Psychopharmacological Treatment Options for Bipolar Disorders

Psychopharmacological treatment of bipolar disorders is meant to suppress psychotic symptoms of mania, long term recurrences, and depression (Preston, O’Neal, & Talaga, 2017). mood stabilizers and antipsychotics and to some extent, antidepressants are used to treat bipolar disorders. Carbamazepine (Tegretol) and Divalproex/valproic acid (Depakote) are effective in treating acute mania. Bipolar border-depression is treated with modern antipsychotics like lurasidone, quetiapine or olanzapine + fluoxetine.

Divaproex is antiepileptic agent that works in the brain. It is not clear how divaproex exerts its stabilizing or therapeutic effect. It is reported that its activity is associated with elevated brain concentration of GABA (gamma-aminobutyric acid). It is also said to block voltage-gated ion channels and inhibiting histone deatylase. The primary use of divaproex is an anti-seizure medication, treatment of migraine mood and bipolar disorders. Divalproex and its formulations have been reported to be effective in the treatment of mixed episodes and acute mania (López-Muñoz et al., 2018). Prior to beginning divalproex, the medical history of the patient is reviewed for any bleeding, hematological and hepatic problems. The side effects associated with this drug include hematological and hepatic dysfunction, gastrointestinal effects, sedation, weight gain, polycystic ovarian syndrome and tremor (López-Muñoz et al., 2018).  Serious reactions may include hallucinations, psychosis, suicidality, pancreatic. Divaproex is contradicted in patients with hepatic impairment, hepatic disorders, mitochondrial and pregnancy. Lithium is associated with side effects, such as dry mouth, diarrhea, excessive thirsty and urination, intoxication, tremors, dizziness, cognitive dulling, heart valve defect, headache and loss of appetite (Gitlin M. (2016).

Health professionals should monitor liver function tests at baseline particularly during the first six months of treatment. The patient should be screened for symptoms of suicidality and behavior change.  A variety of indications involves several medical specialties to administer therapy with divalproex. The mental health professional can share the knowledge of divalproex in relation to contradictions, potential adverse effects for patient safety and better outcomes.

References

Gitlin M. (2016). Lithium side effects and toxicity: prevalence and management strategies. International journal of bipolar disorders, 4(1), 27. https://doi.org/10.1186/s40345-016-0068-y

López-Muñoz, F. et al. (2018). A History of the Pharmacological Treatment of Bipolar Disorder. International Journal of Molecular Sciences, 19(2143);1-38 doi:10.3390/ijms19072143

Preston, J. D., O’Neal, J. H., & Talaga, M. C. (2017). Handbook of clinical psychopharmacology for therapists (8th ed.). Oakland, CA: New Harbinger.

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