Tackling Bipolar Disease with Impulsivity: The Role of Endoxifen
Abstract
Bipolar disorder (BD) is characterized by mood changes, and traits of impulsivity are often reported in these patients. Alcohol use disorder is also reported among patients with BD. Protein kinase C is known to be involved in the pathogenesis of BD, and there are reports on its link to impulsivity as well as alcohol use disorder. Thus, the use of a protein kinase C inhibitor, such as endoxifen, could address all three conditions. We present a case of a male patient with BD who displayed impulsivity and alcohol abuse. Initial management with combination therapy was not successful in reducing symptoms. The addition of endoxifen to the treatment allowed the reduction of dosage of sodium valproate and lithium and led to a rapid improvement in symptoms. This report showcases the utility of endoxifen in the management of bipolar disorder.
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Introduction
Bipolar disorder is a chronic mental health disorder characterized by drastic mood changes. Bipolar mania is linked to overactive protein kinase C (PKC) signaling. Patients experience acute manic or mixed episodes, with changes in mood, energy, and activities.1 Impulsivity is also noted in patients with bipolar disorder during periods of acute mania. This behavior encompasses uncontrolled expenditure and suicide attempts.2 Furthermore, there are reports that patients with comorbid bipolar disorder and alcohol use disorders demonstrate greater impulsivity compared with bipolar disorder patients without alcohol misuse. Conversely, impulsivity associated with bipolar disorder may increase the risk for impulsivity-related disorders such as alcohol use disorder.3 We present in this report, a case of a patient with bipolar disorder who showed traits of impulsivity as well as alcohol abuse. The case describes the use of combination therapy and the introduction of endoxifen in the regimen, which led to rapid improvement in bipolar symptoms.
Conclusion
In conclusion, endoxifen is an effective treatment option for bipolar disorder and impulsivity, and it reduces the overall burden of other medications that have to be prescribed to such patients. In this case, endoxifen treatment enabled rapid control of symptoms within 4 days, and the patient subsequently returned to work. The patient did not resume alcohol consumption while on endoxifen treatment. Endoxifen is effective as well as safe and can be part of a combination treatment regimen.