Topiramate Divalproex

Pharmacotherapy is the cornerstone of acute and maintenance treatment of bipolar disorder. Mood-stabilizing drugs are the usual first-choice treatments and include lithium, divalproex, carbamazepine, and lamotrigine. Atypical antipsychotics other than clozapine are also approved for treatment of acute mania. Lithium, lamotrigine, olanzapine, and aripiprazole are approved for maintenance therapy. Drugs used with less research support and without Food and Drug Administration (FDA) approval include topiramate and oxcarbazepine. Benzodiazepines are used adjunctively for mania. 

Mood stabilizers can be used as augmentation therapy in cases of partial response to antidepressant therapy, especially those with prominent irritability or anger. Anticonvulsants (thought to exert their mechanism in part through antikindling effects) have been effective in treating PTSD. In a retrospective review topiramate reduced nightmares and flashbacks. Divalproex sodium was effective in an open trial. ... 

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