Podcast
Questions and Answers
What is the recommended treatment approach for clients struggling with medication adherence after a successful oral trial?
What is the recommended treatment approach for clients struggling with medication adherence after a successful oral trial?
For a newly diagnosed bipolar 1 patient with an IUD who desires long-term contraception, which medication is the best choice?
For a newly diagnosed bipolar 1 patient with an IUD who desires long-term contraception, which medication is the best choice?
Why is it essential to gather information about both unipolar and bipolar depression in a patient's family history?
Why is it essential to gather information about both unipolar and bipolar depression in a patient's family history?
Why should the distinction between unipolar and bipolar depression be made before deciding on a treatment plan?
Why should the distinction between unipolar and bipolar depression be made before deciding on a treatment plan?
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What strategy should be followed regarding the use of antidepressants in treating depression in patients with bipolar disorders?
What strategy should be followed regarding the use of antidepressants in treating depression in patients with bipolar disorders?
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Which medication can be considered if a bipolar patient wishes to avoid teratogenic effects and is planning for pregnancy?
Which medication can be considered if a bipolar patient wishes to avoid teratogenic effects and is planning for pregnancy?
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What is a common symptom of both unipolar and bipolar depression?
What is a common symptom of both unipolar and bipolar depression?
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Why should antidepressants be used cautiously in clients with bipolar disorder?
Why should antidepressants be used cautiously in clients with bipolar disorder?
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What is a crucial consideration when prescribing antidepressants to clients with bipolar disorder?
What is a crucial consideration when prescribing antidepressants to clients with bipolar disorder?
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Which of the following is a potential side effect of bipolar medication?
Which of the following is a potential side effect of bipolar medication?
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What should be considered when deciding on the use of mood stabilizers in bipolar disorder treatment?
What should be considered when deciding on the use of mood stabilizers in bipolar disorder treatment?
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Why is it important to gather insights from family members about the patient's condition?
Why is it important to gather insights from family members about the patient's condition?
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What is a common symptom shared by both unipolar and bipolar depression?
What is a common symptom shared by both unipolar and bipolar depression?
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Why is it important to gather insights from family members about the patient's condition?
Why is it important to gather insights from family members about the patient's condition?
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Which medication class can have common side effects in bipolar patients?
Which medication class can have common side effects in bipolar patients?
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What is a potential issue with using antidepressants in clients with bipolar disorder?
What is a potential issue with using antidepressants in clients with bipolar disorder?
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Why are patients more likely to talk about depression rather than mania or hypomania?
Why are patients more likely to talk about depression rather than mania or hypomania?
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What is a key aspect to consider when assessing a patient with unipolar and bipolar depression?
What is a key aspect to consider when assessing a patient with unipolar and bipolar depression?
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Why should antidepressants be used cautiously in clients with bipolar disorder?
Why should antidepressants be used cautiously in clients with bipolar disorder?
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What is a common symptom seen in patients with unipolar & bipolar depression?
What is a common symptom seen in patients with unipolar & bipolar depression?
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Why is it important to differentiate between unipolar and bipolar depression before treatment?
Why is it important to differentiate between unipolar and bipolar depression before treatment?
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What should be obtained when assessing a patient with unipolar and bipolar depression?
What should be obtained when assessing a patient with unipolar and bipolar depression?
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Which symptom is commonly associated with both unipolar and bipolar depression?
Which symptom is commonly associated with both unipolar and bipolar depression?
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What is a significant concern when considering the use of antidepressants in clients with bipolar disorder?
What is a significant concern when considering the use of antidepressants in clients with bipolar disorder?
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Which factor should be carefully monitored when prescribing medications to clients with bipolar disorder?
Which factor should be carefully monitored when prescribing medications to clients with bipolar disorder?
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What is a common challenge faced by individuals with unipolar and bipolar depression regarding eating habits?
What is a common challenge faced by individuals with unipolar and bipolar depression regarding eating habits?
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Why should antidepressants never be used as Monotherapy in clients with bipolar disorder?
Why should antidepressants never be used as Monotherapy in clients with bipolar disorder?
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What is a common symptom of unipolar & bipolar depression?
What is a common symptom of unipolar & bipolar depression?
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Which of the following symptoms is NOT commonly associated with unipolar & bipolar depression?
Which of the following symptoms is NOT commonly associated with unipolar & bipolar depression?
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What issue might individuals with unipolar & bipolar depression face regarding eating habits?
What issue might individuals with unipolar & bipolar depression face regarding eating habits?
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Which of the following is NOT a typical symptom of unipolar & bipolar depression?
Which of the following is NOT a typical symptom of unipolar & bipolar depression?
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Which symptom is commonly shared by both unipolar and bipolar depression?
Which symptom is commonly shared by both unipolar and bipolar depression?
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What is the first-line combination therapy for treating a manic episode with depressive features in bipolar 1 disorder?
What is the first-line combination therapy for treating a manic episode with depressive features in bipolar 1 disorder?
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Which neurotransmitter deficiencies are implicated in the monoamine hypothesis of depression?
Which neurotransmitter deficiencies are implicated in the monoamine hypothesis of depression?
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What is a potential consequence if antidepressant therapy is mistaken for bipolar depression treatment?
What is a potential consequence if antidepressant therapy is mistaken for bipolar depression treatment?
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What is one of the most common signs or symptoms of Major Depressive Disorder (MDD)?
What is one of the most common signs or symptoms of Major Depressive Disorder (MDD)?
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Why might some clients not be suitable candidates for combination therapy?
Why might some clients not be suitable candidates for combination therapy?
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What is the prevalence rate of Major Depressive Disorder (MDD) among adults between ages 18-25in the US?
What is the prevalence rate of Major Depressive Disorder (MDD) among adults between ages 18-25in the US?
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What happens if antidepressant therapy is used incorrectly in patients with bipolar disorder?
What happens if antidepressant therapy is used incorrectly in patients with bipolar disorder?
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Which medication class is considered first-line treatment for severe depression?
Which medication class is considered first-line treatment for severe depression?
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What happens if antidepressant therapy is mistaken for bipolar depression treatment?
What happens if antidepressant therapy is mistaken for bipolar depression treatment?
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Why is combination therapy useful for managing symptoms of Major Depressive Disorder (MDD)?
Why is combination therapy useful for managing symptoms of Major Depressive Disorder (MDD)?
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What may happen if antidepressant therapy for Major Depressive Disorder is incorrectly identified as treatment for bipolar depression?
What may happen if antidepressant therapy for Major Depressive Disorder is incorrectly identified as treatment for bipolar depression?
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Which neurotransmitters are associated with the monoamine hypothesis of depression?
Which neurotransmitters are associated with the monoamine hypothesis of depression?
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What is a sign or symptom commonly seen in patients with severe Major Depressive Disorder?
What is a sign or symptom commonly seen in patients with severe Major Depressive Disorder?
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What potential consequence might occur if combination therapy is not utilized when treating Major Depressive Disorder?
What potential consequence might occur if combination therapy is not utilized when treating Major Depressive Disorder?
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Which neurotransmitters are associated with major depressive disorder?
Which neurotransmitters are associated with major depressive disorder?
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What potential risk exists if antidepressant therapy is mistakenly used for bipolar depression?
What potential risk exists if antidepressant therapy is mistakenly used for bipolar depression?
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What percentage of adults in the US are affected by Major Depressive Disorder?
What percentage of adults in the US are affected by Major Depressive Disorder?
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In patients with severe depression, what may be a concerning symptom or experience?
In patients with severe depression, what may be a concerning symptom or experience?
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What risk is associated with using antidepressant therapy incorrectly in individuals under 25 years of age?
What risk is associated with using antidepressant therapy incorrectly in individuals under 25 years of age?
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What is the recommended duration for a trial of SSRI to achieve symptom relief?
What is the recommended duration for a trial of SSRI to achieve symptom relief?
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Which neurotransmitter is targeted by SSRIs?
Which neurotransmitter is targeted by SSRIs?
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What are the common side effects of SSRIs among patients?
What are the common side effects of SSRIs among patients?
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When do SSRIs adverse effects typically subside?
When do SSRIs adverse effects typically subside?
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Which SSRI has mild antihistamine effects?
Which SSRI has mild antihistamine effects?
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Which SSRI is recommended for patients who may forget to take their medication?
Which SSRI is recommended for patients who may forget to take their medication?
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Which SSRI can be given to a patient who takes multiple other medications for chronic conditions?
Which SSRI can be given to a patient who takes multiple other medications for chronic conditions?
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Study Notes
Bipolar Disorder Medication
- Aripiprazole IM is recommended after an oral trial to establish tolerability for clients with bipolar 1 disorder who struggle with medication adherence.
- Lithium is an appropriate medication for Jade, a 24-year-old with bipolar 1 disorder and acute mania, who has an IUD, as it is teratogenic and the IUD will prevent pregnancy.
- Lurasidone is a non-teratogenic alternative for clients who do not want long-term contraception or decide to get pregnant.
Unipolar and Bipolar Depression
- Family history is important to determine whether a patient has unipolar or bipolar depression.
- Patients tend to speak about their depression but not about mania or hypomania, so getting a family member's insight is crucial.
- Antidepressants can make someone manic or cause them to cycle more frequently, so an antidepressant-sparing strategy is recommended.
- Common symptoms of unipolar and bipolar depression include a depressed mood, loss of interest or pleasure, irritability, withdrawal, and problems with sleep, eating, energy, concentration, or self-worth, and thoughts of suicide or psychotic symptoms.
Medication Side Effects and Interactions
- Antidepressants are used cautiously in clients with bipolar disorder and never as monotherapy.
- Combination therapy may be required for symptom management and is useful when additional medications are needed to target depression symptoms.
- First-line combination therapy for bipolar 1 or manic episode with depressive features includes lithium or valproic acid + lamotrigine, aripiprazole, or risperidone.
Major Depressive Disorder (MDD)
- MDD is one of the most common mental disorders affecting approximately 7.1% of adults in the US.
- Signs and symptoms include a depressed mood, loss of interest or pleasure, irritability, withdrawal, problems with sleep, eating, energy, concentration, or self-worth, and thoughts of suicide or psychotic symptoms.
- First-line treatment for severe depression includes SSRIs, SNRIs, and bupropion.
- If antidepressant therapy for MDD is mistaken for bipolar depression, it may precipitate a manic episode or induce a rapid-cycle bipolar depression and contribute to the incidence of death by suicide in children and adults <25 years of age.
Monoamine Hypothesis of Depression
- Depression occurs due to a deficiency of one or all three monoamine transmitters (serotonin, norepinephrine, and dopamine).
- Monoamine neurotransmitters are norepinephrine, dopamine, and serotonin.
SSRIs
- SSRIs are considered the first-line treatment for depression.
- SSRIs take 4-6 weeks to achieve symptom relief, and a trial of 6-8 weeks is best.
- Sexual dysfunction is common with SSRIs.
- Adverse effects of SSRIs may subside after 4-5 days once the body adjusts to increased serotonin levels.
- SSRIs work by targeting 5HT to inhibit their reuptake.
- The SE of SSRIs include diarrhea, HA, weight gain, and sexual side effects.
- Seven side effects of SSRIs are stomach upset, sexual dysfunction, serotonin syndrome, sleep difficulties, suicidal thoughts, stress, and size increase (weight gain).
Prescribing Pearls
- Citalopram has mild antihistamine effects.
- Fluoxetine or escitalopram can be used in patients who may forget to take their medication, as they have no known drug interactions.
- Fluoxetine has the longest half-life of 2-3 days and can be given to patients who take multiple other medications for chronic conditions.
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Description
Test your knowledge on medication management for bipolar disorder patients presenting with acute mania episodes. Explore the use of long-acting injectable antipsychotic medications like aripiprazole in cases of poor medication adherence. Case scenarios involving Adam and Jade provide insight into treatment strategies.
