Bipolar Disorder and Compulsive Behavior
Bipolar disorder is characterized by alternating periods of mania and depression. The manic phase can be productive but can also be disruptive and physically exhausting. Bipolar disorder often responds to treatment with lithium, which is rapidly absorbed from the GI tract and is distributed throughout the body. Lithium may reduce neuronal activity by inhibiting cellular phosphoinositide pathways involving the second messengers inositol trisphosphate and diacylglycerol. Compulsive behaviors impair social interaction and disrupt daily activities. OCD affects at least 2% of the population (males and females approximately equally), with a genetic predisposition. The TCA clomipramine and SSRIs are usually chosen for OCD therapy. Other drugs, given individually or as combination therapy, include different TCAs, lithium, buspirone, clonazepam, dopamine antagonists (eg, haloperidol), and trazodone. Drugs used together with behavioral or psychosocial therapy are usually optimal.