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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 323 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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 324 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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 325  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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 326  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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 327 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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 328 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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Madhusudhan A R et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-52 2017 323-329 329 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.