PsychRounds: The Psychiatry Podcast Bipolar Disorder: Pharmacologic Treatment
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Mar 1, 2024 Dive into the complexities of treating bipolar disorder with pharmacology. Discover the critical distinctions between managing acute mania and depressive episodes. Explore various antipsychotic medications and their FDA-approved uses, emphasizing tailored drug selection for optimal outcomes. Learn about the importance of psychosocial functioning beyond traditional symptom tracking. Plus, find out how sleep plays a pivotal role in treatment decisions, enhancing overall patient quality of life. This discussion showcases the nuanced world of bipolar pharmacotherapy.
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Phases of Bipolar Disorder Treatment
- Bipolar disorders require different approaches for manic ("above") and depressive ("below") phases.
- Maintenance aims to stabilize mood and prevent future episodes across these phases.
Acute Mania Pharmacologic Strategy
- Use mood stabilizers like lithium and valproic acid for acute mania, although lithium can take 1-3 weeks to take effect.
- Add antipsychotics for faster relief, especially if psychotic features are present.
Variable Efficacy of Antipsychotics
- Not all antipsychotics are equally effective for acute mania; some like paliperidone have questionable data.
- Typical antipsychotics like haloperidol have strong evidence but risk inducing depression post-mania.