RESUMO
The important role of the omega-3 fatty acids in the pathophysiology and treatment of bipolar disorder is now supported by a substantial body of indirect and direct evidence. This paper will describe the clinical and pharmacological features of bipolar disorder, review the available data regarding omega-3 fatty acids in bipolar disorder and provide recommendations for future research.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Ácidos Graxos Ômega-3/uso terapêutico , Animais , Transtorno Bipolar/metabolismo , Ácidos Graxos Ômega-3/metabolismo , Humanos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Lithium remains a first-line treatment for the acute and maintenance treatment of bipolar disorder. Although much has been written about the management of the more common adverse effects of lithium, such as polyuria and tremor, more subtle lithium side effects such as cognitive deficits, loss of creativity, and functional impairments remain understudied. This report summarizes our experience in switching bipolar patients from lithium to divalproex sodium to alleviate such cognitive and functional impairments. METHOD: Open, case series design. RESULTS: We report seven cases where substitution of lithium, either fully or partially, with divalproex sodium was extremely helpful in reducing the cognitive, motivational, or creative deficits attributed to lithium in our bipolar patients. CONCLUSION: In this preliminary report, divalproex sodium was a superior alternative to lithium in bipolar patients experiencing cognitive deficits, loss of creativity, and functional impairments.
Assuntos
Transtorno Bipolar/tratamento farmacológico , Transtornos Cognitivos/induzido quimicamente , Lítio/efeitos adversos , Ácido Valproico/uso terapêutico , Adulto , Transtorno Bipolar/psicologia , Transtornos Cognitivos/prevenção & controle , Transtornos Cognitivos/psicologia , Criatividade , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Lítio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Motivação , Qualidade de VidaRESUMO
Considerable controversy exists regarding the relationship between fluoxetine and the emergence of suicidal ideation. Three cases are presented of patients who were reexposed to fluoxetine after having previously made a serious suicide attempt during fluoxetine treatment. All three patients developed severe akathisia during retreatment with fluoxetine and stated that the development of the akathisia made them feel suicidal and that it had precipitated their prior suicide attempts. The akathisia and suicidal thinking abated upon the discontinuation of the fluoxetine or the addition of propranolol. The emergence of suicidal ideation during treatment with fluoxetine may be secondary to the development of akathisia. Gradual increments of fluoxetine dose and the prompt recognition and treatment of akathisia may reduce further the rare occurrence of suicidal ideation during fluoxetine treatment.