Question

Discuss the following medications with use with Bipolar Disorder antipsychotics, mood stabilizers, and antidepressants

What anticonvulsants are approved for the treatment of Bipolar disorder? What are the lab protocols should be used with anticonvulsant used in mood management?

Compare and contrast the different classes of antidepressants and their side effects

Look up the Texas Medication Project for Depression. Discuss how this impacts your clinical determination guidelines

Answer 1

Several anticonvulsant medications are recognized as mood stabilizers to treat or prevent mood episodes in bipolar disorder. At first, anticonvulsants were prescribed only for people who did not respond to lithium. Today, they are often prescribed alone, with lithium, or with an antipsychotic drug to control mania.Anticonvulsants work by calming hyperactivity in the brain in various ways. For this reason, some of these drugs are used to treat epilepsy, prevent migraines, and treat other brain disorders. They are often prescribed for people who have rapid cycling -- four or more episodes of mania and depression in a year.

Anticonvulsants used to treat bipolar disorder include:

• Depakote, Depakene (divalproex sodium, valproic acid, or valproate sodium)
• Lamictal (lamotrigine)
• Tegretol (carbamazepine)

These medicines differ in the types of bipolar symptoms they treat. Depakote and Tegretol, for example, tend to be more effective in treating mania than depressive symptoms while Lamictal appears to have stronger antidepressant than antimanic effects. Lamictal also is used more often to prevent future episodes (rather than treat current episodes). Depakote and Tegretol are used to treat acute episodes more than as preventative treatments. Other anticonvulsants are less well-established for treating mood symptoms in bipolar disorder, and some -- such as Neurontin, Lyrica, or Topamax -- are also used "off label" for other types of problems such as sleep, pain management, anxiety or weight loss.Each anticonvulsant acts on the brain in slightly different ways, so your experience may differ depending on the drug you take. In general, however, these drugs are at maximal effectiveness after taking them for several weeks.

  antidepressants and their side effects

There are several different classes of antidepressants. These include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants (TCAs)
• Monoamine oxidase inhibitors (MAOIs)
• Tetracyclic antidepressants (TeCAs)
• Noradrenergic and specific serotonergic antidepressant (NaSSAs)

• Antidepressant Side Effects

  Antidepressants can cause side effects, including:

• Nausea
• Fatigue
• Drowsiness
• Dizziness
• Dry mouth
• Blurred vision
• Insomnia
• Increased appetite
• Constipation
• Agitation or irritability
• Anxiety
• Loss of sexual desire or other sexual problems
• Erectile dysfunction
• In short-term studies, the medicines increased the risk of suicidal tendencies in some children and young adults with depression or psychiatric disorders.
• Texas medication project   
• the development of consensus medication algorithms for the treatment of patients with major depressive disorder in the Texas public mental health system. To the best of our knowledge, the Texas Medication Algorithm Project (TMAP) is the first attempt to develop and prospectively evaluate consensus-based medication algorithms for the treatment of individuals with severe and persistent mental illnesses. The goals of the algorithm project are to increase the consistency of appropriate treatment of major depressive disorder and to improve clinical outcomes of patients with the disorder.

• The panel consensually agreed on algorithms developed for both nonpsychotic and psychotic depression. The algorithms consist of systematic strategies to define appropriate treatment interventions and tactics to assure optimal implementation of the strategies. Subsequent to the consensus process, the algorithms were further modified and expanded iteratively to facilitate implementation on a local basis.

  CONCLUSION:

  These algorithms serve as the initial foundation for the development and implementation of medication treatment algorithms for patients treated in public mental health systems. Specific issues related to adaptation, implementation, feasibility testing, and evaluation of outcomes with the pharmacotherapeutic algorithms will be described in future articles.