Bipolar disorder is often characterized by a
state of depression with few patients experiencing suicidal tendencies. Patients
with Bipolar disorder often suffer from depression, periods of elevated
optimism, hyperactivity or sudden excitement.
of the elevated excitement episodes appear in patients with Bipolar II disorder
before or after a major depressive incident with characteristics that are unique
to every individual. These signs however are reduced by 5% to 15% with advancing age.
Researchers believe that disturbed sleep-wake cycle is the main cause which
tends to trigger the episodes of hyperactivity or depression.
Neurotransmitters have been
found to be responsible in the activity modifications leading to sudden mood
swings. Thus, the treatment for Bipolar
disorder aims to regulate these neurotransmitters in order to restore normal
mood and cognition. This can be achieved by non-pharmacologic methods like
meditation, relaxation and exercise that do not involve any medication but have
the potential to increase endogenous opioid and nicotinic receptor function
that helps restore normal behaviour.
Stress should be laid on the
careful assessment of the symptoms as there are many psychiatric conditions
like schizophrenia, schizoaffective disorder, post-traumatic stress disorder,
substance abuse (e.g., alcohol, cocaine, or amphetamines), and personality
disorders that may coexist with bipolar disorder.Thorough physical
examination must be conducted with focus on neurologic and endocrine systems, to
rule out possibilities of other mood disorders.
A mental status examination (MSE) is often recommended as it
assesses the patient's general appearance and demeanor, speech, movement, and
interpersonal relatedness with the examiner and others. It also identifies suicidal
tendencies in patients and subtle forms of psychosis, such as paranoia or
Drugs like lithium, anticonvulsants, antipsychotics, and
benzodiazepines have been found to be successful in management of bipolar
disorders.FDA has particularly approved
Lithium for treatment of mania and bipolar disorder. It is a mood stabilizer,
lowers suicide rate in patients with bipolar disorder and has been shown to
mitigate relapse of bipolar disorder preventing occurrence of more manic
episodes. However, it must also be noted that prolonged used of Lithium may
have adverse effects like it can damage the small blood vessels in kidneys that
clean the blood,can lower the activity of thyroid, goiter, and possibly cause
cardiac rhythm disturbances, especially in patients with pre-existing cardiac
Like Lithium, Anticonvulsants too are successful in the treatment
of bipolar disorders as they decrease brain excitation and enhance inhibition
by blocking low-voltage sodium-gated channels. The drug
also tends to lower glutamate and other excitatory amino acids. Valproate,
divalproex, lamotrigine, and carbamazepine are the anticonvulsants generally
used in the treatment.
Antipsychotics have also demonstrated efficacy particularly in
patients exhibiting hyperactivity or mixed states. These are either used as
monotherapy or in combination with lithium, valproate, or carbamazepine.
However, the biggest concern with antipsychotics is that they have a tendency
to cause metabolic syndrome leading to weight gain, glucose intolerance, and
Apart from these,
antidepressants can also be used as a management option in bipolar diseases. Fluoxetine
monotherapy provides relapse prevention benefit after recovery from Bipolar
disorders ensuring that the mood swings do not resurface.
Researchers acknowledge the
role of the pharmacist in counseling the patients on the use of
non-pharmacologic methods as the first choice of
treatment and informing the patients on the drugs available for the management
of bipolar disorders and the need to be sure of the disease by ruling out all
other possibilities of psychotic conditions. The problem can further be solved
by educating the local population about possible adverse reactions of these
drugs thus reducing the risk of hospitalization.
1. Bipolar II Disorder in Adults: A Review of Management Options; Mary Soliman et al; US Pharm. 2011;36(11):HS17-HS24
2. Management, needs and expectations of patients suffering from bipolar Pubmed