Antimaic Drugs

Presented by: Muhammad Bilal Rafique

Roll no MSPSY-23-17
MS Clinical Psychology
Psychophysiology and Psychopharmacology
Antimanic Drugs
Any drug that stabilizes mood by controlling symptoms of mania,
the abnormal psychological state of excitement is called antimanic
drugs.
Mania
Mania is a severe form of emotional disturbance in which a
person is progressively inappropriately euphoric and simultaneously
hyperactive in speech and locomotor behavior. This is often
accompanied by significant insomnia (inability to sleep), excessive
talking, extreme confidence, and increased appetite. As the episode
builds, the person experiences racing thoughts, extreme agitation, and
incoherence, frequently replaced with delusions, hallucinations,
and paranoia, and ultimately may become hostile and violent and may
finally collapse. In some persons, periods of depression and mania
alternate, giving rise to bipolar disorder.
Antimanic Agents
Antimanic agents help to calm episodes of mania in people
with bipolar disorder, and they may be used in other conditions where
people periodically display periods of great excitement or euphoria,
delusions, or over-activity.
Lithium, some anticonvulsants (such as carbamazepine,
lamotrigine, valproate), and some atypical antipsychotics (for example,
aripiprazole, olanzapine, quetiapine) are the most common drugs used
for their mood stabilizing effects and in the control of mania. The most
effective antimanic medications, which are used primarily for bipolar
disorder, are the simple salts lithium chloride or lithium carbonate.
 Although some serious side effects can occur with large doses
of lithium, the ability to monitor blood levels and keep the doses within
modest ranges makes it an effective treatment for manic episodes, and it
can also stabilize the mood swings of the patient with bipolar disorder.
Lithium has a gradual onset of action, taking effect several weeks
following initiation of treatment. The precise mechanism of its action is
not known.
Other compounds used in the treatment of mania include valproic
acid, carbamazepine, gabapentin, benzodiazepines (e.g., clonazepam
and lorazepam), haloperidol, and chlorpromazine. These substances
reduce the transmission of nerve impulses in the brain and thereby
lessen the severity of manic episodes.
 Although experts do not fully understand how antimanic agents
work to stabilize episodes of mania, it is believed that they either
influence levels of chemical neurotransmitters in the brain, such as
dopamine, GABA, norepinephrine, or serotonin; or, when used as
anticonvulsants, reduce the excitability of nerve impulses in the brain.
An effective antimanic agent should:
• Reduce acute episodes of mania to a more manageable level
• Relieve symptoms such as agitation, inappropriate behavior, and sleep
problems
• Prevent symptom relapses and hospitalization.
How do Antimanic Drugs Work?
1. Lithium
If patients take an excessive amount of lithium, or if their normal salt
and water metabolism becomes unbalanced due to anorexia or fluid loss, they
can experience loss of control, drowsiness, fatigue, slurred speech, and
blurred vision, as well as more severe chaotic heart rhythm and brain-wave
activity with seizures. Since lithium is excreted in the urine with sodium,
rehydration and supportive therapy are all that is needed for treatment.
Prolonged use of lithium, on the other hand, can impair the body's ability to
react properly to the hormone vasopressin, which promotes water
reabsorption, leading to the emergence of diabetes insipidus, a condition
characterized by intense thirst and excessive production of very dilute urine.
Lithium may also interfere with the thyroid gland's response to a thyroxine-
stimulating hormone released by the pituitary gland.
2. Second-generation or atypical antipsychotic drugs (asenapine,
olanzapine, quetiapine, risperidone, aripiprazole)
Selective dopamine, 5-HT2A/C, alpha 1, histamine and
muscarinic receptor antagonists. Aripiprazole is a dopamine D2 and 5-
HT1A partial agonist and 5-HT2A receptor antagonist.
3. Carbamazepine
Reduces abnormal electrical activity in the brain by inhibiting
voltage-dependent sodium channels.
4. Valproate
Inhibits the breakdown and reuptake of the inhibitory
neurotransmitter gamma aminobutyric acid (GABA).
Mechanism of Action of Antimanic Drugs
Antimanic agents primarily block D2 dopamine receptors and 5-
HT2A serotonin receptors, which are protein molecules that initiate
excitatory action when stimulated by these neurotransmitters. Some
antimanic agents stimulate H1 histamine receptors in the central
nervous system, producing sedation and calming effects.
Side Effects of Antimanic Drugs
Mood stabilizers have different side effects depending on the type of
drug. Side effects are kept to a minimum for certain drugs by regularly
checking the amount of the drug in the blood. Some people have no side
effects. Others can be bothered by the side effects. Side effects normally
diminish as treatment progresses. The majority of people who take lithium,
about 75%, experience certain side effects, which may be mild. As the
body responds to the medication, it may become less bothersome after a
few weeks. Common side effects are:
• Weight gain
• Poor concentration
• Mental slowness
• Drowsiness or tiredness
• Hair loss
• Acne
• Being very thirsty
• Urinating more often than normal.
• It is possible that your thyroid gland produces less thyroid hormone
than normal.
• Your kidneys can filter waste products from your bloodstream less
efficiently.
Names of some
Antimanic drugs
Abilify
Aripiprazole is used to treat
certain mental/mood disorders (such
as bipolar disorder,
schizophrenia, Tourette's syndrome,
and irritability associated with
autistic disorder). It may also be used
in combination with
other medication to treat depression.
Aripiprazole is known as an
antipsychotic drug (atypical type). It
works by helping to restore the
balance of certain natural chemicals
in the brain (neurotransmitters).
Abilify Maintena
Abilify Maintena
(aripiprazole) is a prescription
medicine given by injection by a
healthcare professional for
maintenance treatment of bipolar.
Abilify MyCite
Abilify MyCite is a
prescription medicine of an
aripiprazole tablet with an Ingestible
Event Marker (IEM) sensor inside it
used in adults for the treatment of
bipolar I disorder alone or when
used with the medicine lithium or
valproate for acute (short-term)
treatment of manic or mixed
episodes and maintenance treatment.
 Aristada
Aristada Initio (aripiprazole
lauroxil) is a prescription medicine
given as a one-time injection and is
used in combination with oral
aripiprazole to start Aristada
(aripiprazole lauroxil) treatment, or re-
start Aristada treatment after a missed
dose, when Aristada is used for the
treatment of schizophrenia in adults.
• Aristada is a prescription medicine
given by injection by a healthcare
professional and used to treat
schizophrenia in adults.
• It is not known if Aristada are safe
and effective in children under 18
years of age.
 Carbamazepine
Carbamazepine is used to
manage and treat epilepsy, trigeminal
neuralgia, and acute manic and mixed
episodes in bipolar I disorder. Indications
for epilepsy are specifically for partial
seizures with complex symptomatology
(psychomotor, temporal lobe),
generalized tonic seizures (grand mal),
and mixed seizure patterns.
• Indicated for treatment of patients
with acute manic or mixed episodes
associated with bipolar I disorder
• Initial: 200 mg PO q12hr
• Increase by increments of 200
mg/day; not to exceed 1600 mg/day
Dosage
Lithium has been the first drug licensed in France (from the age
of 16) and in the USA (from the age of 12), with indications for acute
mania and preventive treatment. Benefits for impulsive and self-
aggressive behavior disorders (especially relevant in case of borderline
personality disorder) have also been documented, although lithium has
not been licensed in any country for those indications. Extended-release
tablets are usually used, at doses targeting for a lithiemia between 0.8
and 1.2mEq/L 12hours after last intake. Because of a narrow therapeutic
window and potential side effects (especially nephrotoxicity), lithium
prescription requires regular blood tests and good treatment compliance.