Anti-Mania Drugs

ANTIMANIC DRUGS

Contents

• Mania

• Lithium Carbonate

• Pharmacological Profile

References

• Essentials of Pharmacology by KD Tripathi, Page No. 434-437

• www.google.com

• Mania is the mood of an abnormally elevated arousal energy level. Elevated

irritability is common along with behavior that seems on the surface to be the
opposite of depression

• Elevated mood is significant and is known as mania or hypomania depending on

the severity.

• They often make poorly thought out decisions with little regard to the
consequences. The need for sleep is usually reduced

• During periods of depression there may be crying, poor eye contact with others,
and a negative outlook on life.

• It is divided into bipolar I disorder if there is at least one manic episode and bipolar
II disorder if there are at least one hypomanic episode and one major depressive
episode.

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 Anti-Mania Drugs

• Treatment commonly includes psychotherapy and medications such as mood

stabilizers or antipsychotics. Examples of mood stabilizers that are commonly
used include: lithium and anticonvulsants

• In periods of mania it is recommended that antidepressants be stopped. If

antidepressants are used for periods of depression they should be used with a
mood stabilizer. Electroconvulsive therapy may be helpful in those who do not
respond to other treatments

• If treatments is stopped it is recommended that this be done slowly. Most people

have social, financial or work related problem due to the disorder.

Lithium Carbonate

• It is used in bipolar disorder i.e. is a mental illness characterized by periods of

elevated mood and periods of depression. The elevated mood is significant and is
known as mania or hypomania depending on the severity.

• It is neither sedative nor euphorient, but on prolonged administration it act as

mood stabilizer

• Given in mania it gradually suppresses the episode taking 1-2 weeks continued
treatment prevents cyclic mood changes.

• Mechanism of action not known. Lithium carbonate is used to treat mania, the
elevated phase of bipolar disorder Lithium ions interfere with ion transport
processes (see “sodium pump”) that relay and amplify messages carried to the
cells of the brain. Mania is associated with irregular increases in protein kinase C
(PKC) activity within the brain. Lithium carbonate and sodium valproate, another
drug traditionally used to treat the disorder, act in the brain by inhibiting PKC’s
activity and help to produce other compounds that also inhibit the PKC

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 Anti-Mania Drugs

• Lithium inhibits the action of ADH on distal tubules and causes a diabetes
insipidus like state.

• It has some insulin like action on glucose metabolisms

• Leucocyte count is increased by lithium therapy

Pharmacokinetics

• Lithium is slowly but well absorbed orally and is neither protein neither bound
nor metabolized.

• It first distributes in the extracellular water and then gradually enters cells and
slowly penetrates into the CNS, attains uniform distribution in total bod water

• It is handled by the didney in much the same way as Na

• When Na is restricted a larger fraction of filtered NA is reabsorbed

• It is excreted in sweet and saliva also and in breast milk

• Adverse Effect

• Side effects are common but are mostly tolerable.

• Toxicity occurs at levels only marginally higher than therapeutic levels

• Nausea, vomiting and mild diarrhea occur initially, can be minimized by starting
at lower doses

• Thirst and polyuria are experienced by most, some fluid retention may occur
initially

• Fine tremors and rarely seizures

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 Anti-Mania Drugs

• Ataxia, giddiness, confusion, slurred speech, coma, convulsions, drowsiness,

diarrhea

• Interactions

• Diuretics by causing Na loss promote proximal tubular reabsorption

• Tetracycline, NSAIDs and ACE inhibitors can also cause lithium retention.

• Lithium reduces pressor response to NA

• Lithium tends to enhance insulin/sulfonylurea induced hypoglycemia

• Succinylcholine and Pancuronium have produced prolonged paralysis in lithium

treated patients.

• Use

• Acute mania

• Prophylaxis of bipolar disorder

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