Hockenbury Discovering Psychology 5th txtbk

Biomedical Therapies611LithiumIn Chapter 13, on psychological disorders, we described bipolar disorder, previouslyknown as manic depression. The medication most commonly used to treat bipolardisorder is lithium, a naturally occurring substance. Lithium counteracts bothmanic and depressive symptoms in bipolar patients. Its effectiveness in treatingbipolar disorder has been well established since the 1960s (Preston & others, 2008).As a treatment for bipolar disorder, lithium can prevent acute manic episodesover the course of a week or two. Once an acute manic episode is under control, thelong-term use of lithium can help prevent relapses into either mania or depression.The majority of patients with bipolar disorder respond well to lithium therapy.However, lithium doesn’t help everyone. Some people on lithium therapy experiencerelapses (Nierenberg & others, 2007).Like all other medications, lithium has potential side effects. If the lithium levelis too low, manic symptoms persist. If it is too high, lithium poisoning may occur,with symptoms such as vomiting, muscle weakness, and reduced muscle coordination.Consequently, the patient’s lithium blood level must be carefully monitored.How lithium works was once a complete mystery. Lithium’s action was especiallypuzzling because it prevented mood disturbances at both ends of the emotionalspectrum—mania and depression. It turns out that lithium affects levels of an excitatoryneurotransmitter called glutamate, which is found in many areas of the brain.Apparently, lithium stabilizes the availability of glutamate within a narrow, normalrange, preventing both abnormal highs and abnormal lows (Dixon & Hokin, 1998;Keck & McElroy, 2009).Bipolar disorder can also be treated with an anticonvulsant medicine called Depakote.Originally used to prevent epileptic seizures, Depakote seems to be especiallyhelpful in treating those who rapidly cycle through bouts of bipolar disorder severaltimes a year. It’s also useful for treating bipolar patients who do not respond tolithium (Davis & others, 2005).Antidepressant MedicationsThe antidepressant medications counteract the classic symptoms of depression—hopelessness, guilt, dejection, suicidal thoughts, difficulty concentrating, and disruptionsin sleep, energy, appetite, and sexual desire. The first generation of anti -depressants consists of two classes of drugs, called tricyclics and MAO inhibitors(see Table 14.9 on the next page). Tricyclics and MAO inhibitors affect multipleneurotransmitter pathways in the brain. Evidence suggests that these medicationsalleviate depression by increasing the availability of two key brain neurotransmitters,norepinephrine and serotonin. However, even though brain levels of norepinephrineand serotonin begin to rise within hours of taking a tricyclic or MAO inhibitor,it can take up to six weeks before depressive symptoms beginto lift (Thase & Denko, 2008).Tricyclics and MAO inhibitors can be effective in reducing depressivesymptoms, but they can also produce numerous side effects (Holsboer,2009). Tricyclics can cause weight gain, dizziness, dry mouth and eyes,and sedation. And, because tricyclics affect the cardiovascular system, anoverdose can be fatal. As for the MAO inhibitors, they can interact witha chemical found in many foods, including cheese, smoked meats, andred wine. Eating these foods while taking an MAO inhibitor can result indangerously high blood pressure, leading to stroke or even death.The search for antidepressants with fewer side effects led to thedevelopment of the second generation of antidepressants. Secondgenerationantidepressants include trazodone and bupropion. Althoughchemically different from the tricyclics, the second-generation antidepressantswere generally no more effective than the first-generationones, and they turned out to have many of the same side effects.Lithium Water Lithium salt, a naturallyoccurring substance, was used in manyover-the-counter medicines before it wasdiscovered to be helpful in the treatmentof mania. As this late-nineteenth-centuryad shows, small amounts of lithium saltwere also added to bottled water. An earlyversion of the soft drink 7-Up includedsmall amounts of lithium (Maxmen & Ward,1995). Marketed as “lithium soda,” the adcampaign claimed that it was the drinkthat took “the ouch out of the grouch!”Medication and Mood Disorders: SineadO’Connor Medication can produce seriousside effects and doesn’t help everyone whosuffers from depression or bipolar disorder.But for some, medication can be a lifesaver.Controversial Irish singer Sinead O’Connorsuffered from depression in her twenties,attempted suicide in her early thirties, andwas finally diagnosed with bipolar disorderin her late thirties. “The best way I can describeit to you is you’re so sad, just terriblysad, that you’re likea bucket of waterwith holes in it.Every pore of you iscrying and you don’teven understandwhy or what,”O’Connor said. Butafter she begantaking lithium andother medications,her moods and behaviorstabilized. “Iactually kind of diedand got born againas a result of takingthe meds and havinga chance to, youknow, build a life.”