MH 701: Quiz 2, Module 4, Mood Stabilizers
Questions and answers with 100% correct
solutions | A+ Grade
Why are antidepressants as monotherapy not indicated in bipolar 1 disorder? ✔✔Not only are
they ineffective, but they may also trigger a shift into mania or rapid-cycling.
Which calcium-channel blocker may reduce the risk of antidepressant-induced mania? ✔✔Verapamil
Which 2 classes of medications are used in the DEPRESSED phase of bipolar illness? ✔✔Mood
stabilizers (No FDA approved, all off-label)
SGAs: Quetiapine, Olanzapine-Fluoxetine in combination (Symbyax), Lurasidone
How is borderline personality disorder (BPD) differentiated from bipolar disorder? ✔✔1. Timing:
BPD = mood changes occur within seconds to hours
Bipolar = mood changes typically take weeks to months
2. Mood:
BPD: Highly dependent on life events
Bipolar: Often independent of life's events
3. Incidence:
BPD: Common (6-10%)
Bipolar: Rare (1-3%)
,Can bipolar disorders co-occur with borderline personality disorder (BPD)? ✔✔Yes
Why is it important to differentiate between bipolar disorders and borderline personality disorder
(BPD)? ✔✔Bipolar disorders: Mainstay of treatment is pharmacology (although therapy may also
be helpful)
BPD: Medications tend to be ineffective. Therapy (e.g. DBT) is the most effective treatment.
What environmental trigger has been associated with manic episodes? ✔✔Sleep deprivation
What role do genetic factors play in Bipolar disorder? ✔✔Increased risk by up to 24x that first
degree relatives of people with bipolar 1 will also have bipolar 1
Which neurotransmitters are theorized to play a role in mania and depression? ✔✔Norepinephrine (NE)
and serotonin (5HT)
True or false. The mechanism of action of Lithium is clearly understood. ✔✔False
Is lithium more effective in treating the manic phase or the depressive phase of bipolar
illness? ✔✔More effective in mania
"Treats from above better than it treats from below"
Lithium is FDA approved for which phases of bipolar illness? ✔✔Bipolar mania
Bipolar maintenance
Used off-label for bipolar depression
, Why are atypical antipsychotics, benzodiazepines, and/or valproate (Depakote) initially used in
addition to lithium for acute mania? ✔✔Due to lithium's delayed onset of action
In an acute manic episode, how long does it take to see a response to lithium (with adequate
plasma levels)? ✔✔May take up to 1-3 weeks
Lithium may decrease the risk of__________________ in bipolar I, bipolar II, and unipolar depression.
✔✔Suicide, by 13 fold
If lithium (in therapeutic levels) is to be stopped, how is this done and why? ✔✔Taper gradually to
avoid relapse and possible suicide
What does this statement mean? Lithium has a narrow therapeutic index. ✔✔Lithium has a
narrow window between its therapeutic level and its toxic level.
The dose needed for therapy is uncomfortably close to the dose that will hurt or kill the patient.
What are lithium's side effects? ✔✔"LMNOP"
Lithium side effects:
Movement (tremors)
Nephrotoxicity/diabetes incipitus
hypOthyroidism
Pregnancy problems (teratogenic)
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