DR Medhat MRCP

• Treatment of bipolar disorder :
Treatment of episode of depression &/or mania when occur.
Mood stabilizers (long term ttt that prevent episodes of mania/hypomania)
Psychological therapy (e.g talking therapy).
Lifestyle advices.
Treatment of episode of mania/hypomania :
- If the patient developed an episode of mania or hypomania while he is already on
antidepressant , he should stop the medication.
- Drugs used in ttt of mania :
If the patient is not on any ttt for mania
• One of the following :
If the patient is already on ttt for mania
1) An Antipsychotic ( in severe disease) e.g
Olanzapine start with low
Quetiapine dose & check
Risperidone for SE esp. in DM.
2) Lithium
In mild symptoms or if it helped before
3) Valproate
(not used in pregnancy `teratogenic`)
4) A benzodiazepine (e.g diazepam )
Combined with one of the above to make
the patient calm & able to sleep.
Check the dose & if needed
If no improvement add
lithium or valproate
Check lithium blood level & dose if
low.
If no improvement add
antipsychotic
Dose if needed.
If no improvement add
antipsychotic
Used in combination with the above
drugs
Treatment of episode of depression :
- If the patient developed an episode of depression while he is already taking anti-manic
treatment , confirm that he is taking proper dose & if no improvement after the proper
dose , shift to other medications.
- If mild symptoms : no antidepressants + review within 2 weeks.
- If severe depression : add SSRI to anti- manic ttt (add Quetiabine if he is not on).
NB : Anti-manic ttt should be taken with anti-depressant as the later can cause mania
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