Bipolar Disorder Treatment

Acute treatment goals for bipolar disorder (3)

1. Stabilize acute episodes (reduce sxs w/in 5-7 days)

2. Achieve response (sx improvement w/in 4-6 weeks)

3. Achieve remission

What are the 2 phases of maintenance in the treatment of bipolar disorder?

1. Continuation phase (2-4 months following acute response)

2. Maintenance phase (mood stability for > 3 months)

How long is typical bipolar disorder treatment duration?

life long

What is first line therapy for acute bipolar mania?

D/C contributing medications + SGA, mood stabilizer or both

Name the mood stabilizers approved to treat acute bipolar mania (2).

1. Lithium

2. Valproic acid

Name the SGAs approved to treat acute bipolar mania (7).

1. Quetiapine

2. Olanzapine

3. Risperidone

4. Aripiprazole

5. Asenapine

6. Ziprasidone

7. Cariprazine

When is it appropriate to combine mood stabilizers and SGAs in patients with acute bipolar mania?

If patient is severe (hospitalization) or if partial response to monotherapy

Name the adjunct options for acute bipolar mania (2).

1. Benzos (lorazepam or clonazepam) - short term only!!

2. Add a second mood stabilizer`

Name the first line agents for patients with rapid cycling bipolar disorder (2).

1. Lithium

2. Valproic acid

Name the second line agent for patients with rapid cycling bipolar disorder.

lamotrigine

Name the first line agents for monotherapy in patients with bipolar depression (4).

1. Quetiapine

2. Lithium

3. Lamotrigine

4. Lurasidone

Name the combo therapy options for patients with bipolar depression (4).

1. Olanzapine + fluoxetine

2. lithium/lamotrigine + quetiapine/lurasidone

3. Mood stabilizer + antidepressant

4. Mood stabilizer + antipsychotic

Name the second line medications for patients with bipolar depression (2).

1. valproic acid

2. carbamazepine

Name the first line agents for patients with bipolar disorder and anxiety (2).

1. Quetiapine

2. Gabapentin

Name the second line agents for patients with bipolar disorder and anxiety (5).

1. Divalproex

2. Lamotrigine

3. SSRIs/SNRIs

4. Olanzapine

5. Olanzapine + fluoxetine combo

True or False: Antidepressants should NOT be used as monotherapy in patients with bipolar disorder.

True! Antidepressants should be combined with a mood stabilizer and only used in patients who spend the majority of symptomatic time in depression rather than mania

Are antidepressants more commonly used in bipolar 1 or bipolar 2?

Bipolar 2

How often should bipolar patients on antidepressants be monitored?

At least weekly

What two antidepressants are allowed to be used as monotherapy in bipolar disorder according to CANMAT?

1. venlafaxine

2. sertraline

What pharmacological agents are typically used for maintenance in bipolar disorder?

1. lithium

2. valproic acid

3. SGAs

4. Combinations

What SGAs show best evidence for "total coverage" in bipolar disorder (2)?

1. Olanzapine

2. Quetiapine

What SGAs show best evidence in treating manic episodes in bipolar disorder (5)?

1. Risperidone

2. Aripiprazole

3. Ziprasidone

4. Asenapine

5. Cariprazine

What SGAs show the best evidence in treating bipolar depression (2)?

1. Quetiapine

2. lurasidone

What SGA shows the best evidence for treating resistant bipolar 1 mania?

clozapine