Fast Five Quiz: Mood Disorders

Stephen Soreff, MD


October 01, 2019

According to the latest guidelines on bipolar disorder from the British Psychological Society and Royal College of Psychiatrists, questionnaires should not be used in primary care to identify bipolar disorder in adults. When diagnosing bipolar disorder in children or young people, mania must be present; euphoria must be present on most days and for most of the time, for at least 7 days; and irritability is not a core diagnostic criterion.

Among other recommendations for treatment, the guidelines state that if a patient develops moderate or severe bipolar depression and is not receiving a drug to treat their bipolar disorder, fluoxetine combined with olanzapine, or quetiapine on its own, should be offered, depending on the patient's preference and previous response to treatment. If the patient prefers, consider either olanzapine (without fluoxetine) or lamotrigine on its own. If the patient has no response to fluoxetine combined with olanzapine, or quetiapine monotherapy, consider lamotrigine on its own.

In addition, the guidelines recommend offering lithium as a first-line, long-term pharmacologic treatment for bipolar disorder and, if lithium is ineffective, consider adding valproate; if lithium is poorly tolerated, or is not suitable (eg, because the patient does not agree to routine blood monitoring), consider valproate or olanzapine instead or, if it has been effective during an episode of mania or bipolar depression, quetiapine. Measure plasma lithium levels 1 week after starting lithium and 1 week after every dose change, and weekly until the levels are stable. Aim to maintain the plasma lithium level between 0.6 and 0.8 mmol/L in patients who are prescribed lithium for the first time.

Classified as a mood stabilizer, lithium is one of the first drugs that has a preventive aspect and potential. It serves both to prevent the highs (manic phase) and the lows (major depression phase) of bipolar disorder. When taken as prescribed and if the proper lithium levels are maintained, many patients with bipolar disorder have fewer psychiatric hospitalizations.

Read more about the treatment of bipolar disorder.


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