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1 or more manic/ mixed episode
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Elevated, expansive, or irritable mood, and increased goal-directed activity or energy lasting ≥1 week (any duration if hospitalized), present most of the day, nearly every day
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Never had a full manic episode
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At least 1 hypomanic episode and at least 1 major depressive episode
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Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased goal-directed activity or energy lasting ≥4 but <7 days, and clearly different from usual nondepressed mood, present most of the day, nearly every day
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Not severe enough to cause marked impairment, not due to substance or medical condition, and no psychosis
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Grandiosity
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Decreased sleep
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Pressured speech
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Racing thoughts
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Distractibility
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Increased activity
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Excessive pleasurable activities/ risk taking
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Grandiose
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Increased activity
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Decreased judgment and sleep
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Delusional
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Irritable
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Non- attentive
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Elevated mood and euphoria
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Speedy speech
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Speedy thoughts
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0.7% population at risk
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2.3 million adults
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Age of onset in 20s normally
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= in males and females
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Treat to remission regardless of the number of medications
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Mood stabilizer or mood stabilizer + SGA
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Discontinue antidepressants
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Relapse risk is highest in first few months after treatment initiation
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Lithium gold standard- but less effective in rapid cycling and mixed episodes
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Lithium
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Depakote
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Tegretol
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Lamictal
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SGAs (acute mania or psychosis)
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Normal level 0.5- 1.2 in acute phase
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Normal level 0.6- 1.0 in maintenance phase
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Dose 1,200- 2,400mg in acute phase; 900- 1,200mg in maintenance phase
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SEs: weight gain, fine hand tremors, nausea, increased urination, thirst
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Interactions: ACEs. ARBs, diuretics, NSAIDs, Topamax
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Increase water intake
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Antisuicidal properties
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Toxicity: confusion, slurred speech, coarse hand tremors, severe GI effects
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Avoid in pregnancy (especially 1st trimester)
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Monitor KIDNEYS
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Normal level 50-125
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Dosage 15- 50 mg/kg/ day
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SEs: nausea diarrhea, abd cramps, sedation tremor, alopecia, liver issues
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Rare: Stevens Johnson
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Avoid in pregnancy
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Interactions: Topamax (increased ammonium), tegretol (decreases levels of both drugs)
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Increases levels of lamictal and SGAs
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Monitor LIVER
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Normal level 6- 12
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Dose 10- 20 mg/kg/ day
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SEs: nausea, dizziness, sedation, headaches, dry mouth, constipation, skin rash, liver issues
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Rare: agranulocytosis/ aplastic anemia, Stevens- Johnson (In asians especially due to HLA-B 1502 allele)
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Avoid in pregnancy
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Monitor LIVER
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No level
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Dosage 25- 600mg/ day
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SEs: dizziness, ataxia, somnolence, diplopia, nausea, headache liver issues
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Rares: Stevens- Johnson
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Maintenance only
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Helps in depressive phases
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Titrate super slow- 25mg q day x 2 weeks, then 50mg q day x 2 weeks etc
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When added to depakote, lamictal level doubles
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When added to tegretol, it is metabolized quicker
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Often added to Lithium, SGAs or antidepressants
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