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a higher rate of non-lethal suicidal behavior. Relapse can also be related to treatment with antidepressants. This is less likely to occur if a mood stabilizer is combined with an antidepressant, rather than an antidepressant being used alone. Evidence from previous studies shows that rapid cycling is linked to use of antidepressants. Rapid cycling is defined as the presence of four or more mood episodes within a year's time. Evidence suggests that rapid cycling and mixed symptoms have become more common since antidepressant medication has come into widespread use. There is a need for caution when treating bipolar patients with antidepressant medication due to the risks that they pose.
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112:. The most common side effects are lethargy and weight gain. The less common side effects of using lithium are blurred vision, a slight tremble in the hands, and a feeling of being mildly ill. In general, these side effects occur in the first few weeks after commencing lithium treatment. These symptoms can often be improved by lowering the dose.
285:. Combination therapy (atypical antipsychotic with lithium or valproate) shows better efficacy over monotherapy in the manic phase in terms of efficacy and prevention of relapse. However, side effects are more frequent and discontinuation rates due to adverse events are higher with combination therapy than with monotherapy.
339:
Antidepressants cause several risks when given to bipolar patients. They are ineffective in treating acute bipolar depression, preventing relapse, and can cause rapid cycling. Studies have shown that antidepressants have no benefit versus a placebo or other treatment. Antidepressants can also lead to
263:
can blunt a patient's response to both mood stabilizers and antidepressants. Furthermore, preliminary research into the use of thyroid augmentation in patients with refractory and rapid-cycling bipolar disorder has been positive, showing a slowing in cycle frequency and reduction in symptoms. Most
125:. The term "anticonvulsant mood stabilizers" is sometimes used to describe these as a class. Although this group is also defined by effect rather than mechanism, there is at least a preliminary understanding of the mechanism of most of the anticonvulsants used in the treatment of mood disorders.
255:
may have a mood stabilizing effect. Compared with placebo, omega-3 fatty acids appear better able to augment known mood stabilizers in reducing depressive (but perhaps not manic) symptoms of bipolar disorder; additional trials would be needed to establish the effects of omega-3 fatty acids
817:
AMA Chakrabarti S. Thyroid
Functions and Bipolar Affective Disorder. Journal of Thyroid Research. 2011;2011:306367. doi:10.4061/2011/306367. MLA Chakrabarti, Subho. "Thyroid Functions and Bipolar Affective Disorder". Journal of Thyroid Research 2011 (2011): 306367. PMC. Web. 19 May 2017.
357:(BDNF). The resulting increase in neural plasticity may be central to lithium's therapeutic effects. How lithium works in the human body is not completely understood, but its benefits are most likely related to its effects on electrolytes such as potassium, sodium, calcium and magnesium.
983:
Raber, Jack H. "Lithium carbonate." The Gale
Encyclopedia of Mental Disorders, edited by Madeline Harris and Ellen Thackerey, vol. 1, Gale, 2003, pp. 571-573. Gale eBooks, link.gale.com/apps/doc/CX3405700220/GVRL?u=tamp44898&sid=GVRL&xid=9ef84e18. Accessed 20 Jan.
336:—in particular, when taken alone. The risk of antidepressant-induced mania when given to patients concomitantly on antimanic agents is not known for certain but may still exist. The majority of antidepressants appear ineffective in treating bipolar depression.
146:(aka Lamictal) – FDA approved for bipolar disorder maintenance therapy, not for acute mood problems like depression or mania/hypomania. The usual target dose is 100–200 mg daily, titrated to by 25 mg increments every 2 weeks. Lamotrigine can cause
87:
The term "mood stabilizer" does not describe a mechanism, but rather an effect. More precise terminology based on pharmacology is used to further classify these agents. Drugs commonly classed as mood stabilizers include:
156:– FDA approved for the treatment of acute manic or mixed (i.e., both depressed and manic mood features) episodes in people with bipolar disorder type I. Carbamazepine can rarely cause a dangerous decrease in
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The precise mechanism of action of lithium is still unknown, and it is suspected that it acts at various points of the neuron between the nucleus and the synapse. Lithium is known to inhibit the enzyme
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Ichikawa J, Dai J, Meltzer HY (July 2005). "Lithium differs from anticonvulsant mood stabilizers in prefrontal cortical and accumbal dopamine release: role of 5-HT(1A) receptor agonism".
353:. This improves the functioning of the circadian clock—which is thought to be often malfunctioning in people with bipolar disorder—and positively modulates gene transcription of
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found it superior to placebo for this purpose. In general, studies have shown T4 to be well tolerated and to show efficacy even in patients without overt hypothyroidism.
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Amit BH, Weizman A. Antidepressant
Treatment for Acute Bipolar Depression: An Update. Depression Research and Treatment . 2012 ;2012:1–10. Available from:
464:
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Preda, A; MacLean, RW; Mazure, CM; Bowers MB, Jr (January 2001). "Antidepressant-associated mania and psychosis resulting in psychiatric admissions".
887:"Do antidepressants increase the risk of mania and bipolar disorder in people with depression? A retrospective electronic case register cohort study"
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are still often prescribed in addition to mood stabilizers during depressive phases. This brings some risks, however, as antidepressants can induce
508:
Marmol, F. (2008). "Lithium: Bipolar disorder and neurodegenerative diseases
Possible cellular mechanisms of the therapeutic effects of lithium".
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Rao JS, Lee HJ, Rapoport SI, Bazinet RP (June 2008). "Mode of action of mood stabilizers: is the arachidonic acid cascade a common target?".
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In routine practice, monotherapy is often not sufficiently effective for acute and/or maintenance therapy and thus most patients are given
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All of the anticonvulsants routinely used to treat bipolar disorder are blockers of voltage-gated sodium channels, affecting the brain's
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364:. For valproic acid, carbamazepine and oxcarbazepine, however, their mood-stabilizing effects may be more related to effects on the
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132:– Available in extended release form. This drug can be very irritating to the stomach, especially when taken as a free acid.
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APA Chakrabarti, S. (2011). Thyroid
Functions and Bipolar Affective Disorder. Journal of Thyroid Research, 2011, 306367.
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Kozier, B et al. (2008). Fundamentals Of
Nursing, Concepts, Process, and Practice. London: Pearson Education. p. 189.
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100:– Lithium is the "classic" mood stabilizer, the first to be approved by the US FDA, and still popular in treatment.
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One possible downstream target of several mood stabilizers such as lithium, valproate, and carbamazepine is the
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studies have been conducted on an open-label basis. One large, controlled study of 300 mcg daily dose of
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301:. The principal exceptions to that rule, because they treat both manic and depressive symptoms, are
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with many medications, including other mood stabilizers (e.g. lamotrigine) and antipsychotics (e.g.
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Most mood stabilizers are primarily antimanic agents, meaning that they are effective at treating
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There is insufficient evidence to support the use of various other anticonvulsants, such as
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108:/L (or millimolar). Signs and symptoms of toxicity include nausea, vomiting, diarrhea, and
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is required to ensure lithium levels remain in the therapeutic range: 0.6 or 0.8–1.2
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Healy D. 2005 Psychiatric Drugs explained 4th ed. Churchill
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Gao, K.; Calabrese, J. R. (2005). "Newer treatment studies for bipolar depression".
717:"Atypical antipsychotic augmentation of mood stabilizer therapy in bipolar disorder"
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Mirnikjoo B, Brown SE, Kim HF, Marangell LB, Sweatt JD, Weeber EJ (April 2001).
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A bottle of lithium capsules. Lithium is the prototypical mood stabilizer.
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Many agents described as "mood stabilizers" are also categorized as
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Geoffroy, P. A.; Etain, B.; Henry, C.; Bellivier, F. (2012).
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system. Lamotrigine is known to decrease the patient's
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Mood stabilizers are best known for the treatment of
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150:, a very rare but potentially fatal skin condition.
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Psychiatric medication used to treat mood disorders
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691:. American Psychiatric Pub. p. 42.
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661:"EQUETRO(carbamazepine) Package Insert"
633:"Lamictal – FDA Prescibing Information"
39:characterized by intense and sustained
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1926:Non-steroidal anti-inflammatory drugs
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75:. Mood stabilizers are also used in
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842:CNS Neuroscience & Therapeutics
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936:The Journal of Clinical Psychiatry
820:http://doi.org/10.4061/2011/306367
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259:It is known that even subclinical
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666:. Validus Pharmaceuticals LLC
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389:Treatment of bipolar disorder
79:when it is the bipolar type.
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251:It is also conjectured that
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148:Stevens–Johnson syndrome
77:schizoaffective disorder
49:schizoaffective disorder
47:and the bipolar type of
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188:, as mood stabilizers.
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1050:at Wikimedia Commons
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372:response to stress.
241:symptoms are absent.
140:should be monitored.
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2018:Antidementia agents
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2078:Psychedelics
2048:Aphrodisiacs
1722:infestations
1698:Sex hormones
1651:Sex hormones
1596:Cicatrizants
1526:
1512:Vasodilators
1479:antianginals
1476:
1328:stomach acid
1327:
1184:Paliperidone
1149:Aripiprazole
1121:Valnoctamide
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668:. Retrieved
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612:. Retrieved
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491:. Retrieved
486:
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223:paliperidone
203:aripiprazole
179:
160:, a type of
120:
86:
58:
28:
26:
2211:Otologicals
2183:antagonists
2149:respiratory
2124:Orexigenics
2119:Neurotoxins
2068:Euphoriants
2058:Entactogens
2053:Depressants
2043:Anxiolytics
1981:Anesthetics
1757:Antifungals
1354:Antiemetics
1342:antagonists
1199:Ziprasidone
1194:Risperidone
1178:+fluoxetine
1159:Cariprazine
1106:Lamotrigine
942:(1): 30–3.
303:lamotrigine
235:ziprasidone
231:risperidone
211:cariprazine
158:neutrophils
144:Lamotrigine
41:mood shifts
2310:Categories
2134:Stimulants
2114:Nootropics
2088:Deliriants
2063:Entheogens
1998:Anorectics
1976:Analgesics
1829:Alkylating
1762:Antivirals
1717:infections
1591:Emollients
1445:Coagulants
1315:metabolism
1189:Quetiapine
1174:Olanzapine
1169:Lurasidone
1131:Valpromide
452:References
395:Categories
315:quetiapine
311:olanzapine
299:depression
227:quetiapine
219:olanzapine
215:lurasidone
186:topiramate
182:gabapentin
174:quetiapine
73:depression
43:, such as
2284:ATC codes
2250:Dressings
2235:Antidotes
2099:Sedatives
2095:Hypnotics
1804:malignant
1661:endocrine
1507:Diuretics
1440:Platelets
1400:and blood
1359:Laxatives
1164:Clozapine
1154:Asenapine
1116:Valproate
562:Brain Res
366:GABAergic
330:psychosis
239:psychotic
207:asenapine
170:interacts
164:, called
130:Valproate
69:hypomania
2129:Serenics
1794:Vaccines
1561:Fibrates
1383:Vitamins
1333:Antacids
1215:Ketamine
1026:21273538
1018:18347600
956:11235925
921:26667012
891:BMJ Open
872:23095277
805:16225556
770:11152679
729:15762830
582:15936730
538:25861243
530:18789369
383:See also
370:cortisol
83:Examples
1986:General
1893:muscles
1862:L03–L04
1858:disease
1810:L01–L02
1806:disease
1556:Statins
1220:Lithium
912:4679886
863:6493634
670:10 July
590:6180568
493:10 July
98:Lithium
92:Mineral
2293:
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2151:system
1903:joints
1856:immune
1663:system
1623:system
1464:system
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233:, and
110:ataxia
71:) and
2274:Drugs
1991:Local
1958:brain
1897:bones
1398:blood
1022:S2CID
984:2021.
664:(PDF)
586:S2CID
534:S2CID
326:mania
295:mania
246:Other
197:Some
168:. It
65:mania
31:is a
1901:and
1578:skin
1014:PMID
952:PMID
917:PMID
868:PMID
801:PMID
766:PMID
725:PMID
693:ISBN
672:2020
616:2016
578:PMID
566:1049
526:PMID
495:2020
313:and
184:and
136:and
67:(or
55:Uses
2222:ATC
1960:and
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1006:doi
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850:doi
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518:doi
138:CBC
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