Depression manic

Treatment of Manic—Depressive Illness. Siace the 1960s, lithium carbonate [10377-37-4] and other lithium salts have represented the standard treatment of mild-to-moderate manic-depressive disorders (175). It is effective ia about 60—80% of all acute manic episodes within one to three weeks of adrninistration. Lithium ions can reduce the frequency of manic or depressive episodes ia bipolar patients providing a mood-stabilising effect. Patients ate maintained on low, stabilising doses of lithium salts indefinitely as a prophylaxis. However, the therapeutic iadex is low, thus requiring monitoring of semm concentration. Adverse effects iaclude tremor, diarrhea, problems with eyes (adaptation to darkness), hypothyroidism, and cardiac problems (bradycardia—tachycardia syndrome). 

Other agents are also used for the treatment of manic-depressive disorders based on preliminary clinical results (177). The antiepileptic carbamazepine [298-46-4] has been reported in some clinical studies to be therapeutically beneficial in mild-to-moderate manic depression. Carbamazepine treatment is used especially in bipolar patients intolerant to lithium or nonresponders. A majority of Hthium-resistant, rapidly cycling manic-depressive patients were reported in one study to improve on carbamazepine (178). Carbamazepine blocks noradrenaline reuptake and inhibits noradrenaline exocytosis. The main adverse events are those found commonly with antiepileptics, ie, vigilance problems, nystagmus, ataxia, and anemia, in addition to nausea, diarrhea, or constipation. Carbamazepine can be used in combination with lithium. Several clinical studies report that the calcium channel blocker verapamil [52-53-9] registered for angina pectoris and supraventricular arrhythmias, may also be effective in the treatment of acute mania. Its use as a mood stabilizer may be unrelated to its calcium-blocking properties. Verapamil also decreases the activity of several neurotransmitters. Severe manic depression is often treated with antipsychotics or benzodiazepine anxiolytics. 

Perhaps one of the most exciting new applications stems from the discovery in 1949 that small daily doses (l-2g) of LI2C03 taken orally provide an effective treatment for manic-depressive psychoses. The mode of action is not well understood but there appear to be no undesirable side effects. The dosage maintains the level of Li in the blood at about I mmol l and its action may be related to the influence of Li on the Na/K balance and (or) the Mg/Ca balance since Li is related chemically to both pairs of elements. 

Bipolar disorder or manic depressive illness, refers to a severe mental illness characterized by recurring episodes of mania and depression. 

Lithium compounds are used in ceramics, lubricants, and medicine. Small daily doses of lithium carbonate are an effective treatment for bipolar (manic-depressive) disorder but scientists still do not fully understand why. Lithium soaps—the lithium salts of long-chain carboxylic acids—are used as thickeners in lubricating greases for high-temperature applications because they have higher melting points than more conventional sodium and potassium soaps. 

Wyatt RJ, Henter I (1995). An economic evaluation of manic-depressive illness—1991. Soc Psychiatry PsychiatrEpidemiol Oy 213—19. 

It has been long believed that a lithium ion-selective electrode would render obsolete the flame photometer in the clinical laboratory. Lithium is administered to manic depressive psychiatric patients. Since the therapeutic range (0.5-1.5 mM) is quite close to the toxic range (>2 mM), it must be closely monitored. Most of the iono-phores propo d to date have not met the Li" /Na selectivity required for an interference-free assay. However, it has been reported that calibration in the presence of 140 mMNa permitted the analysis of Li in serum The errors observed are due to fluctuations in the Na concentrations in the sample. More selective ionophores would certainly improve the accuracy of this method. 

Bipolar disorder is a mood disorder characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is a chronic illness with a course characterized by relapses and improvements or remissions. Mood episodes can be manic, depressed, or mixed. They can be separated by long periods of stability or can cycle... 

The patient may present in a hypomanic, manic, depressed, or mixed state, and may or may not be in acute distress. 

Bell, C. Mehta, H. (1980). The misdiagnosis of black patients with manic depressive illness. /. Natl. Med. Assoc., 72(2), 141-5. 

Mendlewicz, J., Verbanck, P., Linkowski, P. Wilmotte, J. (1978). Lithium accumulation in erythrocytes of manic-depressive patients an in vivo twin study. Br. J. Psychiatry, 133,436-44. 

In the past, Carothers health has been discussed only in terms of manic depression and alcohol. Among those experts who helped me in trying to understand his other medical problems were Peter S. Colley, MD Leon Eisenberg, MD Stephen A. Falk, MD Gary Fujimoto, MD Gerald N. Grob Elaine Henley, MD and Jonathan Q. Purnell, MD. 

Bruce Bower. Pushing the Mood Swings Social and Psychological Forces Sway the Course of Manic Depression. Science News. 157 (Apr. 8, 2000) 232-233. 

G. S. Sachs, A. F. Schatzberg and S. Solomon, National Depressive and Manic-Depressive Association Consensus Statement on the Use of Placebo in Clinical Trials of Mood Disorders , Archives of General Psychiatry 59, no. 3 (2002) 262-70... 

Turning to the pharmacotherapy for mania, for decades lithium was the only effective drug treatment. More recently, a number of antiepileptic drugs including carba maze pine, lamotrigine and valproate have been shown to also act as mood stabilisers and are becoming established for the treatment and prophylaxis of both unipolar mania and bipolar manic depressive disorders. 

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. 

Mood stabilisers are used to regulate the cyclical change in mood characteristic of bipolar disorder, since they can attenuate both manic and depressive phases. Their main use is as a prophylactic for manic depression and unipolar mania. However, they can also be administered concomitantly with antidepressants for refractory (non-responsive) unipolar depression. 

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. 

Goodwin FK. Manic-Depressive Illness. NewYork. Oxford University Press, New York 1990. 

Ikonomov O, Manji HK. Molecular Mechanisms Underlying Mood-Stabilization in Manic-Depressive Illness The Phenotype Challenge. Am J Psychiatry 1999 156 1506-1514. 

Manji HK, Chen G. Lithium upregu-lates the cytoprotective protein bcl-2 in vitro and in the CNS in vivo, a role for neurotrophic and neuroprotective effects in manic-depressive illness. J Clin Psychiatry 2000 61 82-96. 

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