipsychotic drug therapy patients become less agitated and restless, withdrawn and autistic patients may become more communicative, aggressive and impulsive behavior diminishes and hallucinations and disordered thinking disappear. 

Lithium salts are used in the treatment of bipolar affective disorder (i.e., manic depression) and occasionally in mania (but its slow onset of action is somewhat of a disadvantage in this case). Its mechanism of action is still open to debate, but lithium has effects on brain monoamines, on neuronal transmembrane sodium flux, and on cellular phosphatidylinositides related to second messenger systems. Lithium is administered in two salt forms, lithium carbonate (8.98) and lithium citrate (8.99). Side effects are common and include diarrhea, kidney failure, and drowsiness with tremor. 

The sequence, number, and intensity of manic and depressive episodes are highly variable. The cause of the mood swings characteristic of bipolar affective disorder is unknown, although a preponderance of catecholamine-related activity may be present. Drugs that increase this activity tend to exacerbate mania, whereas those that reduce activity of dopamine or norepinephrine relieve mania. Acetylcholine or glutamate may also be involved. The nature of the abrupt switch from mania to depression experienced by some patients is uncertain. Bipolar disorder has a strong familial component, and there is abundant evidence that bipolar disorder is genetically determined. 

An effective treatment for bipolar disorder (manic -depressive illness) is the administration of lithium salts 445/1111-11133 Inhibition of the hydrolysis of inositol phosphate by Li+ (Fig. 11-9) may be related to its therapeutic effect. Reduced phosphatidylinositol turnover may dampen responses to neurotransmitters.1114 Li+ may affect gene expression in neuropeptide-secreting neurons.1115 Bipolar disorder apparently has more than one cause. There are strong indications of genetic susceptibility,1116 and genes that increase susceptibility have been located on chromosomes 4,12,13,18,21, and X.1117... 

Q1 The swings of mood from depression Lo mania suggest a diagnosis of manic depressive disorder (bipolar affective disorder). In this condition, the cycle of manic and depressive periods can take place over months or years, but may occur rapidly over weeks or days this varies between patients. On the other hand, there may be several episodes of depression which follow each other, or the patient may experience several episodes of mania in succession. 

Manic depressive disorder (bipolar affective disorder) is characterized by swings of mood from depression to mania. A patient may be at an increased risk of developing the condition if a first-degree relative is similarly affected. 

In a review of five randomized controlled trials of prevention of relapse in 770 patients with bipolar affective disorder, lithium has been compared with placebo (98). Lithium was more effective than placebo in preventing all relapses and manic relapses, but the effect on depressive relapses was not as impressive and was termed equivocal by the authors. This is not particularly new information, although several of the studies that were included in this meta-analysis were more recent and the analysis was presented as odds ratios rather than episode frequency. 

Dr. J. F. J. Cade, an Australian psychiatrist, first reported on the beneficial use of a lithium compound for a psychiatric disorder, namely, manic behavior in 1949. The early human trials were undertaken after initial experiments on rats, which became quite lethargic after treatment with lithium urate. Fairly large doses were required for treating manic behavior and its use for this disorder has been displaced by organic drugs that carry less risk. His report, however, led to its current nse as a treatment for bipolar affective disorder (also known as manic-depressive disorder). Its use in the United States was curtailed for a decade and a half by the US. Food and Dmg Administration (FDA), which based its decision on incidental poisonings due to overuse of a lithium-based table salt substitute, despite a safe record of controlled psychiatric apphcations in Europe. It has been estimated that by 1985... 

Manic depression currently affects up to 2 percent of the world s population. Clinical studies demonstrate proven effectiveness of lithimn treatment for bipolar affective disorder. Lithium is taken orally and has been used successftdly by some patients for periods exceeding a decade. The action is prophylactic, meaning that it is able to prevent the occurrence of the manic and depressive mood swing phases of the disease once the patient has been... 

In bipolar affective disorder patients suffer episodes of mania, hypomania and depression, classically with periods of normal mood in between. Manic episodes involve greatly elevated mood, often interspersed with periods of irritability or undue... 

There may be abnormalities in eiythrocyte membrane transport properties in patients with bipolar affective disorders, though the interpretation is confounded by the uncertainty with regard to the contribution of hypertension in patients who are coincidentally hypertensive and manic depressive. The administration of lithium also may cause adaptive change (93,117,135-137). This results in an increase in erythrocyte lithium concentrations after prolonged lithium therapy, which could be mediated either by increased flux into the cell or via reduction in efflux rate. An increased content of ankyrins, red cell membrane proteins affecting cytoskeletal structure and functions, has been found in some patients with bipolar affective disorder (138) and this raises further the role of erythrocyte membrane defects in the etiology of the disease. 

Bipolar disorders A group of mental disorders historically referred to as manic depression or bipolar affective disorder, characterized by extreme fluctuations in mood. There are three major diagnoses that fall in this area, bipolar I, bipolar II, and cyclothymia. 

Mood stabilizer that remains DOC for bipolar affective disorder but also usually needs antidepressants to improve depressive phases of the dysfunction. Slow onset (2 weeks) and sedative drugs may be needed initially for manic phase. Lithium has a narrow therapeutic window—eliminated by kidney similarly to Na low Na (or chronic diuretic treatment) enhances toxicity. 

Bipolar affective is when the patient undergoes moods swings from manic (euphoric) to depressive (dysphoric). Lithium is prescribed for bipolar affective disorders. 

Because of concerns of the Food and Drug Administration, lithium vras removed Irom TUP during the early 1950s. At nearly the same time, psychiatrists discovered that the lithium ion has a remarkable therapeutic effect on the mental disorder called bipolar affective disorder, or manic-depressive iUiiess. Over 1 million Americans suffer horn this psychosis, undergoing severe mood swings from deep depression to a manic euphoria. The lithium ion smoothes these mood swin allowing the bipolar patient to function more effectively in daily life. 

In clinical psychiatric terms, the affective disorders can be subdivided into unipolar and bipolar disorders. Unipolar depression is also known as psychotic depression, endogenous depression, idiopathic depression and major depressive disorder. Bipolar disorder is now recognised as being heterogeneous bipolar disorder I is equivalent to classical manic depressive psychosis, or manic depression, while bipolar disorder II is depression with hypomania (Dean, 2002). Unipolar mania is where periods of mania alternate with periods of more normal moods. Seasonal affective disorder (SAD) refers to depression with its onset most commonly in winter, followed by a gradual remission in spring. Some milder forms of severe depression, often those with an identifiable cause, may be referred to as reactive or neurotic depression. Secondary depression is associated with other illnesses, such as neuro-degenerative or cardiovascular diseases, and is relatively common. 

Affective disorders A group of psychoses characterised by a pathological and long-lasting disturbance of mood or affect. They include the unipolar disorders (e.g., depression and mania), and bipolar disorders (e.g., manic depression). 

Bipolar disorder A group of affective disorders characterised by alternating periods of pathologically elevated moods, followed by severely reduced moods. Previously known as manic depression, or manic depressive psychosis. 

Numerous reports of altered neurotransmitter and hormone functions which have been associated with the affective disorders are reviewed by Levell [142]. It was originally proposed that one or more of the neurotransmitter amines in the brain (norepinephrine, dopamine, serotonin) may be functionally elevated in manic patients and reduced in depressed patients [143]. For instance, an increase in the production of dopamine, observed in a number of case reports, is thought to be the cause of the switch into the manic phase in bipolar patients. For example, Bunney et al. reported an increase in the level of homovanillic acid (HVA), a... 

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