Mania with Bupropion: A Dose-Related Phenomenon?

2000 ◽  
Vol 34 (5) ◽  
pp. 619-621 ◽  
Author(s):  
Jessica L Goren ◽  
Gary M Levin
Keyword(s):  
Affective Disorder ◽  
Bipolar Depression ◽  
Bipolar Affective Disorder ◽  
Antidepressant Drug ◽  
Manic Episode ◽  
Total Daily Dose ◽  
High Dose ◽  
Related Phenomenon ◽  
Increased Risk ◽  
Daily Dose

OBJECTIVE: To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania. CASE SUMMARY: A 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attrib uted to high-dose bupropion. DISCUSSION: Due to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Scientific literature supports this theory. CONCLUSIONS: A switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.

Lithium use in a patient on haemodialysis with bipolar affective disorder and lithium-induced nephropathy

2021 ◽  
Vol 14 (7) ◽  
pp. e242841
Author(s):  
Sam Topp ◽  
Emma Salisbury
Keyword(s):  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Dose Titration ◽  
Dialysis Session ◽  
Treatment Resistant ◽  
History Of ◽  
End Stage ◽  
Level Monitoring

Lithium is an effective mood stabiliser used to treat bipolar affective disorder (BPAD); however, it can also adversely affect the kidneys, causing acute toxic effects, nephrogenic diabetes insipidus, chronic renal dysfunction and end-stage kidney disease (ESKD) in a minority of patients. We describe the case of a man with a 34-year history of BPAD type-1 and a 2-year history of ESKD secondary to lithium-induced nephropathy who experienced a manic relapse. He previously responded well to lithium but, following a deterioration in kidney function, was switched to olanzapine and sodium valproate. This precipitated a period of instability, which culminated in a treatment-resistant manic episode requiring hospital admission. After a multidisciplinary team discussion, lithium therapy was restarted and provided remission. This was achieved safely through a reduced dosing schedule of three times a week post dialysis, slow dose titration and blood level monitoring prior to each dialysis session.

scholarly journals Neurocysticercosis presenting as bipolar disorder: a case report

2021 ◽  
Vol 34 (6) ◽  
pp. e100663
Author(s):  
Surbhi Batra ◽  
Sumit Kumar ◽  
Lokesh Singh Shekhawat
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Depressive Symptoms ◽  
Affective Disorder ◽  
Postpartum Period ◽  
Bipolar Affective Disorder ◽  
Taenia Solium ◽  
Manic Episode ◽  
Symptoms And Signs ◽  
Rule Out

Neurocysticercosis is the most common neuro-parasitosis caused by the larval stage of Taenia solium. The most common manifestations include seizures and hydrocephalus. Psychiatric abnormalities are relatively rare but depressive symptoms are frequent in patients with neurocysticercosis. However, mania as a presentation is relatively rare. Pregnancy and the postpartum period are relatively vulnerable times and they can lead to reactivation of existing neurocysterci lesions. We are discussing the case of a 23-year-old female patient with neurocysticercosis leading to the reactivation of lesions in the peripartum and postpartum period leading to bipolar affective disorder. Improvement in the patient was seen with a combination of antipsychotics, antihelmintics, antiepileptics and steroids, along with improved radiological signs of neurocysterci lesions. Although neurocysticercosis is a common illness, its prevalence presenting as a manic episode is merely 2.6% and, hence, missed easily. Therefore, it is important to rule out organic aetiology in patients even with a classic presentation of bipolar affective disorder and those having any other neurological symptoms and signs.

Bipolar illness

2013 ◽  
pp. 301-350
Keyword(s):  
Affective Disorder ◽  
Historical Perspective ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Spectrum Disorder ◽  
Bipolar Illness ◽  
Clinical Notes ◽  
Bipolar Spectrum Disorder ◽  
Hypomanic Episode ◽  
Depressive Episodes

Introduction Historical perspective Mania/manic episode Hypomania/hypomanic episode Bipolar spectrum disorder Bipolar (affective) disorder 1: classification Bipolar (affective) disorder 2: clinical notes Bipolar (affective) disorder 3: aetiology Bipolar (affective) disorder 4: management principles Other issues affecting management decisions Treatment of acute manic episodes Treatment of depressive episodes...

Strategically Playing with Fire: SGLT Inhibitors as Possible Adjunct to Closed-Loop Insulin Therapy

2021 ◽  
pp. 193229682110354
Author(s):  
Melissa-Rosina Pasqua ◽  
Michael A. Tsoukas ◽  
Ahmad Haidar
Keyword(s):  
Closed Loop ◽  
Glycated Hemoglobin ◽  
Total Daily Dose ◽  
Carbohydrate Counting ◽  
Closed Loop Systems ◽  
Increased Risk ◽  
Daily Dose ◽  
Potential Benefits ◽  
Routine Therapy

As closed-loop insulin therapies emerge into clinical practice and evolve in medical research for type 1 diabetes (T1D) treatment, the limitations in these therapies become more evident. These gaps include unachieved target levels of glycated hemoglobin in some patients, postprandial hyperglycemia, the ongoing need for carbohydrate counting, and the lack of non-glycemic benefits (such as prevention of metabolic syndrome and complications). Multiple adjunct therapies have been examined to improve closed-loop systems, yet none have become a staple. Sodium-glucose-linked cotransporter inhibitors (SGLTi’s) have been extensively researched in T1D, with average reductions in placebo-adjusted HbA1c by 0.39%, and total daily dose by approximately 10%. Unfortunately, many trials revealed an increased risk of diabetic ketoacidosis, as high as 5 times the relative risk compared to placebo. This narrative review discusses the proven benefits and risks of SGLTi in patients with T1D with routine therapy, what has been studied thus far in closed-loop therapy in combination with SGLTi, the potential benefits of SGLTi use to closed-loop systems, and what is required going forward to improve the benefit to risk ratio in these insulin systems.

Effects of season and climate on the first manic episode of bipolar affective disorder in Korea

2002 ◽  
Vol 113 (1-2) ◽  
pp. 151-159 ◽  
Author(s):  
Heon-Jeong Lee ◽  
Leen Kim ◽  
Sook-Haeng Joe ◽  
Kwang-Yoon Suh
Keyword(s):  
Affective Disorder ◽  
Bipolar Affective Disorder ◽  
Manic Episode

scholarly journals Thyroid Functions and Bipolar Affective Disorder

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Subho Chakrabarti
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Clinical Course ◽  
Lithium Treatment ◽  
Bipolar Affective Disorder ◽  
High Dose ◽  
Careful Monitoring ◽  
Genetic Studies ◽  
Treatment Refractory ◽  
Hpt Axis

Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition.

A Retrospective Case-Note Study of Bipolar Disorder in Old Age

1991 ◽  
Vol 158 (4) ◽  
pp. 485-490 ◽  
Author(s):  
John Snowdon
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Age Of Onset ◽  
Bipolar Affective Disorder ◽  
Manic Episode ◽  
Case Note ◽  
Retrospective Case ◽  
History Of ◽  
Study Case ◽  
Reason For Admission

In a replication of an earlier published study, case notes of 75 elderly in-patients with bipolar affective disorder were examined. Few of the patients had experienced a manic episode before the age of 40. Mean age of onset of affective disorder was 46 years, and first manic episode at 60 years. Cerebral insults before the first manic attacks were recorded in a substantial number of cases, and a family history of mental illness was less common among this group. Bipolar affective disorder is relatively common as a reason for admission of elderly patients.

A comparative study of the phenomenological features of bipolar depression versus unipolar major depression in chinese patients in a regional hospital in hong kong

2011 ◽  
Vol 26 (S2) ◽  
pp. 260-260
Author(s):  
S.M.Q. Wong
Keyword(s):  
Family History ◽  
Affective Disorder ◽  
Bipolar Depression ◽  
Conditional Logistic Regression ◽  
Bipolar Affective Disorder ◽  
Unipolar Depression ◽  
Chinese Patients ◽  
Time Interval ◽  
History Of ◽  
The Mean

ObjectivesTo determine the characteristics and time course of diagnostic conversion from unipolar depression to bipolar depression in a retrospective cohort of psychiatric outpatients, and to compare the clinical and sociodemographic profiles of the bipolar switch group against a matched group without conversion.MethodThis is a retrospective case-control study in which outpatients newly diagnosed of unipolar depression from 1st January 1994 to 31st December 1999 were reviewed. Those with conversion to bipolar depression were identified and controls were matched.Multivariate conditional logistic regression was carried out to identify predictors of bipolar switch.Results88 patients out of 823 were identified with bipolar switch. The mean age at switch was 37.58 years old. The mean time interval from presentation to conversion was 58.13 months. Sodium valproate was most commonly used after switch. Bipolar switch was associated with male sex (OR 2.601, 95% CI 1.279 – 5.291, p = 0.008), an earlier age at presentation of depression of < 37 years old (OR 2.238, 95% CI 1.136 – 4.409, p = 0.020), family history of bipolar affective disorder (OR 5.684, 95% CI 1.149 – 28.124, p = 0.033) and use of 3 or above different antidepressants in the first five years after presentation (OR 2.105, 95% CI 1.082 – 4.098, p = 0.028).ConclusionThe incidence of bipolar switch found in this study was 10.7%. Family history of bipolar affective disorder and frequent switch of antidepressants in depressive patients presenting at a young age can be helpful guidance for identification of those at high risk for a bipolar course.

scholarly journals Modern approaches to the treatment of bipolar affective disorder (a review of the recommendations of professional psychiatric association’s)

2019 ◽  
Author(s):  
Nataliya Maruta
Keyword(s):  
Affective Disorder ◽  
Bipolar Depression ◽  
Bipolar Affective Disorder ◽  
Treatment Algorithm ◽  
Professional Organizations ◽  
Adherence To Treatment ◽  
Treatment Algorithms ◽  
Treatment And Prevention ◽  
Three Stages ◽  
Relapse Therapy

The article provides recommendations on the treatment and prevention of bipolar aff ective disorder (BAD) with based on the guidelines of leading professional organizations. The article describes the treatment algorithms in three stages BAD: the acute phase (stopping), supportive and preventive (anti-relapse) therapy. Highlighted recommendations for the treatment of manic/hypomanic and mixed conditions; bipolar depression and BAD with a fast cycle. The article emphasizes that the choice of the drug is based not only on the level of its proven eff ectiveness and safety, but also on the analysis of clinical features (aff ect polarity, type of course, dominant symptomatology), somatoneurological status, comorbid patho logy and adherence to treatment Keywords: bipolar aff ective disorder, therapy, prevention, treatment algorithm

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