Valproate carbamazepine and

Consequently, the choice for a primary mood stabilizer in acute therapy now includes lithium, valproate, carbamazepine, and the atypical antipsychotics. Among these, lithium and valproate remain first-line agents. Valproate and lithium are probably equally effective in the treatment of classic euphoric mania, but valproate and, for that matter, carbamazepine do not appear to provide the same degree of protec-... 

Valproate, carbamazepine, and other anticonvulsants pose teratogenic risks. Despite this, treatment should continue during pregnancy, as the potential threat to the fetus by a seizure is greater However, it is mandatory to administer the lowest dose affording safe and effective prophylaxis. Concurrent high-dose administration of folate may... 

Rattya, J., Vainionpaa, L., Knip, M., Panning, P., and Isojarvi, J.I. (1999) The effects of valproate, carbamazepine, and oxcarbaze-pine on growth and sexual maturation in girls with epilepsy. Pediatrics 103 588-593. 

Emrich HM, Dose M, Von Zerssen D The use of sodium valproate, carbamazepine and oxcarbazepine in patients with affective disorders. J Affect Disord 8 243-250, 1985... 

Rattya J, Turkka J, Pakarinen AJ, Knip M, Kotila MA, Lukkarinen O, Myllyla VV, Isojarvi JI. Reproductive effects of valproate, carbamazepine, and oxcarbazepine in men with epilepsy. Neurology 2001 56(l) 31-6. 

Although there is only an isolated report of an interaction between valproate and imipenem, there are now several reports of the interaction between valproate and meropenem or panipenem. Seizures or increased seizure frequeney have been reported. It would therefore seem prudent to monitor the valproate levels in any patient also given carbapenems, being alert for the need to increase the valproate dosage, or to use another antibacterial, or an alternative to valproate. Carbamazepine and phenytoin did not interact in the above reports. The manufacturers of ertapenem have no reports of an interaction on their files, but prudently warn about a possible interaction with valproate because of the interactions seen with other carbapenems. 

Varoglu AO, Yildirim A, Aygul R, Gundogdu OL, Sahin YN. Effects of valproate, carbamazepine, and levetiracetam on the antioxidant and oxidant systems in epileptic patients and their clinical importance. Clin Neuropharmacol 2010 33(3) 155-7. 

The first mood stabilizer was lithium (its antimanic action being discovered in 1948) more recently the anticonvulsant drugs carbamazepine and valproate have been found to be effective in acute mania. Unfortunately these mood stabilizers are only successful in controlling mania to a limited extent and few patients are well enough to leave hospital at the end of 3 weeks of treatment using these drugs as monotherapy. It is increasingly common for combination treatment to be advocated, in which an antipsychotic dmg is combined with lithium or an anticonvulsant. 

Monitor for acute and chronic adverse effects of AEDs. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, carbamazepine, and valproate. 

Introduced in clinical practice in the 1960s, lithium was the first mood stabilizer to be used in China. This was followed by carbamazepine and sodium valproate. For many years, these were the only treatment options available as mood stabilizers. Although lamotrigine was approved for maintenance treatment of bipolar I disorder in 2003 by FDA (Food and Drug Administration) in the USA, this indication has not yet been approved by the Chinese authorities. At present, only one atypical antipsychotic drug, risperidone, has been approved for treating acute mania (February 2005 by SFDA [State Food and Drug Administration]) in China (see Table 6.1). 

Bowden C and Muller-Oerlinghausen B (2000). Carbamazepine and valproate Use in mood disorders. In PF Buckley and JL Waddington (eds), Schizophrenia and Mood Disorders (pp. 179-189). Butterworth-Heinemann, Oxford, UK. 

Carbamazepine (Tegretol, Equetro). Carbamazepine is another anticonvulsant with documented efficacy in treating BEAD, and was recently FDA approved for this indication. Like valproate, carbamazepine is usually preferred to lithium in cases of mixed mania or rapid cycling. 

Carbamazepine is also most beneficial for patients with mixed episodes and rapid cycling. However, many patients find the side effects of carbamazepine more troublesome than those of valproate, and becanse carbamazepine has a penchant for nntoward drug-drug interactions, we reserve the use of carbamazepine for those patients who are unable to tolerate valproate, lithium, and the atypical antipsychotic... 

Mood Stabilizers. Lithium (Eskalith, Lithobid), valproic acid (Depakene), sodium valproate (Depakote), and carbamazepine (Tegretol) are most often used by psychiatrists to treat the bipolar disorders. These so-called mood stabilizers are also used to treat impulsivity and agitation in a variety of psychiatric disorders including dementia, certain personality disorders, and the disruptive behavior disorders of childhood. 

Anti-epileptic drugs, such as phenytoin, carbamazepine and valproate, may lead to neural tube defects if administered during pregnancy. Concurrent administration of folate supplements, such as folic acid, is recommended. 

Duncan, J.S., Shorvon, S.D., and Trimble, M.R. (1990) Effects of removal of phenytoin, carbamazepine, and valproate on cognitive function. Epilepsia 31 584-591. 

Herranz, J.L., Armijo, J.A., and Arteaga, R. (1988) Clinical side effects of phenobarbital, primidone, phenytoin, carbamazepine, and valproate during monotherapy in children. Epilepsia 29 794-804. 

Sozuer, D.T., Atakil, D., Dogu, O., Baybas, S., and Arpaci, B. (1997) Serum lipids in epileptic children treated with carbamazepine and valproate. Eur J Pediatr 156 565—567. 

The use of combination therapy with carbamazepine and valproate (Keck et al. 1992b Ketter et al. 1992) may also be helpful in avoiding or delaying the development of episodic breakthroughs progressing toward tolerance. We have observed that many animals show cyclic response to the anticonvulsants while they are progressing toward the development of complete loss of efficacy via tolerance [Post and Weiss 1996). If doses of... 

Well known for their clinical role as antimanic agents, anticonvulsants such as carbamazepine and valproate have also been used in both bipolar and unipolar TRD (Post et al. 1994a, 1994b). In one series. Post et al. (1994a) found a greater response in patients with bipolar (15/40) versus those with unipolar (2/17) TRD. Open studies of valproate also suggest limited antidepressant efficacy, but only a paucity of data with anticonvulsants on TRD exists. More recently, in open trials, lamotrigine (a partial anticonvulsant that inhibits glu-... 

Mosolov SN [Comparative effectiveness of preventive use of hthium carbonate, carbamazepine and sodium valproate in affective and schizoaffective psychoses]. Zh Nevrol Psikhiatr Im S S Korsakova 91 78-83, 1991... 

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Weiss SRB, Post RM, Sohn E, et al Cross tolerance between carbamazepine and valproate on amygdala-kindled seizures. Epilepsy Res 16 37-44, 1993 Weiss SRB, Clark M, Rosen JB, et al Contingent tolerance to the anticonvulsant effects of carbamazepine relationship to loss of endogenous adaptive mechanisms. Brain Res Brain Res Rev 20 305-325, 1995 Weissman MM Panic disorder impact on the quality of life. J Clin Psychiatry 52 [suppl) 6-8, 1991... 

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