Anticonvulsants SSRIs

Antidepressants. In our experience, clinicians who are trying to manage the behavior of impulsive or aggressive patients too often overlook antidepressants. Antidepressants are often just as effective as anticonvulsants, antipsychotics, or benzodiazepines, especially when managing mild-to-moderate behavioral disturbances. Furthermore, antidepressants are generally easier to use and easier to tolerate than these alternatives. Once again, the SSRIs are best studied and so represent the favored first-line treatment for managing mild-to-moderate behavioral lability... 

Drugs that may affect cyclosporine include allopurinol, amiodarone, androgens (eg, danazol, methyltestosterone), anticonvulsants (eg, carbamazepine, phenobarbital, phenytoin), azole antifungals (eg, fluconazole, ketoconazole), beta-blockers, bosentan, bromocriptine, calcium channel blockers, colchicine, oral contraceptives, corticosteroids, fluoroquinolones (eg, ciprofloxacin), foscarnet, HMG-CoA reductase inhibitors, imipenem-cilastatin, macrolide antibiotics, methotrexate, metoclopramide, nafcillin, nefazodone, orlistat, potassium-sparing diuretics, probucol, rifamycins (rifampin, rifabutin), serotonin reuptake inhibitors (SSRIs eg, fluoxetine, sertraline),... 

According to the Expert Consensus Panel for Mental Retardation Rush and Frances, (2000), the mainstays of the pharmacological treatment of acute mania or bipolar disorder in adults are anticonvulsant medications (divalproex, valproic acid, or carbamazepine) or lithium. Both divalproex or valproic acid and lithium were preferred treatments for classic, euphoric manic episodes. Divalproex or valproic acid was preferred over lithium and carbamazepine for mixed or dysphoric manic episodes and rapid-cycling mania. For depressive episodes associated with bipolar disorder, the addition of an antidepressant (SSRI, bupropion, or venlafaxine) was recommended. According to the Expert Consensus Panel, the presence of MR does not affect the choice of medication for these psychiatric disorders in adults. 

Valproic add (Depakote 6 ) is an anticonvulsant with good antimanic action that is especially suited for patients with rapid cycling and mixed episodes (Bowden et id., 1994). However, it is a poor antidepressant, necessitating the use of a low-dose SSRI in the treatment of depression that may occur in the course of bipolar disease. 

May inhibit metabolism of SSRIs, anticonvulsants (phenobarbital, phenytoin, primidone), tricyclic antidepressants, and coumarin anticoagulants, requiring downward dosage adjustments of these drugs... 

Usually administered as adjunctive medication to benzodiazepines, SSRIs, and/or SNRIs in the treatment of anxiety disorders and to SNRIs, gabapentin, other anticonvulsants, and even opiates in the treatment of chronic pain... 

Because bipolar disorders are recurring illnesses, clients will often require an ongoing regimen of medication. There are various categories of psychotropic medications that are used in the treatment of bipolar disorders. This includes the SSRIs (discussed in chapter 4), which are generally used to treat depression and some types of anxiety, and the most recent addition Zyprexa (olanzapine), which is one of the newer antipsychotic medications (Portyansky, 2000). Of all of the medications that can be used, however, the most common are generally termed mood stabilizers (Dulcan, 1999) and include Lithium or other medications that fall within the anticonvulsant category. 

The anticonvulsant topiramate has also been reported to be effective in reducing binge and purge frequencies in comparison with placebo. However, bothersome side-effects such as paresthesias, impaired cognition, and renal calculi may lessen its usefulness. Naltrexone is a possible adjunct in patients who are refractory to SSRIs, especially those with comorbid alcoholism and/or self-injurious behavior. ... 

Drug interactions sedatives/hypnotics, opioids, barbiturates, antihistamines, alcohol, neuroleptics, anticonvulsants, and SSRIs can all enhance the sedative effects of BNZs. 

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