Clonazepam bipolar disorders

Ikeda M, Fujikawa T, Yanai I, Horiguchi J, Yamawaki S. Clonazepam-induced maniacal reaction in a patient with bipolar disorder. Int Clin Psychopharmacol 1998 13(4) 189—90. 

The medications known as anticonvulsants are often used as front-line treatment of the bipolar disorders. The most common of these medications include Tegretol (carbamazepine), Depakene or Depakote (valproate or valproic acid), and Klonopin (clonazepam), and they are used under the following circumstances (a) inadequate response or intolerance to antipsy-chotics or lithium (b) manic symptoms (c) rapid cycling of the condition (d) EEG abnormalities and (e) head trauma (Kaplan Sadock, 1996). In practice, these medications seem particularly effective for clients who suffer from schizoaffective disorders or agitated depression of a cyclic nature. They are considered the medication of choice if an individual has a history of brain damage or of severe or rapid mood swings (Dulcan, 1999). Furthermore, if an individual has atypical features of the mental... 

A) Alprazolam is effective in the management of obsessive-compulsive disorders Clonazepam has effectiveness in patients who suffer from phobic anxiety states Diazepam is used for chronic management of bipolar affective disorder in patients who are unable to tolerate lithium Intravenous buspirone is usefiil in status epilepticus... 

There is a report of seizures, unsteady gait and blurred speech in a patient with bipolar disorder and cystic fibrosis taking lithium and paroxetine both drugs were discontinued. However, this patient was abusing oxycodone and clonazepam and was also on a variety of anti-asthma medications (salbutamol, salmeterol, budesonide, montelukast and cromoglicate), so the exact cause of the seizures is unclear. ... 

Chouinard G. Clonazepam in the acute and maintenance treatment of bipolar affective disorder. J Clin Psychiatry 1987 48(Suppl 10) 29-36. 

Antipsychotic drugs are also indicated for schizoaffective disorders, which share characteristics of both schizophrenia and affective disorders. No fundamental difference between these two diagnoses has been reliably demonstrated. They are part of a continuum with bipolar psychotic disorder. The psychotic aspects of the illness require treatment with antipsychotic drugs, which may be used with other drugs such as antidepressants, lithium, or valproic acid. The manic phase in bipolar affective disorder often requires treatment with antipsychotic agents, although lithium or valproic acid supplemented with high-potency benzodiazepines (eg, lorazepam or clonazepam) may suffice in milder cases. Recent controlled trials support the efficacy of monotherapy with atypical antipsychotics in the acute phase (up to 4 weeks) of mania, and olanzapine and quetiapine has been approved for this indication. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

Several antiseizure drugs have some effectiveness in bipolar affective disorder. Of the dmgs listed, clonazepam does not appear to cause teratogenic effects and would be the safest during pregnancy. The answer is (B). 

C. Clinical Use Lithium carbonate is used in the treatment of bipolar affective disorder (manic-depressive disease). Maintenance therapy with lithium decreases manic behavior and reduces both the frequency and the magnitude of mood swings. Drug therapy with neuroleptics or benzodiazepines may also be required at the initiation of lithium treatment. Antidepressant drugs may be required adjunctively during maintenance. Alternative drugs of value in bipolar affective disorder include carbamazepine, clonazepam, gabapentin, and valproic acid. 

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