Antimanic Drugs: Complete Study Guide

The antimanic drug, any medication that helps to control mood by reducing signs of mania, the abnormal psychological condition of excitement.

Mania is a serious type of emotional distress in which an individual becomes increasingly and excessively euphoric while also being hyperactive in speech and locomotor behaviour. This is often accompanied by severe insomnia, constant talking, extreme confidence, and an increase in appetite. As the episode progresses, the individual experiences racing thoughts, intense agitation, and incoherence, which are often replaced by delusions, hallucinations, and hysteria, and can eventually become aggressive and violent until collapsing. Periods of depression and mania alternate in some people, resulting in bipolar disorder.

The simple salts lithium chloride or lithium carbonate are the most common antimanic drugs, which are mainly used to treat bipolar disorder. While large doses of lithium can cause severe side effects, the ability to control blood levels and maintain doses within reasonable ranges makes it an effective medication for manic episodes, and it can also regulate the mood swings of bipolar disorder patients. Lithium has a progressive onset of action, taking place several weeks after treatment begins. The exact mechanism of action is unknown.

How Do Antimanic Drugs Work?

As previously discussed, the process by which mood stabilisers function is not completely known. The drugs are thought to function in a variety of ways to restore equilibrium and balance to regions of the brain that have become overstimulated and overactive or to prevent this condition from forming. They are thought to either affect the levels of chemical neurotransmitters in the brain, such as dopamine, GABA, norepinephrine, or serotonin, or, in the case of anticonvulsants, reduce the excitability of nerve impulses in the brain.

If patients take an excessive amount of lithium, or if their normal salt and water metabolism becomes unbalanced due to anorexia or fluid loss, they can experience loss of control, drowsiness, fatigue, slurred speech, and blurred vision, as well as more severe chaotic heart rhythm and brain-wave activity with seizures. Since lithium is excreted in the urine with sodium, rehydration and supportive therapy are all that is needed for treatment. Prolonged use of lithium, on the other hand, can impair the body's ability to react properly to the hormone vasopressin, which promotes water reabsorption, leading to the emergence of diabetes insipidus, a condition characterised by intense thirst and excessive production of very dilute urine. Lithium may also interfere with the thyroid gland's response to a thyroxine-stimulating hormone released by the pituitary gland.

Effective Antimanic Agent must:

• Reduce acute mania episodes to a more manageable level

• Relieve symptoms including agitation, inappropriate activity, and sleep disturbances.

• Prevent relapses of symptoms and hospitalisation.

Side Effects of Antimanic Drugs

Mood stabilisers have different side effects depending on the type of drug. Side effects are kept to a minimum for certain drugs by regularly checking the amount of the drug in the blood. Some people have no side effects. Others can be bothered by the side effects. Side effects normally diminish as treatment progresses. The majority of people who take lithium, about 75%, experience certain side effects, which may be mild. As the body responds to the medication, it may become less bothersome after a few weeks. Common side effects are:

• Weight gain

• Trouble remembering

• Poor concentration

• Mental slowness

• Hand tremor

• Drowsiness or tiredness

• Hair loss

• Acne

• Being very thirsty

• Urinating more often than normal.

• It is possible that your thyroid gland produces less thyroid hormone than normal.

• Your kidneys can filter waste products from your bloodstream less efficiently.

Relationship to Antidepressants

Most mood stabilisers are mainly antimanic agents, which means they are effective at treating mania as well as mood cycling and shifting but not acute depression. Lamotrigine, lithium carbonate, olanzapine, and quetiapine are the main exceptions to this law since they treat both psychotic and depressive symptoms.

Despite this, antidepressants are often administered in addition to mood stabilisers throughout depressive episodes. However, there are some dangers since antidepressants may cause mania, psychosis, and other troubling symptoms in people with bipolar disorder, particularly when taken alone. The possibility of antidepressant-induced mania, when given to patients who are also taking antimanic medications, is unknown, but it is possible. The vast majority of antidepressants tend to be unsuccessful in the treatment of bipolar disorder.

When antidepressants are administered to bipolar patients, they pose a number of risks. They are unsuccessful at treating acute bipolar disorder, preventing relapse, and can result in rapid cycling. Antidepressants have been shown in studies to be ineffective as compared to a placebo or another drug. Antidepressants can also increase the risk of non-lethal suicidal actions. Relapse may also be linked to antidepressant care. This is less likely to happen if a mood stabiliser is used in combination with an antidepressant, rather than an antidepressant used alone. Previous research indicates that antidepressant use is associated with rapid cycling. Rapid cycling is described as having four or more mood episodes within a year. Evidence indicates that after the widespread use of antidepressant medication, fast cycling and mixed symptoms have become more popular. Because of the risks associated with antidepressant medication, there is a need for caution when treating bipolar patients with it.

Examples of Antimanic Drugs or Mood Stabilisers

Lithium

One of the most commonly used and researched drugs for bipolar disorder is lithium (Eskalith, Lithobid). Mania is less severe and occurs less often when lithium is taken. It may also aid in the treatment or prevention of bipolar disorder. Lithium has been shown in studies to substantially reduce the risk of suicide. Lithium also aids in the prevention of possible bipolar and depressive episodes. As a result, it can be prescribed as maintenance therapy for extended periods of time (even between episodes).

Lithium has an impact on the central nervous system (brain and spinal cord). Doctors aren't sure how lithium acts to regulate a person's mood, but it is thought to help improve nerve cell connections in brain regions involved in mood, perception, and behaviour regulation.

Lithium typically takes several weeks to start working. Since lithium can impair kidney or thyroid function, doctors can prescribe blood tests on a regular basis during care. Lithium performs better when the volume of the medication in the body remains constant. It is important that the body's lithium levels are not too low or too high. During recovery, doctors will generally advise drinking eight to twelve glasses of water or fluid a day and including a normal amount of salt in the diet. Since both salt and fluid will influence the levels of lithium in blood, it's important to drink a consistent amount every day.

The dose of lithium varies depending on the person and the stage of their illness. While bipolar disorder is often treated with several medications, some people can manage their condition with lithium alone.

Lithium Side Effects

Around 75% of people who take lithium for bipolar disorder experience certain side effects, which could be mild. When the body responds to the medication, it may become less bothersome after a few weeks. Side effects of lithium can often be relieved by adjusting the dosage. There are a few significant dangers to consider. The drug has been linked to some birth defects and should be avoided by pregnant women, especially during the first three months of pregnancy. The protection of breastfeeding when taking lithium is debatable and should be discussed with the doctor ahead of time. Long-term lithium therapy may also interfere with kidney function or cause irreversible kidney damage in certain patients, which is why blood tests to determine kidney function should be done on a regular basis.

Anticonvulsants

Many agents classified as "mood stabilisers" are also anticonvulsants. This class is often referred to as "anticonvulsant mood stabilisers." Although this category is often characterised by effect rather than function, most anticonvulsants used in the treatment of mood disorders have at least a preliminary understanding of their mechanism.

Valproate – This medication is available in an extended-release form. This medication can be extremely irritating to the stomach, especially when taken as a free acid. The function of the liver and the CBC should be controlled.

Lamotrigine – FDA-approved for bipolar disorder maintenance treatment only, not for severe mood disorders such as depression or mania/hypomania. The typical target dose is 100–200 mg per day, titrated in 25 mg increments every two weeks. Stevens-Johnson syndrome, an uncommon but potentially fatal skin disease, may be caused by lamotrigine.

Carbamazepine – This medication has been approved by the FDA for the treatment of acute manic or mixed symptoms in people with bipolar disorder type I. Carbamazepine can rarely cause agranulocytosis, a dangerous decrease in neutrophils, a form of a white blood cell. It interacts with a wide range of drugs, including mood stabilisers (such as lamotrigine) and antipsychotics (e.g. quetiapine).

Conclusion

Any drug that helps to stabilise mood by reducing mania symptoms is considered an antimanic drug. Mania is a severe form of emotional disorder in which a person becomes excessively euphoric. The most popular antimanic medications are the simple salts lithium chloride or lithium carbonate, which are mostly used to treat bipolar disorder. Lithium has a gradual onset of action that occurs several weeks after treatment starts. Large doses of lithium may have serious side effects, but the ability to monitor blood levels and keep doses within safe limits allows it an effective treatment for psychotic episodes. Antidepressants can induce mania, psychosis, and other disturbing symptoms in people with bipolar disorder. The majority of mood stabilisers primarily act as antimanic agents. They are effective in treating mania, mood cycling, and mood shifting, but not in treating acute depression. Some people experience no side effects, while others can find them upsetting. Side effects usually fade as the procedure progresses. The vast majority of people who take lithium, about 75%, do not experience any side effects.