Methylphenidate Valproate

ECT should be considered for more severe forms of depression (e.g., those associated with melancholic and psychotic features, particularly when the patient exhibits an increased risk for self-injurious behavior) or when there is a past, well-documented history of nonresponse or intolerance to pharmacological intervention. Limited data indicate that bipolar depressed patients may be at risk for a switch to mania when given a standard TCA. A mood stabilizer alone (i.e., lithium, valproate, carbamazepine, lamotrigine), or in combination with an antidepressant, may be the strategy of choice in these patients. Some elderly patients and those with acquired immunodeficiency syndrome may also benefit from low doses of a psychostimulant only (e.g., methylphenidate) (see also Chapter 14, The HIV-Infected Patient ). Fig. 7-1 summarizes the strategy for a patient whose depressive episode is insufficiently responsive to standard therapies. 

Noninterfering acetaminophen, acetazolamide, amphetamine, bilirubin, caffeine, diazepam, dimenhydrinate, meperidine, meprobamate, methamphetamine, methaqualone, methylphenidate, nicotine, propojcyphene, theophylline, valproate Interfering phensuximide... 

Two patients aged 4 and 6 years old experienced tics and dyskinetic movements after starting on methylphenidate added to pre-existing treatment with valproate. Both patients improved when methylphenidate was no longer administered. 

Serum levels of clonazepam are decreased by the enzyme-inducing properties of phenobarbitai, phenytoin, and CBZ. Concurrent administration of amphetamines, methylphenidate, ethanol, antianxiety drugs, or antipsychotics may cause CNS depression or altered respiration. The combined administration of clonazepam and valproate may cause absence status, and in patients displaying a mixed seizure pattern, clonazepam may precipitate grand mal seizures. 

Two children taking valproic acid rapidly developed severe dyskinesias and bruxism after the first and second dose of methylphenidate, respectively. Valproate appears to potentiate the effects of methylphenidate, possibly by a pharmacokinetic mechanism, or because of additive dopaminergic effects. The authors of the re-... 

A 7-year-old male patient was presented at the department of paediatrics with orofacial and limb dyskinesia after his first dose of methylphenidate (18 mg) treatment for a diagnosis of ADHD. The patient was also receiving sodium valproate (250 mg bid) for epilepsy [28 ]. 

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