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Bipolär sjukdom – profylaktisk behandling med litium eller valproinsyra?
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2016 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund: Bipolär affektiv sjukdom är en kronisk psykisk sjukdom som drabbar cirka 2-3% av befolkningen. Etiologin till bipolär sjukdom är okänd, dock spelar både miljö och genetik en viktig roll. Sjukdomen kännetecknas av perioder med depression omväxlande med perioder av mani. Symptomen uppkommer i skov som då behandlas akut, men det är långtidsbehandling som är essentiell för bipolärt sjuka patienter då den i viss mån förhindrar uppkomsten av nya affektiva episoder. Vid bipolär sjukdom används profylaktiskt stämningsstabiliserande läkemedel såsom litium och antiepileptiska läkemedel som valproat. Dessa mediciner kan användas som monoterapi, i form av kombinationsbehandling med varandra eller med andra läkemedel. Sedan mer än 60 år tillbaka är litium förstahandsvalet för profylaktisk behandling av bipolär sjukdom, dock har litium en rad besvärliga biverkningar. Näst mest använda läkemedlet för långtidsprofylax är valproinsyra som har en mildare biverkningsprofil. Syfte: Syftet med detta examensarbete var att jämföra litiumbehandling med valproinsyrabehandling som profylax vid bipolär sjukdom. Metod: Detta examensarbete är en litteraturstudie där kliniska studier och andra vetenskapliga artiklar granskades. Sökandet efter artiklar skedde i databasen PubMed, där fyra kliniska studier och en epidemiologisk kohortstudie valdes. I artiklarna jämfördes litium med valproat som profylaktisk behandling av bipolär sjukdom. Resultat: Endast den epidemiologiska kohortstudien konstaterade att litium var överlägsen valproat som profylaktisk behandling vid bipolär sjukdom. Kliniska studier fann däremot inga signifikanta skillnader mellan profylaktisk behandling med litium eller valproat. Slutsats: Lättare läkemedelshantering, inte lika täta blodkontroller, mildare biverkningar samt likvärdig effekt med litium bidrar till att valproat kan utgöra ett bättre alternativ än litiumbehandling som profylaktisk behandling av bipolär sjukdom.

Abstract [en]

Background: Bipolar affective disorder is a chronic mental illness that affects approximately 2-4% of the population. The etiology of bipolar disorder is unknown, nevertheless both environment and genetics play important roles. The disease is characterized by periods of depression alternating with periods of mania. Patients get symptoms now and then but between these periods act as normal. When being in a mood episode patients get treatment to deal with this, but the most essential treatment for bipolar patients is the long-term treatment. Prophylactic treatment is very important because it prevents to some extent the occurrence of new affective episodes. Medications that are commonly used to treat bipolar disorder include mood stabilizers such as lithium and anticonvulsants such as valproate/valproic acid.

These drugs can be used as monotherapy, in combination therapy with each other or with other medications. Lithium has been used for more than 60 years and it is still the first choice medication to treat bipolar disorder. Indeed, lithium is frequently used as prophylaxis to treat bipolar disorder, however it can have potentially serious side effects. These side effects include for instance deterioration in the functioning of the thyroid gland and kidneys. The second most commonly used drug for long-term treatment is valproic acid which does not have such severe side effects.

Objective: The aim of this study was to compare the efficiency of lithium with that of valproate and find out whether or not valproate is superior to lithium for maintenance monotherapy of bipolar disorder patients. 

Method: This study is a literature review in which clinical studies and other scientific articles were analyzed. The PubMed database was used to search for articles. Four clinical studies and one observational register-based cohort study were selected. In these articles lithium was compared with valproate for prophylaxis of bipolar disorder.

Results: Only the epidemiological observational cohort study found that lithium was superior to valproate as maintenance monotherapy treatment of bipolar disorder. Clinical studies, however, found no significant differences between prophylactic treatment with lithium or with valproate.

Conclusions: Valproate can be a better option than lithium as a maintenance treatment of bipolar disorder because of a variety of reasons. Valproate is easier to dose, requires not as frequent blood checks as for lithium, has a less severe side effects profile and is as good as lithium as a prophylactic treatment of bipolar disorder patients. 

Place, publisher, year, edition, pages
2016. , 33 p.
Keyword [sv]
Bipolär sjukdom, profylaktisk behandling, litium, valproinsyra, valproat
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-52072OAI: oai:DiVA.org:lnu-52072DiVA: diva2:919448
Subject / course
Pharmacy
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2016-04-14 Created: 2016-04-13 Last updated: 2016-04-14Bibliographically approved

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