USMLE STEP 3 MCQ 36:A patient with suspected manic depression


A patient with suspected manic depression suffers from severe mood swings. The most appropriate treatment would be


a) selective Serotonin Re-uptake Inhibitors
b) St. Johns Wort
c) lithium
d) monoamine Oxidase Inhibitors
e) carbamazepine

Correct Answer: C


Lithium is used to help stabilise the mood-swings associated with Manic Depression. Lithium enhances the synthesis of 5-hydroxytryptamine (5HT) and is thought to increase the turnover of noradrenaline. Both of these are neuro-transmitters which control many of the functions disturbed during a manic, hypo-manic or depressive episode. It takes at least two weeks and often even longer for Lithium to become effective, and for some people Lithium has only a partial effect in stabilising mood swings, and for some people it has no effect at all. The level of Lithium in the Blood needs to be monitored closely and frequently. The side effects associated with Lithium therapy can include: thirst, increase in urine output, weight increase, gastro-intestinal disturbances, headaches and tremor. Lithium can also cause people to become dehydrated, so care must be taken to ensure an adequate fluid intake. Alcohol consumption should also be kept within sensible limits. Lithium has been used for about 25 years for the treatment of mania. Recently, it has received some research in its ability to prevent depression as well. However, approved use is currently for preventing manic episodes. Lithium is fairly rapidly and easily absorbed and is usually absorbed within 7-8 hours. Slow release lithium products are available on the market. However, most patients will take their lithium 2-3 times a day to keep adequate blood levels. Blood levels are checked on a regular basis to ensure that the lithium is in a therapeutic range. That is not too high or too low. High levels can produce vomiting, diarrhea, coordination problems, abdominal pain, sedation(to coma) and seizures. Occasional patients will have cardiac irregularities. Lithium can affect serum sodium and thyroid levels and these must be checked closely. It should be used with extreme caution-or not at all-with diuretics.

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