Treatment+in+Special+Population

 Specialized bipolar treatment is recommended for certain special populations. This is necessary because some medications that are used to treat the general population can be toxic and have other harmful effects for certain people. This section will describe bipolar treatments for pregnant women, the elderly and children and teens.
 * Special Populations: Pregnant Women, the Elderly and Children/Teen **

**__ Pregnant Women  __** ** Lithium ** · Lithium is given to pregnant women · Lithium has fewer risks to the developing fetus · Need to stay hydrated to prevent toxicity the women and the fetus · need to continue taking Lithium while giving birth, to prevent relapse of bipolar symptoms · breast fed newborns whose mothers take Lithium need to have their blood levels monitored

 ** Depakote ** · Depakote is harmful to fetuses so is not recommended for pregnant women · Depakote does not affect breast milk

·  Tegretol should only be  used if there are no other options · women who take Tegretol after conception incur more risk of serious side effects (such as rare blood disorder and liver failure) than women receiving treatment with Tegretol at the time of conception · Concentrations of Tegretol in breast milk is low and safe for the infant · Clozapine, Olanzapine, Quetiapine, and Risperidone are second-generation drugs; all other antipsychotic medications are referred to as First Generation Drugs · Some health care professionals suggest that a woman's medication be switched from lithium or an anticonvulsant to a first-generation antipsychotic medication for either the entire pregnancy or the first trimester · The switch appears to be especially beneficial for women who have benefited from mood stabilization with these medications in the past · No adverse indications in breast fed babies
 * Tegretol **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">
 * First Generation Antipsychotic medications **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">

** Second Generation Antipsychotic Medications **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Several second-generation antipsychotic medications have not yet been approved for maintenance therapy for bipolar disorder, including Seroquel and Risperdal <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Early studies indicate that Zyprexa used for the treatment of acute mania, is not associated with birth defects <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· However, Zyprexa has been associated with weight gain, gestational diabetes, and high blood pressure <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Weight gain, blood sugar levels, and blood pressure should be monitored carefully in all pregnant women taking Zyprexa.

** Tranquilizers and Sedatives **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Difficulty sleeping and anxiety are powerful triggers for the recurrence of episodes in bipolar disorder- Tranquilizers and sedatives, which help to regulate sleep, may reduce the risk of episodes during or after pregnancy <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Sedatives and hypnotics are excreted in breast milk, but there have been few reports of complications due to their use

** Electroconvulsive therapy **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· When used in women who are pregnant, ECT may pose fewer risks than untreated mood episodes or treatment with medications known to be harmful to fetus <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Complications of ECT during pregnancy are uncommon

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: #0000ff; font-family: 'Times New Roman',Times,serif;"> though little research has been done on the direct or indirect effects of non-pharmacological treatments, it is widely believed that psychotherapy can help improve functioning in social and occupational settings, minimize loss of sleep (which often precipitates mania), and help prevent relapses <span style="color: #0000ff; display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">**__ The Elderly __** <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· older patients have difficulty <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Side effects include ataxia, subjective complaints of memory problems, polyuria, and tremor <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">·  These side effects are more pronounced in elderly patients, who often have concomitant medical or neurologic illnesses
 * Psychotherapy **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">
 * <span style="color: #f17209; font-family: Times New Roman; msoansilanguage: EN-US; msobidifontsize: 12.0pt; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">Lithium **

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Carbamazepine (CBZ) and valproic acid (VPA) are better tolerated in the elderly <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· VPA, and to a lesser extent CBZ, has become the first-line treatment used in our geriatric mood disorders program for the acute treatment of mania <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">·  Many of the patients have clinical profiles similar to the <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The traditional antipsychotics are frequently used as the sole therapy of manic patients <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: #1403f7; mso-fareast-font-family: Calibri; msofareastfontfamily: Calibri; msospacerun: yes;"> These medications are useful as adjunctive pharmacotherapy and offer a number of advantages over traditional neuroleptics
 * Anticonvulsants **
 * Antipsychotics **

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· These agents, especially verapamil, are as effective as lithium in the treatment of mania <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The elderly are particularly vulnerable to the potential side effects of calcium-channel blockers, such as hypotension, sinus bradycardia, and atrioventricular block <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The rate of side effects may be increased when combining calcium-channel blockers with other agents used to treat mania, including lithium
 * Calcium-Channel Blockers **

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Electroconvulsive therapy (ECT) may be the ideal treatment for bipolar disorder- <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· The response rate to ECT is approximately 80% for depressive and manic symptoms
 * ECT **

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· conventional, first-generation antipsychotic medications used to treat elderly patients increases their risk of death from cardiovascular or respiratory diseases, compared to second generation, atypical antipsychotics <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· <span style="color: #1403f7; mso-fareast-font-family: Calibri; msofareastfontfamily: Calibri; msospacerun: yes;"> <span style="color: #1403f7; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">Increased risk of death in patients with dementia **__ Children and Teens __** ** Lithium **, **Risperidone** <span style="font-family: Times New Roman; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">, **Aripiprazole**<span style="msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· These are the only medications approved by the U.S. Food and Drug Administration (FDA) to treat bipolar disorder in young people <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Lithium can help treat and prevent manic symptoms in children ages 12 and older. <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· There is some evidence that lithium might act as an antidepressant and help prevent suicidal behaviour <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Risperidone and aripiprazole are a type of medication called an atypical, or second-generation, antipsychotic <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Short-term treatment with risperidone can help reduce symptoms of mania or mixed mania in children ages 10 and up <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">·  Aripiprazole is approved to treat these symptoms in children 10-17 years old who have bipolar
 * First Generation Antipsychotics **
 * <span style="color: #f17209; font-family: Times New Roman; msoansilanguage: EN-US; msobidifontsize: 12.0pt; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">Second Generation Antipsychotics **

<span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· For some children, anticonvulsants may work better than lithium <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Not every child can take lithium <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· If the child takes only an antidepressant, he or she may be at risk of switching to mania or hypomania <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· He or she may also be at risk of developing rapid cycling symptoms <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Rapid cycling is when someone has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Some antidepressants that may be prescribed to treat symptoms of bipolar depression are: <span style="color: #f17209; font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o<span style="color: #f17209; font: 7pt 'Times New Roman',Times,serif;"> Fluoxetine (Prozac) o Paroxetine (Paxil) <span style="color: #f17209; font-family: 'Courier New'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;">o Sertraline (Zoloft). <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Children and teens may also benefit from therapies that address problems at school, work, or in the community. <span style="color: #1403f7; font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol; msobidifontfamily: Symbol; msofareastfontfamily: Symbol; msolist: Ignore;">· Some psychotherapy treatments used for bipolar disorder include: ** Cognitive behavioural therap **<span style="color: #1403f7; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">helps young people with bipolar disorder learn to change harmful or negative thought patterns and behaviours. <span style="color: #1403f7; font: 7pt 'Times New Roman'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;"> <span style="color: #1403f7; mso-fareast-font-family: Arial; msofareastfontfamily: Arial; msospacerun: yes;"> ** Interpersonal and social rhythm therapy **<span style="color: #1403f7; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> helps children and teens with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. <span style="color: #1403f7; font: 7pt 'Times New Roman'; mso-fareast-font-family: 'Courier New'; msofareastfontfamily: 'Courier New'; msolist: Ignore;"> ** Psychoeducation **<span style="color: #1403f7; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;"> teaches young people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full- blown episode occurs. Psychoeducation also may be helpful for family members and caregivers. <span style="color: #333333; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-fareast-font-family: 'Times New Roman';"> includes a child's family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their child. This therapy also improves communication and problem-solving. <span style="color: #1a07cf; font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">
 * Anticonvulsant medications **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">
 * Antidepressant medications **<span style="color: #f17209; msoansilanguage: EN-US; msobidilanguage: AR-SA; msofareastfontfamily: 'Times New Roman'; msofareastlanguage: EN-US;">
 * Psychotherapy **