People with bipolar disorder have
Bipolar is a fairly newly established euphemism for manic depression. It was named manic depression in _______ and was called bipolar ____ year later in _______.
Bipolar is the modern (newest) name for Manic Depression. A simple spiral graph may show cycles fluctuating between severe mania and depression with a baseline or hypomania mode within the limits of a single individual or a mass population. The following mostly focuses on a single individual.
First, are not recommended for women wanting to become pregnant or expecting mothers nor is any drug without consulting with a doctor prior. Mood stabilizers can increase the risk of central nervous system complications in the child.
Lithium: like other mood stabilizing medication are not addictive although can have certain side effects such as disease of the liver or kidneys. Blood is drawn and tested frequently during the priming stage (when medication is being commenced) and quarter annually once a constant baseline is established.
Mechanics of Medications:
Mood stabilizers are given during the acute phase (priming stage) and are continued during the maintenance phase. A mood stabilizer, a medication that has to be effective in (1) treating acute manic, mixed, and/or depressive episodes of bipolar without causing a switch to the opposite pole of the mode or rapid cycling (i.e., rapidly alternating between poles) and (2) preventing future episodes from occurring. Antidepressants like fluoxetine (Prozac) are not considered mood stabilizers, because they impact only depression, not mania, and because they can cause rapid cycling if given alone.
Medications have at least two names: a generic name that reflects the chemistry (which is listed first) followed by a specific brand name created by the pharmaceutical company that develops the generic drug for commercial use (which is in parentheses). Doctors and pharmacies usually refer to drugs by their brand name. The main mood stabilizers in use today are lithane (lithium carbonate) and the anticonvulsants, typically divalpoex sodium or valproate (e.g., Depakote, Depakene), lamotrigine (lamictal), or the older agent carbamazepine (Tegretal). Certain of the atypical antipsychotic/antidepressant medications, such as quetiapine (Seroquel), aripiprazole (Abilify), and olanzapine (Zyprexa), also qualify as mood stabilizers.
A clients mood stabilizing medications are likely to change over time, both in type and dosage. Medication changes does not mean manifestation. No single medication works to alleviate bipolar symptoms over a person’s entire life span. It’s also likely to be treated with more than one mood stabilizing medication or atypical antipsychotic/antidepressant agent at some point or perhaps even on an ongoing basis (e.g., lithium and divalproex together). Many people with bipolar experience an additive therapeutic benefit from taking more than one mood stabiliser or atypical. Perhaps this is because agents like lithium and divalproex have different but complementary effects on the brain, such as the protein kinase C signalling pathways.
Taking more than one medication does not mean the individual or group is becoming sicker than another individuals or groups – it just may mean that the unique physiology doesn’t respond as well to one individual or groups compound as it may to another. People vary in response to medication depending on their patterns of symptoms, such as whether they have pure manic highs versus mixed episodes, or rapid cycling versus infrequent and distinctive episodes.
Types of Mood stabilizers
Lithane (Lithium Carbonate):
The most well-known mood stabilizer is lithane (lithium carbonate), which is dispersed under brand names like Eskalith, Lithobid, Lithonate, and Cibalith-S. Lithium was the first medication proven to stabilize mood in bipolar and also to prevent manic or depressive episodes from returning. Although various forms of lithium bromide were used during the late 1800s to quell agitation or overexcitement, the discovery of lithium as a mood stabilizer in bipolar is usually attributed to John Cade of 1949.
Lithium is usually given in 300- or 450-milligram (mg) capsules, and are usually taken between one and eight of these per day (300-2,400 mg). Some clients take lithium in divided doses, several times a day, and some only once based on how best to control side effects. An optimum dosage is one that brings a clients blood level into a therapeutic (optimum) range. The therapeutic range target during and acute episode may be higher than one during ongoing maintenance, which is usually between 0.8 and 1.2 mill-equivalents per litre (a chemical measure of lithium concentration in the blood). Children and persons over the age of 65 can often be maintained on lower dosages of lithium.
The Discovery of Lithium:
Lithium has been known to have mood-calming properties since at least a.d. 200, when a Greek doctor named Galen used it in baths for moody people. Various lithium bromide compounds were marketed to the public in the 1800s, but were found to be highly toxic. The soft drink 7Up used to have lithium in it.
John Cade was an Australian physician who theorized that there were toxic compounds in the urine of clients with what was then called manic depression. He happened to discover lithium by accident. His experiment involved injecting uric acid mixed with lithium into the bloodstream of guinea pigs. Injection with lithium calmed the animals down and made them less active. Cade then thought to try lithium with human guinea pig, one of his most severely ill manic clients, a 51-year-old man. The client responded very well and for the first time was able to function outside of a hospital. This story of scientific serendipity is tempered somewhat by the fact that this client took himself off the medication, against medical advice, 6 months later, perhaps foreshadowing the wide ranging problem of medication non adherence among people doctored for bipolar. Nonetheless, lithium came into general use in the 1960s and has been used regularly in the United States since 1970, greatly benefiting many.
Effectiveness of Lithium:
How well does lithium work? About 60-70% of people with bipolar show a remission of their manic symptoms when doctored with lithium (Goldberg, 2000), lithium reduces rates of hospitalisation by 82%, but clients still have an average of about one manic or depressive episode per year when taking lithium (Tondo et al., 2001). In seven placebo-controlled trials that lasted between 1 and 2 years each, lithium was associated with a 22.5% relapse rate, compared to 50% on a placebo (Coryell, 2009). A meta-analysis (a ‘study of studies’) of maintenance trials of long-term lithium usage, which included 770 participants, concluded that lithium was effective in preventing manic relapses but was only marginally better than placebo in preventing depressive relapses (Geddes et al., 2004).
Despite its apparent lower effectiveness in treating depression, lithium is the only single medication for bipolar that has been found to reduce the risk of suicide or suicidal behaviours. In a study of 21,000 clients by Dr. Frederick Goldwin and colleagues at George Washton University, people with hipolar who were taking lithium were less likely to attempt complete suicide, and less likely to require hospitalisation for suicide attempts, than people taking either divalproex or carbamazepine (Goodwin et al., 2003). So, on balance, lithium is still the first choice for bipolar 1 depressive or manic episodes.
Clients Response to Lithium:
Many studies tried to predict who will respond to lithium, with inconclusive results. The symptoms and course patterns listed below tend to go along with a good response to lithium. These factors may better help one understand why doctors recommend lithium versus an anticonvulsant, alone or in combination. In general, the more that bipolar reflects the textbook description of bipolar, (euphoric, grandiose, manic highs followed by deep depressions, combined with a family history of bipolar in one or more of a clients first-degree relatives), the more likely one is to respond positively to lithium. If bipolar is atypical (e.g., irritability and dysphoric, sad mood rather that euphoric mania), some doctors will recommend an anticonvulsant instead of (or in addition to) lithium. We used to think that rapid cycling or mixed episodes were better managed with anticonvulsants than lithium, but the latest data does not support this conclusion (Coryell, 2009).
How Lithium Works:
We don’t know exactly why lithium is effective in controlling manic and (to a lesser extent) depressive episodes, but we suspect it has effects on a client underlying biological vulnerabilities. Lithium appears to affect pathways that determine whether chemical massages are sent successfully from the brain to other parts of the body or from one part of the brain to another. Even more intriguing is the possibility that by increasing some proteins and enzymes in the brain and inhibiting others, lithium slows down or even stops the process of cell death in various brain structures. Those structures include parts of the limbic system, which is central to emotional processing and higher-order control over lower parts of the brain. Lithium may improve the structural stability of cells and even cause new cells to grow or proliferate (Machado-Vieira et al., 2009). As a result, clients who take lithium or valproate may have increased gray-matter volumes in a certain part of the prefrontal cortex than people with bipolar who haven’t taken these medications.
Side Effects of Lithium
Clients with bipolar have some predictable side effects with lithium, but their severity will vary a great deal from person to person. Common side effects of lithium include thirst, retaining water, frequent urination, fatigue, diarrhoea, or a metallic taste in the mouth which usually normalises (abates) in the maintenance phase. More troublesome side effects of lithium may include rapid weight gain or rapid weight loss resulting in lower to upper spinal cord hernia which over time can result in paralysis if not monitored. To avoid these long term problems, it is very important to keep physically fit and eat well balanced meals. Problems with sluggishness or problems with memory, shaky hands (turbulence) usually occurs in the priming phase as does development or flare-up of skin conditions (such as acne or psoriasis), or stomach discomfort or pain. Some clients also develop hypothyroidism, a condition in which the thyroid gland does not produce enough hormone. Kidney functioning (i.e., the ability of the kidney to concentrate urine) can also be affected when lithium is taken over a long period of time. The side effect of lithium can be related to the dosage taken, the chemical combination of medication(s) taken with it, and pre-existing physical health conditions. Lithium is sometimes gradually increased to a therapeutic dosage (optimum regulated dose) while always keeping side effects in check through blood screening and communication with a local specialist.