Treatment

• Anti-manic drugs
• Anti-depressants
• Mood stabilising drugs
• Lithium
• Depot medication

Anti-manic drugs

Drugs used to treat manic or hypomanic symptoms (anti-manic drugs) include:

• Olanzapine
• Risperidone
• Quetiapine
• Amisulpride
• Sulpride
• Chlorpromazine
• Haloperidol
• Fluphenazine
• Flupenthixol

These drugs are described as anti-psychotics and are used to treat long term symptoms as well as in higher doses by injection for hypo manic/manic relapses.

Some people in the community be may be treated with depot preparations (long acting forms of the drug given by injection) of anti-psychotic agents such as haloperidol.

Anti-depressants

Drugs used to treat depressive symptoms (anti depressants).

There is a wide range of different drugs available. The individual drugs are listed below [trade name in brackets] together with some of the more common side effects.

• Citalopram [Cipramil]
• Fluoxetine [Prozac]
• Fluvoxamine [Faverin]
• Paroxetine [Seroxat]
• Sertraline [Lustral]

Side effects of the above include nausea, diarrhoea, headache, insomnia, agitation and sexual dysfunction. Some of these medicines may cause adverse effects if suddenly stopped.

• Amitriptylline [Lentizol]
• Amoxapine [Asendis]
• Clomipramine [Anafranil]
• Dosulepin/Dothiepin [Prothiaden]
• Doxepin [Sinequan]
• Imipramine [Tofranil]
• Lofepramine [Gamanil]
• Nortriptylline [Allegron, motipress, motival]
• Trimipramine [Surmontil]

Side effects include irregularity of heart rhythm, low blood pressure, drowsiness, convulsions, hence dangerous in overdose and can cause death. Can also cause blurred vision, dry mouth, constipation and urinary retention. All of these can reduce compliance with treatment.

Drowsiness and blurred vision may be dangerous for those who drive, operate machinery or work at heights.

3. More recently introduced anti depressants include the following:

• Venlafaxine [Efexor, Efexor XL]
• Reboxetine [Edronax]
• Mirtazapine [Zispin]
• Moclobemide [Manerix]
• Brofaromine
• Cimoxatone
• Toloxatone
• Mianserin
• Maprotiline
• Trazodone [Molipaxin]
• Flupenthixol/flupentixol [Fluanxol]

Mood stabilising drugs

This term includes all the antidepressant drugs listed at 2 and 3 above and:

Note: Whilst the level of medication may be helpful, it should not be used on its own to determine the level of functional restriction.

Lithium

Lithium salts (lithium carbonate and lithium citrate) are given by mouth on a long-term basis to prevent the occurrence of further episodes of mania or depression, and maintain a stable mood. Lithium is more successful in preventing recurrence of symptoms of mania than those of depression. The amount of lithium in the blood needs to be monitored by regular blood tests to ensure that the dose is effective. The dose is tailored to stabilise mood in the individual person. A typical daily dose would be 600mg per day.

Blood tests may need to be taken frequently if the lithium dose is being increased. Lithium may affect the function of the thyroid gland and at high blood levels may damage kidney function. Inter current illnesses such as gastro-enteritis may precipitate the toxic effects of lithium. People taking lithium are required to have regular blood tests to monitor kidney and thyroid function every 3-6 months, in addition to those to measure the amount of lithium in the blood.

Depot medication

Depot medication is a long acting preparation of the drug given by injection, which releases the medication slowly into the body over several weeks. Medication is given in this way to those people who are unable to be reliable about taking oral medication on a daily basis. Injections may be given on a 2, 3 or 4 weekly basis. It is unusual for people with mania/hypomania to be treated with depot injections on a long-term basis and is likely to indicate a severe condition.

Drugs and typical dosages used include:

Click on link below for full details of:

• Other forms of treatment/management
• Dis-inhibited and Anti-social behaviour
• EMC medication website

Amended December 2010