Manic Therapy

Symptoms of Mania

• Elation
• Excitement
• Rapid Passing of Ideas
• Unstable attention span

When someone is experiencing mania, their mind is going off a million miles a minute, you can’t get their attention, and they’re bouncing off the walls.  It’s called bi-polar cause if they’re manic and depressed, they could go back and forth between the two conditions really fast.  For depression, the cause may potentially be a lack of norepinephrine or serotonin, but in the case of mania, however, it’s due to too much norepinephrine in the junctional space.

Manic Therapy

• Lithium (Eskalith, Lithobid) – p.o.

Lithium (Li+) is the simple positively charged cation you would find on the periodic table.  Lithium is used in therapy because it helps assist in with the reuptake of norepinephrine.  The problem is that it takes 5-6 days for it to work.  If you have an unstable person who isn’t listening to you and the drug isn’t going to work for 5-6 days, you have to add a drug that will work.  The antipsychotic drugs (major tranquilizers) are used with lithium for at least 5-6 days but often approved to go on for a longer time as well.

Side Effects of Lithium

• GI upset (one of the most common side effects)
• tiredness
• polydipsia (excessive thirst)
• polyuria (urinating frequently)
• fine hand tremor (very common side effect)

Toxicities

Lithium has a low therapeutic index (Therapeutic Ratio/Index = LD50/ED50) and narrow therapeutic range.  In other words, it’s not safe and you don’t have a lot of play with lithium.

The toxic effects include vomiting, profuse diarrhea, and convulsions.  So it’s very important to have a right dosage.

Drug/Drug Interaction

Lithium (Li+) is a cation (positively charged).  Sodium (Na+) is floating around the blood.  Lithium will gladly replace sodium in your blood stream.  If anything causes a depletion of sodium, lithium will take over.  This causes sodium concentration in the blood to go up.   What drug class will cause a person to lose sodium?  Diuretics.  Therefore, diuretics have a very dangerous drug interaction with lithium.

Alternatives for Manic Therapy

These are alternatives to lithium and they are these couple of anticonvulsant drugs which have been approved for the treatment of bipolar disorder.

• Carbamazepine (Tegretol®)
• Divalproex (Depakote®)