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What is Bipolar Disorder? Bipolar Disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, and functioning. It affects 2.3 million adult Americans, which is about 1.2 percent of the population, and can run in families. The disorder affects men and women equally. Bipolar Disorder is characterized by episodes of mania and depression that can last from days to months. Bipolar Disorder is a chronic and generally life-long condition with recurring episodes that often begin in adolescence or early adulthood, and occasionally even in children. It generally requires lifelong treatment, and recovery between episodes is often poor. Generally, those who suffer from Bipolar Disorder have symptoms of both mania and depression (sometimes at the same time).The category of bipolar disorder breaks down into a few sub-categories. The University of Maryland Medical Center Web site (www.umm.edu/patiented/index) has this to say about the varieties:
What are the symptoms of mania? Mania is the word that describes the activated phase of Bipolar Disorder. The symptoms of mania may include:
- either an elated, happy mood or an irritable, angry, unpleasant mood
- increased activity or energy
- more thoughts and faster thinking than normal
- increased talking, more rapid speech than normal
- ambitious, often grandiose, plans
- poor judgement
- increased sexual interest and activity
- decreased sleep and decreased need for sleep
What are the symptoms of depression? Depression is the other phase of Bipolar Disorder. The symptoms of depression may include:
- depressed or apathetic mood
- decreased activity and energy
- restlessness and irritability
- fewer thoughts than usual and slowed thinking
- less talking and slowed speech
- less interest or participation in, and less enjoyment of activities normally enjoyed
- decreased sexual interest and activity
- hopeless and helpless feelings
- feelings of guilt and worthlessness
- pessimistic outlook
- thoughts of suicide
- change in appetite (either eating more or eating less)
- change in sleep patterns (either sleeping more or sleeping less)
What is a "mixed" state? A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation.
What is rapid cycling? Sometimes individuals may experience an increased frequency of episodes. When four or more episodes of illness occur within a 12-month period, the individual is said to have Bipolar Disorder with rapid cycling. Rapid cycling is more common in women.
Bipolar Disorder Categories Bipolar disorder is classified according to symptom severity as bipolar disorder I, bipolar disorder II, and cyclothymic disorder. Some experts believe these are actually separate disorders with different biologic factors accounting for their differences.Additional types of bipolar disorder are under consideration, but are not yet considered standard diagnostic categories. These additional types include
- Bipolar Disorder Type I. Bipolar disorder type I is characterized by at least one manic episode, with or without major depression. With mania, either euphoria or irritability may mark the phase, and there are significant negative effects (such as sexual recklessness, excessive impulse shopping, sudden traveling) on a patients' social life, work, or both. Untreated mania lasts at least a week or results in hospitalization. Typically, depressive episodes tend to last six to 12 months if untreated. However, untreated manic episodes last three to six months.
- Hypomania and Bipolar Disorder Type II. Bipolar disorder type II is characterized by at least one episode of hypomania and at least one episode of major depression. With hypomania the symptoms of mania (euphoria or irritability) appear in milder forms and are of shorter duration. Bipolar II depression is the most commonly expressed form of all bipolar disorders and it is also highly associated with suicide risk.
- Cyclothymic Disorder. Cyclothymic disorder is not as severe as either bipolar disorder II or I, but the condition is more chronic. The disorder lasts at least two years, with single episodes persisting for more than two months. Cyclothymic disorder may be a precursor to full-blown bipolar disorder in some people or it may continue as a low-grade chronic condition.
Course of the Illness Bipolar disorder can be severe and long-term, or it can be mild with infrequent episodes. The usual pattern of bipolar disorder is one of increasing intensity and duration of symptoms that progresses slowly over many years. (Patients with the disease, however, may experience symptoms in very different ways.) A bipolar disorder patient averages 8 to 10 manic or depressive episodes over a lifetime, but some people experience more and some fewer episodes.
- Typical Bipolar Cycles.
- In most cases of bipolar disorder, the depressive phases far outnumber manic phases, and the cycles of mania and depression are neither regular nor predictable. Many patients, in fact, experience mixed mania, or a mixed state, in which both mania and depression occur.
- Rapid Cycling.
- About 15% of patients have a temporary, complicated phase known as rapid cycling, in which the manic and depressive episodes alternate at least four times a year and, in severe cases, can even progress to several cycles a day. (Some experts suggest that rapid cycling may first occur in bipolar disorder patients who are on antidepressants, which trigger a switch to mania and set up a cyclical pattern.)
G-aminobutyric acid (GABA) is the most important inhibitory neurotransmitter in the central nervous system (CNS) and is widely distributed throughout the brain. Approximately 60-75% of all synapses in the CNS are GABAergic.Finally, medications that increase GABA concentration or effectiveness tend to cause sleepiness, and benzodiazepines (which enhance GABA activity) are occasionally prescribed as sleep medication for occasional insomnia (see Section 3.9). GABA reuptake inhibitors may also promote sleepiness. It may be that the increase in GABA activity or concentration, which produces sleepiness in many individuals, acts primarily to counter mania (without sleepiness) in those who have bipolar disorder,
The Role of GABA in CNS GABA binds to three principal receptors, each of which is involved in different physiologic functions:Enhancing GABA Activity GABAergic activity may be enhanced by either:
- GABA-A receptors mediate fast inhibitory synaptic transmissions; they regulate neuronal excitability (eg, seizure threshold) and rapid changes in mood (eg, anxiety, panic, and response to stress); they are targets of benzodiazepines, barbiturates, and ethanol
- GABA-B receptors mediate slow inhibitory potentials; they appear to be important in memory, mood (depression), and pain
- GABA-C receptors-their physiologic role has not yet been described
GATs are membrane-transporter proteins that remove GABA from the synaptic cleft. Four distinct GATs have been identified: GAT-1, GAT-2, GAT-3, and BGT-1; they are located on neurons, both pre- and postsynaptically, and on glial cells. They differ in CNS distribution and localization.
- Stimulating GABA-A receptors (GABA-A-receptor agonists or modulating compounds)
- Inhibition of GABA metabolism
- Direct inhibition of GABA reuptake from the synapse by blocking the action of GATs (selective GABA-reuptake inhibitors)
- GAT-1 is the primary GABA transporter in the brain.
- The density of GAT-1 is highest in the frontal and parietal cortex.
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Lithobid | Lithium Carbonate | Lithium salt | 24 hours | 5 days | Bipolar Disorder (Manic phase) | Depression (Adjunctive) |
Priadel | Lithium Citrate | Lithium salt (liquid form) | 24 hours | 5 days | Bipolar Disorder (Manic phase) | Depression (Adjunctive) |
Chemical Name | Brand Names (Principal in Bold) |
Lithium Carbonate | Lithobid, Camcolit, Carbolit, Carbolith, Carbolithium, Ceglution 300, Ceglution, Contemnol, Duralith, Eskalith, Eskalith-Cr, Hynorex Retard, Lentolith, Licab, Licarb, Licarbium, Lidin, Limas, Liskonum, Litarex, Lithane, Litheum 300, Lithicarb, Lithionate, Lithizine, Lithocap, Lithonate, Lithotabs, Litilent, Litocarb, Maniprex, Milithin, Neurolepsin, Neurolithium, Phanate, Phasal,Plenur, Priadel Retard, Priadel, Quilonium-R, Quilonorm Retardtabletten, Quilonum Retard, Quilonum SR, Teralithe, Theralite |
Lithium Citrate | Priadel |
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Depacon | Sodium Valproate | 24 hours | 5 days | Bipolar Disorder (Manic phase); Seizures (Monotherapy, Adjunctive) | Depression | |
Depakene | Valproic Acid | 24 hours | 5 days | Bipolar Disorder (Manic phase); Seizures (Monotherapy, Adjunctive) | Depression | |
Depakote | Divalproex | 24 hours | 5 days | Bipolar Disorder (Manic phase); Seizures (Monotherapy, Adjunctive) | Depression | |
Chemical Name | Brand Names (Principal in Bold) |
Divalproex | Depakote, Convulex, DPA, Depakene, Depakine, Dipropylacetic acid, Divalproex sodium, Elvetium, Epilim, Epival, Ergenyl, Everiden, Mylproin, N-dipropylacetic acid, N-DPA, Novoseven, Propylvaleric acid, Valcote, Valnar |
Sodium Valproate | Depacon, Convulex Syrup, Convulex, Depakene, Depakin, Depakine Depakote, Druppels, Depakine, Depakote, Depalept Chrono,Depalept, Epilam, Epilex, Epilim Chrono, Epilim, Epival, Ergenyl, Leptilan, Orfil, Orfiril, Orfiril Retard, Petilin, Valcote, Valeptol, Valoin, Valpakine, Valparin, Valporal, Valprax, Valpro, Valsup |
Valproic Acid | Depakene, 2 PP (base), Alti-Valproic, Bruceine D, Convulex, DPA, DPA (VAN), Delepsine, Depacon, Depakin, Depakine, Deproic, Di-n-propylacetic acid, Di-n-propylessigsaure, Dipropylacetic acid, Dom-Valproic, Epiject, Epilex, Epilim, Epival, Ergenyl, Kyselina 2-propylvalerova, Leptilan, Med Valproic, Mylproin, Myproic Acid, N-Dipropylacetic acid, N-DPA, Novo-Valproic, Nu-Valproic, Orfiril, Penta-Valproic, 2-propyl-Pentanoic acid, Propylvaleric acid, Sodium hydrogen divalproate, Sprinkle, Valcote, 2-propyl-Valeric acid, Valparin, Valporal, Valpro, Valproate semisodique, Valproate semisodium, Valproato semisodico, Valproatum seminatricum, Valprosid |
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Tegretol | Carbamazepine | Tricyclic | 16 hours | 3 days | Seizures (Partial, not Absence) | Bipolar Disorder (Manic phase) |
Trileptal | Oxcarbazepine | Tricyclic | 11 hours | 3 days | Seizures (Partial, Monotherapy and Adjunctive) | Bipolar Disorder (Manic phase) |
Chemical Name | Brand Names (Principal in Bold) |
Carbamazepine | Tegretol, Apo-Carbamazepine, Atretol, Biston, Calepsin, Camapine, Carbadac, Carbamazepen, Carbamezepine, Carbatol, Carbatrol, Carbazene, Carbazep, Carbazepine, Carbazina, Carbelan, Carbium, Carmaz, Carpaz, Carzepin, Carzepine, Clostedal, Convuline, Degranol, Epileptol, Epileptol CR, Epitol, Eposal Retard, Equetro, Espa-lepsin, Finlepsin, Foxalepsin, Foxalepsin Retard, Hermolepsin, Karbamazepin, Kodapan, Lexin, Macrepan, Mazetol, Neugeron, Neurotol, Neurotop, Neurotop Retard, Nordotol, Novo-Carbamaz, Nu-Carbamazepine, Panitol, Sirtal, Stazepin, Stazepine, Tardotol, Taro-Carbamazepine, Taro-Carbamazepine Cr, Taver, Tegol, Tegretal, Tegretol, Tegretol Chewtabs, Tegretol Cr, Tegretol-Xr, Telesmin, Telestin, Temporal Slow, Temporol, Teril, Timonil, Timonil Retard |
Oxcarbazepine | Trileptal, Oxaprozin, Oxaprozine, Oxcarbamazepine |
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Gabitril | Tiagabine | 8 hours | 2 days | Seizures (Partial, Adjunctive) | Bipolar Disorder (Manic phase); Generalized Anxiety Disorder; Panic Disorder; Post-Traumatic Stress Disorder | |
Neurontin | Gabapentin | 6 hours | 1 day | Seizures (Partial, Adjunctive); Neuralgia (Postherpetic, i.e., from Herpes infections) | Bipolar Disorder (Manic phase) | |
Chemical Name | Brand Names (Principal in Bold) |
Gabapentin | Neurontin, Aclonium, Gabapentine, Gabapentino, Gabapentinum, Gabapetin, Novo-Gabapentin |
Tiagabine | Gabitril, Tiagabina, Tiagabinum |
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Lamictal | Lamotrigine | Phenyltriazine | 33 hours | 7 days | Bipolar Disorder (General), type I; Seizures (Partial, Monotherapy or Adjunctive); Seizures (Generalized, Adjunctive) | Depression |
Topamax | Topiramate | Monosaccharide | 21 hours | 4 days | Seizures (Adjunctive) | Bipolar Disorder (General), type I; Depression |
Chemical Name | Brand Names (Principal in Bold) |
Lamotrigine | Lamictal, Lamictal Cd, Lamotrigina, Lamotriginum |
Topiramate | Topamax, Tipiramate, Tipiramato, Topamax (TN), Topamax Sprinkle, Topiramato, Topiramatum |
Main Brand Name | Chemical Name | Chemical Type | Half Life | Washout Time | On-Label Uses | Off-Label Uses |
Ativan | Lorazepam | Benzodiazepine | 18 hours | 4 days | anxiety; Seizures | Bipolar Disorder (Manic phase); Insomnia |
Klonopin | Clonazepam | Benzodiazepine | 36 hours | 1 week | Panic Disorder (with or without agoraphobia); Seizures (Monotherapy, Adjunctive) | Bipolar Disorder (Manic phase) |
Librium | Chlordiazepoxide | Benzodiazepine | 36 hours | 1 week | anxiety | Bipolar Disorder (Manic phase) |
Tranxene | Clorazepate | Benzodiazepine | 2 days | 10 days | anxiety; Seizures (Adjunctive) | Bipolar Disorder (Manic phase) |
Valium | Diazepam | Benzodiazepine | 2 days | 10 days | anxiety; Muscle Spasms | Bipolar Disorder (Manic phase) |
Xanax | Alprazolam | Benzodiazepine | 11 hours | 4 days | Panic Disorder (with or without agoraphobia) | Bipolar Disorder (Manic phase) |
Chemical Name | Brand Names (Principal in Bold) |
Alprazolam | Xanax, Alplax, Alpronax, Alviz, Bestrol, Cassadan, Constan, D 65MT, Esparon, Frontal, Intensol, Niravam, Restyl, Solanax, TUS-1, Tafil, Tranax, Trankimazin, Tranquinal, Xanax XR, Xanor |
Chlordiazepoxide | Librium, A-Poxide, Abboxide, Apo-Chlordiazepoxide, Balance, CD 2, CDO, CDP, Chloradiazepoxide, Chlordiazachel, Chlordiazepoxid, Chlordiazepoxide Base, Chlordiazepoxidum, Chloridazepoxide, Chloridiazepide, Chloridiazepoxide, Chlorodiazepoxide, Chlozepid, Clopoxide, Clordiazepossido, Contol, Control, Decacil, Eden, Elenium, Helogaphen, Ifibrium, Kalmocaps, Librax, Librelease, Librinin, Libritabs, Limbitrol, Limbitrol Ds, Lygen, Menrium, Mesural, Methaminodiazepoxide, Mildmen, Multum, Napoton, Napton, Novo-Poxide, Psicosan, Radepur, Risolid, Silibrin, Tropium, Viopsicol |
Clonazepam | Klonopin, Antelepsin, Antilepsin, Chlonazepam, Cloazepam, Clonazepamum, Clonopin, Iktorivil, Klonopin, Klonopin Rapidly Disintegrating, Landsen, Rivotril |
Clorazepate | Tranxene, Chlorazepate, Chlorazepic acid, Clorazepate dipotassium, Clorazepic acid, Clorazepic acid, Gen-xene |
Diazepam | Valium, Alboral, Aliseum, Alupram, Amiprol, An-Ding, Ansiolin, Ansiolisina, Apaurin, Apo-Diazepam, Apozepam, Armonil, Assival, Atensine, Atilen, Bensedin, Bialzepam, Calmocitene, Calmpose, Cercine, Ceregulart, Condition, DAP, Diacepan, Dialag, Dialar, Diapam, Diastat, Diazemuls, Diazemulus, Diazepam Intensol, Diazepan, Diazetard, Dienpax, Dipam, Dipezona, Dizac, Domalium, Duksen, Duxen, E-Pam, Eridan, Eurosan, Evacalm, Faustan, Faustan, Freudal, Frustan, Gewacalm, Gihitan, Horizon, Kabivitrum, Kiatrium, LA III, La-Iii, Lamra, Lembrol, Levium, Liberetas, Mandrozep, Methyldiazepinone, Methyldiazepinone, Pharmaceutical, Morosan, Neurolytril, Noan, Novazam, Novo-Dipam, Paceum, Pacitran, Paranten, Paxate, Paxel, Plidan, Pms-Diazepam, Pro-Pam, Q-Pam, Q-Pam Relanium, Quetinil, Quiatril, Quievita, Relaminal, Relanium, Relax, Renborin, Ruhsitus, S.A. R.L., Saromet, Sedapam, Sedipam, Seduksen, Seduxen, Serenack, Serenamin, Serenzin, Servizepam, Setonil, Sibazon, Sibazone, Solis, Sonacon, Stesolid, Stesolin, Tensopam, Tranimul, Tranqdyn, Tranquase, Tranquirit, Tranquo-Puren, Tranquo-Tablinen, Umbrium, Unisedil, Usempax Ap, Valaxona, Valeo, Valiquid, Valitran, Valrelease, Vatran, Velium, Vival, Vivol, Zetran, Zipan |
Lorazepam | Ativan, (+/-)-Lorazepam, Almazine, Alzapam, Anxiedin, Aplacassee, Bonatranquan, Delormetazepam, Emotival, Idalprem, L-Lorazepam Acetate, Lorabenz, Lorax, Loraz, Lorazepam Intensol, Lorsilan, O-Chlorooxazepam, O-Chloroxazepam, Pro Dorm, Psicopax, Punktyl, Quait, Securit, Sedatival, Sedazin, Somagerol, Tavor, Temesta, Wypax |
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