Valproate is an antiepileptic drug that has been established to be effectual in acute mania and is often utilized in maintenance treatment of bipolar disorder (BPD).Valproate takes a shorter period than lithium before the patient may see benefit. Valproate can be useful as a short-term BPD treatment when rapid mood stabilization is warranted (Nemade & Dombeck, 2018).Valproate acid is thought to be more effective than lithium for treating mania, rapid cycling, or mixed states BPD. It does not seem to be as effective as lithium for the treatment of depressive states, however (Nemade & Dombeck, 2018). The Advantage of Oxcarbazepine over Carbamazepine. Oxcarbazepine is a mood stabilizer chemically related to carbamazepine. Oxcarbazepine is less likely to cause bone marrow suppression and therefore, unlike with carbamazepine, repeated complete blood counts are not essential. Repeated measurement of serum levels is not needed. However, oxcarbazepine can cause bone marrow suppression in rare cases (Hsiao, Wei & Huang, 2010). Oxcarbazepine is not metabolized to the 10, 11-epoxide that is believed to be responsible for several adverse effects associated with carbamazepine (Hsiao, Wei & Huang, 2010). Lamotrigine Use and Risks. Lamotrigine is an anticonvulsant drug that’s applied in the treatment of bipolar I disorder.it’s FDA-approved for the maintenance treatment of bipolar I disorder to retard the time of reoccurrence of mood episodes in patients treated for acute mood episodes with standard therapy (“Mood Stabilizers | Psych Education”, 2018) According to (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018) the treatment of acute manic or mixed episodes is not recommended with lamotrigine. The FDA is warning that the medicine lamotrigine (Lamictal) for seizures and bipolar disorder could cause a uncommon very life-threatening response that excessively activates the body’s immune system, which could stimulate critical inflammation throughout the body. and lead to death (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018).The immune system response, called hemophagocytic lymph histiocytosis (HLH), causes the uncontrolled reaction by the immune system. HLH generally exhibits as a persistent fever, generally greater than 101В°F, and it could lead to severe problems with blood cells and organs throughout the body such that of the liver, kidneys, or lungs. It’s crucial to observe for Stevens-Johnson Syndrome (SJS) (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018).Therefore, we slowly titrate Lamotrigine up to the therapeutic dose amount. Additionally, the literature from (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018) identifies it should not be restarted at the optimal dosage after the patient has stopped taking the drug.It again needs to be reintroduced slowly until the therapeutic level is reached. There are also drug interactions with lamotrigine. Valproate increases lamotrigine concentrations more than 2-fold. Carbamazepine, phenytoin, phenobarbital, primidone, and rifampin decrease lamotrigine concentrations by approximately 40%. Estrogen-containing oral contraceptives decrease lamotrigine concentrations by approximately 50% Protease inhibitors lopinavir/ritonavir and atazanavir/lopinavir decrease lamotrigine exposure by approximately 50% and 32%, respectively. Dosage readjustment might be required in moderate and severe hepatic impairment. Reduced maintenance doses of lamotrigine might be required in substantial renal impairment (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018). Mental Health Patients that Benefit from Gabapentin. Gabapentin is an analgesic and antiepileptic drug structurally associated to gamma-aminobutyric acid (GABA), the key inhibitory neurotransmitter in the cerebral cortex. While gabapentin isn’t approved by the FDA for the treatment of any anxiety disorder, numerous clinicians prescribe it if off-label. According to Murray, (2018), off-label gabapentin could be especially effective for an adjunct to benzodiazepines or serotonergic antidepressant drugs in individuals with anxiety who experienced a partial response. Practice guidelines recommend gabapentin as a third-line adjunctive treatment for maintenance treatment of bipolar disorder (Murray, 2018).Also, gabapentin works for anxiety, insomnia, and alcohol use disorder. The Advantages of Topiramate Topiramate is utilized to address posttraumatic stress disorder, mood disorders, and eating disorders. It’s an anti-convulsive drug that stands apart of all other drugs utilized to address convulsions or mood disorders for it doesn’t share the same chemical composition. There are two matters that set Topiramate apart from other drugs in that class. First, MDs some of the times prescribe it when other mood-stabilizing drugs fail to be efficacious for a patient. Secondly, the kind of side effects that patients might see is quite dissimilar on Topiramate compared to other mood stabilizers. Topiramate is most valuable for people who have bipolar mood disorders that other mood stabilizers have been incapable of controlling (Lieber, 2018).It can relieve symptoms and make consuming antidepressants achievable for people who are not able to consume them before without going through mania or a mixed state. Topiramate has a good side effect profile (Lieber, 2018).
The Advantage of using Chlorpromazine. This medicine is utilized to address disorders (such as as schizophrenia, psychotic disorders, the manic phase of bipolar disorder, and severe behavioral problems in children) (“Chlorpromazine – DrugBank”, 2018).Chlorpromazine is a phenothiazine and conventional antipsychotic agent with anti-emetic action. Chlorpromazine maintains its antipsychotic result by blocking postsynaptic dopamine receptors in cortical and limbic regions of the brain, thereby forestalling the overabundance of dopamine in the brain (“Chlorpromazine – DrugBank”, 2018). This contributes to a decrease in psychotic symptoms. Chlorpromazine assists the patientt. to think more clear and experience lower anxiousness. It can reduce aggressive behavior and the desire to harm one’s self or other people. The Advantage of Olanzapine. Olanzapine is an atypical antipsychotic presently with indications for the treatment of schizophrenia, acute mania and the prevention of relapse in bipolar disorder (Narasimhan, Bruce & Masand, 2007).Olanzapine-fluoxetine compounding (OFC) therapy and quetiapine are the only FDA authorized medications for the treatment of acute bipolar depression. Acute mania trials have showed superior efficacy from olanzapine to placebo, equivalent or superior efficacy to valproate and superior efficacy in combination therapy with lithium or valproate compared to mood stabilizer monotherapy (Narasimhan, Bruce & Masand, 2007).Olanzapine is an effective antipsychotic with fewer EPS and a potentiality to reduce positive and negative symptoms to a better degree than some conventional antipsychotics and other ‘atypical’ antipsychotics. There’s good tolerability. The Uses for Risperidone. Risperidone is an atypical antipsychotic, serotonin-dopamine antagonist; second-generation antipsychotic utilized to address symptoms of schizophrenia in adolescents and adults. The medication is sometimes used to treat bipolar disorder. Second generation antipsychotics, including risperidone, are efficacious in the treatment of manic symptoms in acute manic or mixed exacerbations of bipolar disorder (Yildiz, Vieta, Leucht & Baldessarini, 2014). In children and adolescents, risperidone may be more effectual than lithium or divalproex, but has several metabolic side effects (Gitlin & Frye, 2012).As maintenance therapy, long-acting injectable risperidone is efficacious for the prevention of manic episodes but not depressive episodes (Gitlin & Frye, 2012) The long-acting injectable configuration of risperidone may be beneficial over long acting first generation antipsychotics, because it’s better tolerated (less extrapyramidal issues) and the long acting injectable preparations of first-generation antipsychotics could increase the chance of depression (Gitlin & Frye, 2012). Aripiprazole use in the patient population. Aripiprazole is an atypical antipsychotic. It’s recommended and chiefly utilized for the treatment of schizophrenia and bipolar disorder. Additional uses include the treatment in major depressive disorder (MDD),as an add-on, tic disorders, and irritability related with autism.Additionally, a 2014 systematic review reasoned that add-on therapy with low dose aripiprazole is an effectual treatment for obsessive-compulsive disorder (OCD) that doesn’t improve on SSRIs solely. The determination was supported by the outcomes of two comparatively small, short-run trials, each of which exhibited improvements in symptoms (Veale et al., 2014). The Advantage of Quetiapine with Patients Experiencing Mania. Quetiapine is a second-generation dibenzothiazepine, that received Food and Drug Administration (FDA) approval for use as monotherapy or adjunctive therapy for acute mania, particularly when sensitivity to extrapyramidal effects limits treatment options (Brahm, Gutierres & Carnahan, 2018).Pharmacotherapy for acute mania typically involves a mood stabilizer, such as lithium or certain anticonvulsants, and often an antipsychotic is given to reduce excessive psychomotor agitation. Combination therapy with these agents during acute mania is quite common because of the need to rapidly stabilize patients, (Brahm, Gutierres & Carnahan, 2018) as the goal of treatment is to restore normal or near-normal functioning as quickly as possible and prevent further deterioration (Monson & Schoenstadt, 2018). Quetiapine is effective for treating episodes of mania or depression and helped prevent symptoms of bipolar disorder from returning (Monson & Schoenstadt, 2018).For bipolar mania episodes, it helped to decrease the manic symptoms (Monson & Schoenstadt, 2018). Reducing the Risk of Suicide with Bipolar Patients. “Risk factors could assist to distinguish patients at increased suicidal risk, but ongoing clinical appraisal is crucial to limit the risk. Empirical short-term interventions to manage acute suicidal risk include close clinical oversight, speedy hospital care, and electroconvulsive therapy (ECT). Rem evidence of the long-run effectualness of most treatments against suicidal behavior is scarce. A noted exception is lithium (Li) prophylaxis, which is linked with consistent evidence of major (approximately 80%), sustained reducings of danger of suicides and attempts. These benefits are unproven for different treatments typically used to care for bipolar disorder patients, including anti-convulsants, antipsychotics, antidepressants, as well as psychosocial interventions.” (Baldessarini, Pompili & Tondo, 2006).
The Difference Between Bipolar Depression and Unipolar Depression. Patients with bipolar disorder are oftentimes misdiagnosed with major depressive disorder (unipolar depressive disorder) (Hirschfeld, Lewis & Vornik, 2003).whenever these patients are treated with antidepressants for unipolar depression, this could prove to be ineffectual treatment but ,could exacerbate their condition by bringing on rapid cycling or activating a change over to a manic/mixed, manic, or hypomanic episode (Hirschfeld, Lewis & Vornik, 2003). Olanzapine, quetiapine, aripiprazole and olanzapine-fluoxetine have been found to be efficacious in treating bipolar depression. If antidepressant drugs are used to address bipolar depression, they’re compounded with the use of a mood stabilizer or atypical antipsychotic medicine to prevent the appearing of bipolar mania (“Mood Stabilizers | Psych Education”, 2018). The biological science of these disorders are dissimilar, efficacious treatments are dissimilar, and in a way the symptoms are as well different. Both forms of depressive disorder can be very serious and carry a danger of suicide. However, the fundamental difference is that people with Bipolar Depression also undergo episodes of either mania or hypomania. Bipolar Depression is more probable to be accompanied by more substantial symptoms of anxiety. One-half to two-thirds of patients with Bipolar Depression have a co-occurring anxiety disorder such as as obsessive-compulsive disorder (OCD), panic disorder or social anxiety disorder (“Mood Stabilizers | Psych Education”, 2018). According to (“Mood Stabilizers | Psych Education”, 2018) there are three specifically approved medications for bipolar depression treatment: Lurasidone HCI (Latuda), Olanzapine-fluoxetine combination (Symbax), Quetiapine (Seroquel).There are four medications approved for the maintenance of bipolar disorder symptoms: Lithium, Lamotrigine (Lamictal), Aripiprazole (Abilify), and Olanzapine (Zyprexa).