Section - Video Lectures

06. Management of Mania Without Mixed Features: The Role of Lithium (Node 2d)

Published on May 21, 2019 Expired on April 1, 2023

David Osser, M.D.

Associate Professor of Psychiatry - Harvard Medical School

Key Points

The first-line treatment for acute classic (nonmixed) mania is lithium. It has many advantages over the competition.
SGAs are reasonable alternative first-line agents, and quetiapine may be the first choice among them if its side-effect profile is acceptable.
The evidence base on valproate as an acute antimanic agent is much less impressive than commonly believed, and it appears to be overused in nonmixed mania. Its demonstrated maintenance effectiveness is also weak at best.

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Slides and Transcript

Slide 1 of 13

We come now to video 6 which is management of classic mania with psychopharmacology, mania without mixed features with particular emphasis on the role of lithium. We are at node 2d.

Management of Mania Without Mixed Features: The Role of Lithium (Node 2d) Slide 1 of 13

Slide 2 of 13

So why is that? What are the advantages of lithium? Well, it’s the only mood stabilizer that is decently effective for all phases of bipolar. It’s effective for acute mania. It prevents acute mania with good efficacy. It prevents depression. And there are reasons why lithium may be optimizable to make it a better treatment for acute mania but it seems to have the best overall track record on the various phases of mania both acutely and preventatively. And remember, we said in video number 1 that a key factor in choosing what to do for second and third is not only efficacy but ability to prevent the next episodes. And that’s where lithium is particularly outstanding. A second advantage of lithium is it’s the only bipolar med that has this clear evidence of effectiveness for suicide risk. It’s better than anything else we have. Nothing has been shown to actually have a specific anti-suicide risk except lithium. And finally, lithium is the only psychopharmacology medication with a clear neuroprotective effect. It actually enhances the functioning of cortical gray matter and hippocampal gray matter that may be critical in mood stabilization.

References:

Baldessarini, R. J., Tondo, L., Davis, P., Pompili, M., Goodwin, F. K., & Hennen, J. (2006). Decreased risk of suicides and attempts during long‐term lithium treatment: a meta‐analytic review. Bipolar disorders, 8(5p2), 625-639.
Hayes, J. F., Marston, L., Walters, K., Geddes, J. R., King, M., & Osborn, D. P. (2016). Lithium vs. valproate vs. olanzapine vs. quetiapine as maintenance monotherapy for bipolar disorder: a population‐based UK cohort study using electronic health records. World Psychiatry, 15(1), 53-58.
Hajek, T., Cullis, J., Novak, T., Kopecek, M., Höschl, C., Blagdon, R., … & Alda, M. (2012). Hippocampal volumes in bipolar disorders: opposing effects of illness burden and lithium treatment. Bipolar disorders, 14(3), 261-270.

Management of Mania Without Mixed Features: The Role of Lithium (Node 2d) Slide 2 of 13

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07. Classic Mania (Without Mixed Features): What if Response to Lithium Is Unsatisfactory? (Node 3)

Learning Objectives:

After completing this activity, the learner will be able to:

Outline the lines of management for bipolar mania and hypomania
Understand how to manage co-occurring conditions in bipolar mania

Original Release Date: May 21, 2019

Review and Re-release Date: March 1, 2023

Expiration Date: April 1, 2023

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Medical Academy designates this enduring activity for a maximum of 1.25 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.