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08. Managing Geriatric Bipolar Disorder: Use of Lithium and Anticonvulsants

Published on September 20, 2017 Expired on March 31, 2022

Sandra A. Jacobson, M.D.

Research Associate Professor - University of Arizona

Key Points

  • Lithium
    • Serum levels are kept low (0.4-0.8 mEq/L), even for the treatment of mania
    • It is advised to dose it on a once nightly basis with an immediate acting formulation
  • Lamotrigine
    • The lengthy titration period in elderly patients limits its value as monotherapy
  • Valproate
    • The extended-release formulation (Depakote ER) and sprinkles provide steadier serum levels with reduced peak-level adverse effects

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Transcript

Now, we will talk about mood stabilizers. Selected concepts.
If a patient is presenting with a first manic episode in late life, a medical cause should be considered.

References

  1. Al Jurdi RK, Marangell LB, Petersen NJ, et al: Prescription patterns of psychotropic medications in elderly compared with younger participants who achieved a “recovered” status in the systematic treatment enhancement program for bipolar disorder . Am J Geriatr Psychiatry 16:922-933, 2008
  2. Jacobson SA. Clinical Manual of Geriatric Psychopharmacology, 2nd Ed. Washington, DC: American Psychiatric Publishing , Inc., 2014.
  3. D’Souza R, Rajji TK, Mulsant BH, et al: Use of lithium in the treatment of bipolar disorder in late-life . Curr Psychiatry Rep 13:488-492, 2011
  4. Singh LK, Nizamie SH, Akhtar S, et al.: Improving tolerability of lithium with a once-daily dosing schedule . Am J Ther 18:288-291, 2011

Learning Objectives:

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

  1. Review pharmacokinetic changes associated with aging and interpret how they influence prescribing decisions
  2. Recognize side effects of particular relevance in the elderly population
  3. List preferred agents and formulations for common psychiatric conditions in the elderly population

Original Release Date: 09/20/2017

Expiration Date: 03/31/2022

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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