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IJAMSCR |Volume 5 | Issue 2 | Apr - Jun - 2017
www.ijamscr.com
Review article Medical research
Bipolar disorder symptoms and its marketed drugs-a review
A.Madhusudhan Reddy P.Srinivasababu Y. Sai Tejaswi I.V.Sainadh S.Sai Madhuri
V. Sowmya V.Sowmya T.Joseph
Vignana pharmacy college Vadlamudi Guntur dt.Andhrapradesh India.
Corresponding Author: A. Madhusudhan reddy
Email id: msreddympharmgmail.com
ABSTRACT
Bipolar disorder is an illness of the brain that causes severe cycles in a person’s frame of mind mood energy
level thinking and activities. According to the criteria defined in Diagnostic and statistical manual DSM -IV-
TR people with Type I bipolar disorder will experience at least one episode of mania that may include mixed
depressive and hypomanic episode. Similarly for type II bipolar disorder patients may experience only
hypomanic and depressive episodes. But for Cyclothymic disorder they may be diagnosed by having not
experiencing any manic mixed and depressive episodes. They only experience numerous periods of both
depressive and hypomanic symptoms for minimum of 2 year or with symptom free period.
3
There are 4 types of bipolar diorders bipolarI II cyclothymia and bipolar disorder not specified. There is no
single known cause for bipolar disorder as many provoking factors act together to produce the bipolar disorder
illness. The symptoms that are seen in bipolar disorder are remarkable and erratic mood changes. The illness
may have two strongly contrasting phases: mania and depression.
Keywords: Bipolar disorder Diagnostic and statical manual Cyclothymic.
INTRODUCTION
Synonyms
Bipolar affective disorder bipolar illness manic
depression bipolar disease 1 4 Bipolar disorder is
an illness of the brain that causes severe cycles in a
person’s frame of mindmood energy level thinking
and activities. The disorder was first described by
French scientist Jules Baillarger in 1854 as “dual-
form mental illness.” The term Manic-depression was
coined by Emil Kraepelin.Later in 1980s Manic
depressive illness was replaced by Bipolar disorder as
the name was used psychiatrists to describe this
condition
4.
According to the criteria defined in Diagnostic
and statistical manual DSM-IV-TR people with
Type I bipolar disorder will experience at least one
episode of mania that may include mixed
depressive and hypomanic episode. Similarly for
type II bipolar disorder patients may experience
only hypomanic and depressive episodes. But for
Cyclothymic disorder they may be diagnosed by
having not experiencing any manic mixed and
depressive episodes. They only experience
numerous periods of both depressive and
hypomanic symptoms for minimum of 2 year or
with symptom free period 3.
ISSN:2347-6567
International Journal of Allied Medical Sciences
and Clinical Research IJAMSCR
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324
Bipolar disorder
4Bipolar disorder is considered as a brain
disorder that causes severe shifts inmood energy
level thinking and behavior aspects.
For example people with bipolardisorder may
often experience episodes of overly high “highs”
extreme irritability and depression conditions.
While everyone has good and bad moods and can
feel irritable the unprovoked and intense highs and
lows of people with bipolar disorder can be
unpredictable extreme and debilitating. Patients
with bipolar disorder can show four forms of mood
swings which includes: mania depression mixed
episodes and hypomania.
Bipolar disorder occurs in all age groups
young and old. Until recently bipolar disorder in
children and adolescents was thought to be an
extremelyrare condition but it may in fact be
more common than previously thought.However
not all children who have severe temper tantrums
or momentsof excessive moodiness irritability
and overexcitement have bipolardisorder. For
those with bipolar disorder the mood cycles
areprolonged severe and interfere with daily
functioning.4
Different types of bipolar disorder 6
Bipolar I disorder Manic or mixed episode with or without psychosis and/or major
depression
Bipolar II disorder Hypomanic episode with major depression no history of manic or mixed
episode
Cyclothymia Hypomanic and depressive symptoms that do not meet criteria for bipolar
II disorder no major depressive episodes
Bipolar disorder not
otherwise specified
Does not meet criteria for major depression bipolar I disorder bipolar II
disorder or cyclothymia e.g. less than one week of manic symptoms
without psychosis or hospitalization 6
Causes of bipolar disorder 4
There is no single known cause for bipolar
disorder as many provoking factors act together to
produce the bipolar disorder illness. Most recent
research points out that the leading contributor of
bipolar disorder is through the inherited from their
parents.
For example evidence clearly shows that
bipolar disorder mostly occurs in families having
their parents with bipolar disorder leading to 4 to 6
fold of increased risk of developing the illness.
This meansthat approximately 10 percent 1 in 10
of people who havea parent with bipolar I disorder
will develop the illnessthemselves. The risk is even
higher when full bipolar spectrum is considered.
Scientists are currently working to identify which
genes or the combinations of genes that are
influencing the risk for bipolar disorder.However
genes are not the only factor that cause bipolar
disorder but the studies of identical twins those
whoshare the same genes shows that other factors
are also involved. If bipolar disorder was
exclusively caused by genes then an identical twin
of someone with bipolar disorder would always
have to experience the illness themselves.
Research shows this is not the case. Other
biological social and emotional factors also must
play arole in the development of the disorder.For
example clinical experience suggests that trauma
or stressful life eventscan sometimes trigger an
episode of bipolar disorder in people who
aregenetically vulnerable. In fact new research has
found that stress hormonesmay change the way
genes function allowing illnesses like bipolar
disorderto emerge 4.
Suspection of bipolar disorder:
A family history of people experiencing
bipolar disorder or manic depression.
Problems with alcohol consumption.
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A history of complicated and disrupted
circumstances Eg. Includes multiple
relationships switching jobs frequently or
frequent change of address.
Symptoms of bipolar disorder in children and
adults 4
The symptoms that are seen in bipolar disorder
are remarkable and erratic mood changes. The
illness may have two strongly contrasting phases:
mania and depression.
SYMPTOMS DURING MANIC
EPISODES
Mood:
• Elevated or overjoyed mood without a clear
cause.
• Short-tempered angry or uncontrolled mood
that is out of proportion to anyreasonable
cause.
• Sad or empty moods.
• Feelings of hopelessness or pessimism.
• Feelings of guilt worthlessness or
helplessness.
• Lack of interest or delight in activities once
enjoyed.
• Physical injury that is not responsible for
causing pains.
• Irritability.
Thinking
• Having many thoughts at a time.
• Thoughts that change from one idea to another
without any correct judgement.
• Distractibility or inability to concentrate.
• Unrealistic and unshakable beliefs in one’s
abilities and powers.
• Thoughts of suicide or death or a suicide
attempt.
• Difficulty concentrating remembering and
making decisions.
Energy
• Prominent energy.
• Decreased need of sleep.
• Increased activity level.
• Decreased energy or a feeling of fatigue or
of being “slowed down.”
Behavior
• Increased activity level that coincides with
changes in mood thought or energy.
• Speech that is faster louder than usual more
difficult to interrupt.
• Flight of ides.
• Giddy silly goofy behavior that cannot be
stopped despitenegative consequences.
• Angry behavior that results in destroyed
property physical aggression crying.
• Inappropriate sexual behavior.
• Poor judgment.
• Restlessness or irritability.
• Sleeping too much or not enough
• Unintended weight loss or gain
• Social isolation.
ACCORDING TO THE DIAGNOSTIC
AND STATISTICAL MANUAL OF
MENTAL DISORDERS DSM-IV-TR
A manic episode is diagnosed if a person
suffers from multiple diagnostic symptoms that
last seven days or that require hospitalization.One
of the mood symptoms must be irritability or
elation to be diagnosedwith mania. Also these
symptoms cannot be explained by other medical
Neurologic or mental health conditions and
must impair or change thechild’s normal
functioning.
A depressive episode is diagnosed if a person
has a depressed mood or lossof interest or
pleasure along with a number of the
symptoms listed above thatlast most of the
day nearly every day for two weeks or
longer. In children andadolescents the mood
may be irritable rather than sad.
Children and adults with bipolar disorder
frequently shows depression along with
physical problems such as headache stomach
pain and feeling of tired.
4
Symptoms in depressive episode may 7
Feel very down or sad.
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Sleep too much or too little.
Feel like they can’t enjoy anything.
Feel worried and empty.
Have trouble concentrating.
Forget things a lot.
Eat too much or too little.
Feel tired or slowed down.
Have trouble sleeping.
Think about death or suicide7
The DSM-V criteria for episodes of mania and
depression 8
An episode of mania must involve a sustained
abnormalmood plus three of the following
features present orfour features if the patient’s
mood is irritable rather thanelevated to meet
DSM-V criteria.
Increased talkativeness.
Decreased need for sleep e.g. is rested after
threehours sleep.
Excessive involvement in high-risk activities.
A major depressive episode is defined by five
or more ofthe following symptoms that are
present at the same time for at least a two-
week period.
Depressed mood is seen almost every day.
Markedly reduced interest or pleasure in all or
almost all of the day’s activities.
Insomnia or hypersomnia nearly every day.
Feelings of worthlessness or excessive guilt.
MECHANISM OF ACTION OF
VARIOUS CLASS OF DRUGS 10
Phenothiazines
Ex: Chlorpromazine Fluphenazine Thioridazine
Thioxanthene
Thiothixene
MECHANISM OF ACTION
Blockade of dopaminergic receptors especially D2
receptors more than 5-HT2 receptors
Butyrophenone: Haloperidol
Mechanism of action
Blockade of dopaminargic receptors especially
D2 receptors more than 5-HT2 receptors Blockade
of dopaminergic receptors especially D2 receptors
more than 5-HT2 receptors
Atypicals
Aripiprazole Clozapine Olanzapine
Quetiapine Risperidone Ziprasidone
Mechanism of action
Blockade of histamine receptor particularly 5-
HT2 receptors more commonly than D2 receptors
Lithium
Mechanism of action
Uncertain suppresses IP3 and DAG signaling
Newer drugs for bipolar affective disorder:
Carbamazepine Lamotrigine Valproic acid
Mechanism of action
Carbamazepine: Blocks voltage-gated Na+
channels and decreases glutamate release
Lamotrigine: Blocks Na+ and Ca2+ channels
decreases glutamate
Valproic acid: Blocks high-frequency
firing.10
MEDICATION
Mechanism-Based Classification For Antidepressants 5
category mechanism example Current
classificationif any
1 Selective blockade of NE
reuptakeSNRIs
DMI NT amoxapine moprotiline
reboxetine
TCAs
2 Selective blockade of 5-HT
reuptake SSRIs
Citalopram fluoxetine paroxetine
sertraline
SSRIs
3 Nonselective enhancement of NE
and 5-HT transmission
IMI AMI phenelzine
tranylcypromine venlafaxine
TCAs
MAOIs
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mirtazapine
4 Unknown potent stimulatory
effects on NE or 5-HT
trimipramine bupropion nefazodone
trazodone
TCA
5-HT 5-hydroxytryptamine serotonin AMI
amitriptyline DMI desipramine IMI imipramine
MAOI
Monoamine oxidase inhibitor NE norepinephrine
NT nortriptyline SNRI selective norepinephrine
Reuptake inhibitor SSRI selective serotonin
reuptake inhibitor TCA tricyclic
antidepressant.20
B. Treatment Options
Marketed Drugs For Bipolar Disorder
9
Drug name Generic
name
Drug class Company
name
Brand names
Lamictal Lamotrigine
systemic
Triazine anticomvulsants Glaxosmithk
line llc
Lamotrigine
Seroquel Quetiaine
systemic
Atypical antipsychotic Astrazenica
pharms
Apotex inc
Alkem labs
ltd
Abilify Aripiprazol
e systemic
Atypical antipsychotic Alembic
pharms ltd
Accord
hlthcare
Aripiprazole
Klonopin Clonazepam
systemic
Benzodiazepinebenzodiazepineanti
convulsants
Roche
Alembic
pharms ltd
Apotex inc
glaxosmithk
line
Lamotrigine Lamotrigine
systemic
Triazine anticonvulsants Mylan
Aurabindo
pharma
pharma
Cipla Dr
reddys
Lamictal
lamictalodt
lamictal cd
Lithium Lithium
systemic
Miscellaneous antipsychotic agents Lithobid
Latuda Lurasidone
systemic
Atypical antipsychotic Sunovion
pharms
Depakote Divalproex
sodium
systemic
Fatty acid derivative anticonvulsants Abbvie
Risperdal Risperidone
systemic
Atypical antipsychotic Janseen
pharms
Seroquel
XR
Quetiapine
Systemic
Atypical antipsychotic Astrazeneca
Geodon Ziprasidone
systemic
Atypical antipshycotic Peizer
Sandoz inc
Mylan
pharms
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Lupin
pharm
Sapharis Asenapine
systemic
Atypical antipsychotic Forest labs
llc
Zyprexa Olazapine
systemic
Atypical antipsychotic Lilly
Clonazepam Clonazepam
systemic
Benzodiazepine benzodiazepine
anticonvulsants
Roche
Teva
Watson
Sandoz
Klonopin
Depakote
ER
Divalproex
sodium
systemic
Fatty acid derivative anticonvulsants Abbvie
Tegretol Carbamazep
ine
systemic
Dibenzazepine anticonvulsants Novartis
Taro pharm
inds
Wockhards
Quetiapine Quetiapine
systemic
Atypical antipsychotic Astrazeneca
pharms
Aurabindo
Alkem labs
ltd
Alembic
pharm ltd
Seroquel
seroquel XR
Divalproex
sodium
Divalproex
sodium
systemic
Fatty acid derivative anticonvulsants Abbvie
Mylan
Actavis labs
Anchen
pharms
Depakotedepa
kote ER
depakote
sprinkles
Gabapentin Gabapentin
systemic
Gama amino butyric analogs Pfizer
pharms
Pake davis
Alkem labs
ltd
Catapres Clonidine
systemic
Anti adrenergic agents centrally
acting
Mylan
Prinston lnc
Sun pharm
inc
unichem
Bupropion Buprapoin
systemic
Miscelleneous
antidepressentssmoking cession
agents
Valeantintl
Impax labs
mylan
Risperidone Risperidone
systemic
Atypical antipsychotic Janssen
pharms
Biopharma
inc
Apotex inc
Risperdalrisp
erdal consta
risperdal M-
tab
Seratraline Seratraline
systemic
Selective seratonin reuptake
inhibitor
Pfizer
Apotex inc
Aurabindo
pharma
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Carbamazep
ine
Carbamazep
ine
systemic
Dibenzazepine anticonvulsants Novartis
Wockhardt
Taro pharm
inds
Tegretol
equetrotegret
olXR
Oxacarbaze
pine
Oxacarbaze
pine
systemic
Dibezazepine anticonvulsants Novartis
Amneal
pharms
Sunpharm
inds ltd
REFERENCE
1. Bipolar Disorder from Wikipedia.
2. “The Two Types of Bipolar Disorder". Psych Central.com.Retrieved 2015.
3. Practice guideline for the treatment of patients with bipolar disorder second edition
4. Bipolar disorder parents’ medication guide for bipolar disorder in children adolescents.
5. Mechanism of action of antidepressants and mood stabilizers Robert H. Lenox Alan Frazer
6. Bipolar disorders: A review: Amy L. Price MD Eastern Virginia Medical School Norfolk
Virginia. Gabrielle R. Marzani-Nissen MD University of Virginia School of Medicine Charlottesville
Virginia
7. Bipolar disorder
8. Bipolar disorder: Identifying supporting patient in primary care
9. www.Drugs .com
10. katzung and trevors Pharmacology examination and board review-text book
How to cite this article: A.Madhusudhan Reddy P.Srinivasababu Y. Sai Tejaswi I.V.Sainadh S.Sai
Madhuri V. Sowmya V.Sowmya T.Joseph. Bipolar disorder symptoms and its marketed drugs-a
review. Int J of Allied Med Sci and Clin Res 2017 52: 323-329.
Source of Support: Nil. Conflict of Interest: None declared.