How Do Antimanic Agents Work?

Antimanic agents are medications used as mood stabilizersinpsychiatricconditions such asbipolar disorderandschizophrenia. In addition, some antimanic agentscontrolabnormalelectrical activity in thebrainand are used to treatneurologicalconditions such asepilepsyandtrigeminal neuralgia.

Antimanic agents controlmania, an extremely euphoric and excited mood associated with psychiatric disorders. Antimanic agents also controlinvoluntarymuscle收缩或paincaused by the abnormal firing ofnervecells (neurons). Antimanic agents work by regulating the chemicalbalanceand activity, and electrical activity in the brain.

Antimanic agents help reducemanicexcitement by acting on several neurotransmitters such asdopamine,serotoninandnorepinephrine, which are chemical messengers that neurons release to communicate with each other and stimulate activity.

Antimanic agents primarily block D2 dopamine receptors and 5-HT2A serotonin receptors, which areproteinmolecules that initiate excitatory action when stimulated by these neurotransmitters. Some antimanic agents stimulate H1histaminereceptors in thecentral nervous system, producing sedation and calming effects.

Antimanic agents prevent abnormal electrical impulses by stabilizing thesodiumchannels in neurons and reducing their electrical conductivity.

• Antimanic agents may be administered as:
• Oraltablets, capsules, solutions or suspensions
• Intramuscularorsubcutaneousinjections

Antimanic agents are used to treat the following conditions:

FDA-approved:

• Schizophrenia
• Bipolar I disordermania
• Majordepressive disorder
• Autism
• Tourette syndrome(a nervous system disorder involving repetitive movements or unwanted sounds)
• Epilepsy
• Trigeminalneuralgia
• Bipolar I disorder (manic or mixed episodes)
• Bipolar I disorder maintenance
• Agitation associated with schizophrenia and bipolar I mania
• Bipolardepression

Off-label uses:

• Restless legssyndrome
• Postherpetic neuralgia
• Chemotherapyassociatednauseaor vomiting
• Stuttering
• Alcoholdependence
• Insomnia
• Psychosisor agitation related to Alzheimerdementia
• Posttraumaticstressdisorder (创伤后应激障碍)

Orphan designation:

• N-glycanase 1 deficiency

Side effects of antimanic agents may include the following:

• Weight gain
• Headache
• Agitation
• Insomnia
• Anxiety
• Nausea
• Vomiting
• Akathisia(restlessness)
• Lightheadedness
• Increased appetite
• Constipation
• Dyspepsia(indigestion)
• Abdominaldiscomfort/pain
• Diarrhea
• Gastritis
• Anorexia(loss of appetite)
• Ataxia(impaired coordination, balance and speech)
• Dizziness
• 乏力
• Somnolence(drowsiness)
• Lethargy
• Sedation
• Confusion
• Increased waist circumference
• Increaseddiastolicblood pressure
• Tachycardia(rapid heartbeat)
• AbnormalECG
• Orthostatic hypotension(blood压力drop when standing up from sitting or lying down)
• Syncope(fainting)
• Hypotension(low blood pressure)
• Bradycardia(slow heartbeat)
• Palpitations
• Atrial fibrillation
• Chest pain
• Myocardial infarction(heart attack)
• Congestive heart failure(CHF)
• Aggravation ofhypertension/hypotension
• Aggravation ofcoronary artery disease
• Atrioventricularblock
• Bundle branch block (block of electrical impulse pathway to theheart)
• Arrhythmia(irregular heartbeat)
• Cardiomyopathy(heart muscledisease)
• 心肌炎(inflammationof heart muscle)
• Suddencardiacdeath
• Cerebrovascular disease
• Transient ischemic attack(strokecaused by reduced blood supply to the brain)
• Hypertriglyceridemia (hightriglyceridesin the blood)
• Hypercholesterolemia(highcholesterolin the blood)
• Hyperprolactinemia (increase in bloodprolactinlevels)
• Hyperglycemia(increase inblood glucoselevels)
• Increased HbA1c values
• Increase in bloodinsulinlevels
• Diabetic ketoacidosisandcoma
• Increasedcreatininephosphokinase
• Elevated levels ofliverenzymesALTandAST
• Liverinjury
• Jaundice
• Hepatitis
• Pancreatitis
• Hepatosplenomegaly(enlargement of liver andspleen)
• Liver failure
• Extrapyramidal symptoms (drug-induced movement disorders)
• Asthenia(weakness)
• Falls
• Accidental injury
• Xerostomia(dry mouth),soreand inflamedmouthandlips
• Dryness of thepharynx
• Rhinitis(inflammation of the鼻passage)
• Nasopharyngitis (inflammation of the鼻passage and pharynx)
• Rhinorrhea(runny nose)
• Cough
• Blurred vision
• Parkinsonism
• Tremor
• Pituitary adenoma(benigntumorin thepituitary gland)
• Drooling
• Dysgeusia(tastedisorders)
• Hyperacusis (sensitivityto sounds)
• Tinnitus(ringing in ears)
• Earpain
• Back pain
• Neck pain
• Connective tissueandbonedisorders
• Musculoskeletal stiffness
• Pain in extremities
• Muscle spasms
• Muscle rigidity
• Muscle weakness
• Myalgia(muscle pain)
• Arthralgia(jointpain)
• Dyskinesia(involuntary muscle movements)
• Enuresis(urinary incontinence)
• Nocturnal enuresis(bedwetting)
• Urinaryfrequency
• Urinary retention
• Dysuria(painful urination)
• Azotemia(increasedblood urea nitrogen[BUN] and creatinine)
• Renalfailure
• Ileus(temporary lack of intestinal musclecontraction)
• Intestinal obstruction
• Colonischemia(reduced blood supply to the colon)
• Fecaloma (impactedstool)
• Fecal incontinence
• Decreasedthyroidfunction
• Hypersensitivity reactions such as:
  • Rash
  • Pruritus(itching)
  • Urticaria(hives)
  • Angioedema(swelling in thetissueunder theskinormucousmembranes)
  • Laryngospasm and oropharyngealspasm(throatspasms)
  • Photosensitivity
  • Erythema multiforme(roundlesions like bullseye)
  • Erythematous nodosum (painfulbumpsunder the skin)
  • Exfoliativedermatitis(redness and peeling of the skin)
  • Generalized exanthematouspustulosis(pustular eruptions)
  • Onychomadesis (separation ofnailfrom nail bed)
  • Drug rash witheosinophiliaandsystemicsymptoms (DRESS)
  • Anaphylaxis(severeallergic reaction)
  • Stevens-Johnson syndrome(a rare medical emergency withflu-like symptoms and a painful rash)
  • Toxicepidermalnecrolysis (a severe skinconditionwith widespread redness, skincelldeath and exfoliation which can lead tosepsis)
• Aggravation oflupuserythematosus (anautoimmunedisorder)
• Infections
• Alopecia(hair loss)
• Diaphoresis (excessivesweating)
• Excessive salivation
• Excessive thirst
• Injection site pain and reactions
• Facialedema
• Pitting edema
• Decrease in weight
• Blood disorders such as:
  • Neutropenia(low levels ofneutrophil, a type ofimmunecell)
  • Increase or decrease in levels ofleukocytes
  • Agranulocytosis(lowgranulocytes, immune cells with granules)
  • Anemia(lowred blood cellcount)
  • Aplastic anemia(anemia due to reduced red cell production)
  • Pancytopenia(decrease in all types of blood cells)
  • Eosinophilia (high level of eosinophils, a type of immune cell)
  • Thrombocytopenia(decrease inplatelet count)
  • Thrombotic thrombocytopenic purpura(a rare disorder characterized by clotting in small blood vessels, resulting in a lowplateletcount)
  • Porphyria(a group of disorders that can cause nerve or skin problems)
• Bone marrowdepression
• Hemorrhage
• Epistaxis(nasal bleeding)
• Vasculitis(inflammation of blood vessels)
• Thrombophlebitis(inflammation of veins withblood clot)
• Thromboembolism(obstructionof a bloodvesselby a blood clot)
• Deep vein thrombosis(DVT)
• Pulmonary embolism
• Adenopathy(swelling of glands)
• Lymphadenopathy(swelling oflymphnodes)
• Hyperpyrexia (hightemperature)
• Dyspnea(shortness of breath)
• Pneumonia/pneumonitis (lung inflammation)
• Sleep apnea(interruptedbreathingduringsleep)
• Gynecomastia(breasttissue growth in males) in children
• Sexualdysfunction
• Precocious puberty
• Menstrualdisorders
• Vaginal discharge
• Impotence
• Retrogradeejaculation
• Priapism(persistent and painful erection)
• Aggressivereaction
• 爱说话
• Depression with agitation
• Amnesia(loss ofmemory)
• Schizophrenia
• Altered mental status
• Blunted affect(reduced ability to express emotions)
• Delirium
• Nightmares
• Autonomic instability (dysfunction of theautonomic nervous system)
• Depressed level of consciousness
• Peripheralneuritis(damage to peripheral nerves)
• Paresthesia(abnormal skin sensations)
• Dysphagia(swallowing difficulties)
• Hiccups
• Hypothermia(drop in body temperature)
• Oculogyric crisis (prolonged upward deviation of the eyes)
• Punctate (marked by tiny holes or dots)corticallensopacities
• Increasedocular压力
• Transientdiplopia(双活力ion)
• Visual hallucinations
• Nystagmus(involuntaryeyemovement)
• Conjunctivitis(inflammation of theconjunctiva,membraneover the whites of the eye and inner surface of eyelids)
• Teary eyes
• Eyedischargeand margin crusting
• Eye andeyelidswelling
• Dry eyes
• Ocular hyperemia (redness of eyes)
• Light sensitivity
• Reducedvisual acuity
• Glaucoma(a condition that damages theoptic nerve)
• Neurolepticmalignantsyndrome (a rare life-threatening drug reaction)
• Tardive dyskinesia(a neurological disorder that causes involuntary repetitive movements)
• Stuttering and other speech disorders
• Restless legs syndrome
• Rhabdomyolysis(breakdown ofskeletal musclecells)
• Seizure
• Status epilepticus(a medical emergency, when a seizure lasts longer than five minutes)
• Suicidalideation and attempt
• Pathological gambling
• Syndrome of inappropriate antidiuretic hormonesecretion (SIADH, a disorder which causeswater retention)
• Hyponatremia(reduced sodium levels in the blood)
• Reducedcalciumin the blood leading to骨质疏松症
• Immune hypersensitivity reaction
• Hypogammaglobulinemia (immune systemdisorder that preventsantibodyproduction)
• Drug withdrawal syndrome

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with yourdoctororpharmacistto make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking yourmedicationand never change your dose or frequency without consulting your doctor.

Genericand brand names of antimanic drugs include:

• Abilify
• Abilify Maintena
• Abilify MyCite
• aripiprazole
• Aristada
• Aristada Initio
• carbamazepine
• Carbamazepine Chewtabs
• Carbatrol
• Epitol
• Equetro
• olanzapine
• olanzapine/samidorphan
• Perseris
• quetiapine
• Risperdal
• Risperdal Consta
• risperidone
• Seroquel
• Seroquel XR
• Tegretol
• Tegretol XR
• Teril
• Zyprexa
• Zyprexa Relprevv
• Zyprexa Zydis