Guide As The Mood Prescribes

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You'll be It has prophylactic efficacy against both manic and depressive relapse. Although lamotrigine is not approved for bipolar disorder in Australia, internationally it is considered a first-line treatment for bipolar depression. Lamotrigine is generally well tolerated, with little to no sedation or weight gain. Stop treatment if any rash appears. There is reasonable evidence supporting an antimanic effect of carbamazepine, but lithium, valproate or atypical antipsychotics are often preferred.

Furthermore, the adverse effect burden, drug interactions and enzyme induction complicate dosing. Carbamazepine tends to be used only when other treatments have failed. In acute mania, the atypical antipsychotics olanzapine, quetiapine, risperidone, aripiprazole, ziprasidone, paliperidone and asenapine have placebo-controlled trials to support them as monotherapies.


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All but paliperidone have studies which show antimanic equivalence to other mood stabilisers and typical antipsychotics. On meta-analysis, lithium, valproate and antipsychotics are more effective than placebo and have similar effect sizes 13 , 14 in treating mania. Atypical antipsychotics olanzapine, quetiapine, risperidone and asenapine added to mood stabilisers are more effective than mood stabilisers alone in mania. Meta-analysis 14 , 15 shows a faster and greater response to combination treatment, but at the cost of more adverse effects.

Regarding acute antidepressant effect, the best placebo-controlled evidence is for quetiapine 16 , 17 and then for olanzapine. Some studies show that atypical antipsychotic drugs except paliperidone may protect against relapse, but this is mainly because of their ability to prevent manic episodes. They are less effective in preventing depressive relapse. Atypical antipsychotics demonstrate acute-phase efficacy alone or in combination and assist with relapse prevention when used with mood stabilisers.

Cognitive and metabolic adverse effects elevations in triglycerides, glucose and cholesterol, appetite increase and weight gain , sedation and somnolence are most problematic. The frequency, severity and extent of these adverse effects varies between treatments. Although they are less frequent than with typical antipsychotics, there may be extrapyramidal adverse effects. Tardive dyskinesia can also occur. Antidepressants are not mood stabilising in bipolar disorder. The largest and most rigorous studies of antidepressants in bipolar depression fail to show any benefit.

However, antidepressants remain one of the most prescribed treatments for bipolar disorder and much controversy surrounds their use. Antidepressants are necessary in a proportion of patients, but should only be prescribed with a mood stabiliser, with close monitoring, and should be discontinued sooner than would usually be considered in unipolar depression. Patients with bipolar depression, mixed episodes, psychotic features, rapid-cycling and comorbid dysthymia, anxiety or substance use disorders often do not respond, let alone remit, on monotherapy.

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The vast majority of patients need combination therapy. The combination of lithium and valproate has recently been shown to be superior in maintenance to either drug alone. The prescriber needs to ensure that appropriate pre-treatment evaluation, baseline investigations and longitudinal monitoring occur.

The International Society for Bipolar Disorders consensus guidelines for safety monitoring 23 are an excellent guide to investigation and monitoring Fig. Pregnancy and the postpartum are times of increased risk of a bipolar episode. The risks of treatment need to be weighed against the risks to the mother and her child, if there is an untreated episode or mood instability during pregnancy and afterwards.

Detailed review, discussion and planning should occur pre-conception, where possible.


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  • Although all mood-stabilising treatments can be used during pregnancy, if considered necessary, there are risks of teratogenicity and increased obstetric and neonatal complications. There is a growing body of evidence identifying various non-pharmacological treatments with phase-specific and relapse-prevention efficacy see Box. These should be used to augment pharmacological strategies where possible. Bipolar disorder is a complex and difficult disorder to treat. An awareness of available treatments and their specific benefits and hazards, along with early and accurate diagnosis, will hopefully facilitate better outcomes for those suffering this extremely distressing and disabling chronic illness.

    Lithium remains the most useful drug for acute treatment and prevention.

    Mood stabilisers - NPS MedicineWise

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    Summary Many of the drugs used to treat bipolar disorder can be considered to stabilise specific mood phases. Quetiapine might also have true mood stabilising properties. Introduction The bipolar disorders are characterised by irregular acute episodes of depression, mania, hypomania and mixed states various admixtures of elevated and depressed mood.

    What is a mood stabiliser? To be considered a mood stabiliser, a drug should: treat acute depression treat acute mania prevent depression prevent mania. How mood stabilisers work There is no specific psychopharmacological mechanism, so how mood stabilisers work is unknown. Page last reviewed: 21 November Next review due: 21 November Exercise for depression - Moodzone Secondary navigation Common problems I feel really down I'm so stressed I feel anxious and panicky I often feel angry I think I have the winter blues I'm worried someone is depressed I'm worried my child might be depressed I think I'm having panic attacks Mood self assessment.

    Low mood and depression How to feel happier Beating the winter blues Tips for coping with depression Exercise for depression Mental health issues if you're gay, lesbian or bisexual Raising low self-esteem Going to work after mental health issues Student mental health. Anxiety in children Dealing with panic attacks 10 ways to fight your fears. Breathing exercise for stress 10 stress busters Easy time-management tips Coping with exam stress Coping with money worries Dealing with jealousy Student stress Tips on surviving exams Bullying at work. How to control your anger Tips on child anger.

    Different types of therapy Benefits of talking therapy Mental health helplines Self-help therapies Can I get free therapy or counselling? Depression support groups. Learn about the 5 steps Mindfulness for mental wellbeing Connect for mental wellbeing Get active for mental wellbeing Give for mental wellbeing Learn for mental wellbeing. Coping with bereavement Dealing with grief and loss Children and bereavement Bereavement and young people. Loneliness in older people How to help lonely older people. Coping with your teenager Teen aggression and arguments Worried about your teenager?

    Talking to children about feelings Talking to your teenager. Unhelpful thinking Sleep problems Anxiety control Depression Low confidence.