Mood Stabilizers Carlat Reports

Research Update

Which Medications Have the Lowest Risk of Side Effects?

From The Carlat Child Psychiatry Report, Mood Disorders in Children and Adolescents

REVIEW OF: Solmi M et al, World Psychiatry 2020;19(2):214–232 Adverse effects are important considerations when choosing psychotropic medications, especially in children and adolescents. This study pooled available research to compare the safety profiles of various psychotropics used in the pediatric population. The authors screened thousands of st

Article

Antipsychotic Maintenance: How Long is Enough?

From The Carlat Psychiatry Report, Esketamine

Your 58-year-old patient started risperidone to augment lithium 2 years ago. It got her out of a severe mania, and she has stayed well since then. Now she’s worried about long-term risks and wondering if it’s time to come off. Augmentation with an atypical antipsychotic may offer rapid relief from mania and depression, but antipsychotics’ potenti

Research Update

Brexpiprazole Ineffective in Mania

From The Carlat Psychiatry Report, Mood Disorders

REVIEW OF: Vieta E et al, J Psychopharmacol 2021;35(8):971–982 TYPE OF STUDY: Phase III randomized controlled trials Brexpiprazole is FDA approved in schizophrenia and as an adjunct for major depression and is one of the better-tolerated antipsychotics. Like aripiprazole, it is a partial D2 and 5-HT1A agonist. Unlike most antipsychotics, brexpiprazo

Research Update

Maintenance Pharmacotherapy of Bipolar Disorder: How Long Is Long Enough?

From The Carlat Psychiatry Report, Problems with Generics

Review of: Kishi T et al, Psychol Med 2020 Oct 13:1–9; PMID: 33046156 Type of study: Meta-analysis of double-blind, randomized placebo-controlled trials Bipolar disorder is a lifelong illness whose treatment is an ongoing challenge, complicated not least by difficulties in treatment adherence. What do we know and what can we tell our patients about

Clinical Update

How to Use Lamotrigine

From The Carlat Psychiatry Report, Mind-Gut Connection

Lamotrigine is FDA approved as maintenance treatment for bipolar disorder—that is, for delaying episodes of depression, hypomania, or mania. However, it is not approved for active depression or mania—which has given it a reputation as a “light” mood stabilizer. For patients who appreciate tolerability, that’s a good thing, but it isn’t the f

Research Update

Mood Stabilizers: What You Don’t Know Can Hurt Them

From The Carlat Psychiatry Report, Mood and Menopause

Topics: | | | | | | | | | | | | | | | | | | | | | | | | Antipsychotics Aripiprazole Asenapine Bipolar Depression Bipolar Disorder Bipolar II Cariprazine Lithium Lurasidone Mania Medication adherence Mood Stabilizers olanzapine Oxcarbazepine Pharmacology Pharmacology Tips Psychopharmacology Psychopharmacology Tips Quetiapine Research Research Update Risperidone safety Saphris Side Effects

Review of: Bai Y et al, J Clin Psychopharmacol 2020;40(2):167–179 STUDY TYPE: Combined meta-analysis and literature review of placebo-controlled trials Medication adherence is an ongoing struggle in bipolar disorder, and it’s compounded by the fact that our patients often don’t advertise their non-adherence. While numbers vary, reviews general

Expert Q&A

Who Should Get Lithium?

From The Carlat Psychiatry Report, When to Use Lithium

TCPR: Lithium has been called the gold-standard treatment in bipolar disorder. Why is it not used more often? Dr. Rybakowski: That is a paradox. On the one hand, lithium is accepted as a first-line treatment for bipolar disorder, but it is also greatly underutilized. And I think there are two main reasons. One is aggressive promotion of branded mood st

Research Update

Two Augmentation Strategies Compared in Bipolar I

From The Carlat Psychiatry Report, When to Use Lithium

Review of: Missio G et al, Trials 2019;20(1):608 STUDY TYPE: Randomized, open-label controlled trial It’s rare to see full recovery in bipolar I disorder with a single medicine, so we often depend on some combination of mood stabilizers and/or antipsychotics. Even then, weight gain and metabolic problems are deal-breakers. Some experts favor the c

Expert Q&A

The Psychopharmacology Algorithm Project

From The Carlat Psychiatry Report, Psychopharmacology Algorithms

TCPR: What would be the biggest change in practice if psychiatrists followed your algorithms?Dr. Osser: One area is bipolar depression. This is a disorder where there is an exceptionally large deviation between what the evidence says and what people are doing, especially when it comes to antidepressants. They are still being used rampantly, even in pati

Clinical Update

Oxcarbazepine: Close, but no Cigar

From The Carlat Psychiatry Report, Bipolar II

You are selecting a mood stabilizer for a 29-year-old woman with mania. If it works, she’ll need to take it long term, but with adherence rates hovering around 50% in this illness, that’s not a likely prospect. The FDA-approved options are not very high on tolerability, but what about oxcarbazepine? Oxcarbazepine (Trileptal) is often used in bipo

Expert Q&A

Psychopharmacology in Bipolar II

From The Carlat Psychiatry Report, Bipolar II

Topics: Bipolar Disorder | Hypomania | Mania | Mixed Features | Mood Stabilizers

TCPR: You’ve carved out a unique practice with difficult-to-treat bipolar disorders. Tell us about the patients you see. Dr. Kelly: I see a lot of bipolar II and “softer bipolar.” Clinically these patients have chronic depression, often mixed with hypomanic symptoms. Nearly all have tried multiple antidepressants that didn’t work, stopped worki

Highlights

Highlight From This Issue

From The Carlat Psychiatry Report, Bipolar II

In bipolar disorder, oxcarbazepine is slightly better tolerated than carbamazepine, but less effective. While its medical risks are different, they are by no means safer than carbamazepine’s. Its drug interactions can be a problem as well. On average, higher doses of second-generation antidepressants do not bring greater recoveries in major depress

Research Update

Mood Stabilizers and Stroke Risk in Bipolar Disorder

From The Carlat Psychiatry Report, Side Effects Part I

Topics: Bipolar Disorder | Lithium | Medical Comorbidities | Mood Stabilizers | Pharmacology

Review of: Chen PH et al, Br J Psychiatry 2018;1–6. doi:10.1192/bjp.2018.203 Study Type: Case-crossover study People living with bipolar disorder already have a decreased life expectancy of 10+ years compared to the general population (Crump C et al, JAMA Psychiatry 2013;70:931–939). Most of these years of lost life have been attributed to cardiov

Expert Q&A

How to Evaluate and Treat Mood Disorders in Pregnancy

From The Carlat Psychiatry Report, Medication in Pregnancy

Topics: Mood Stabilizers | Pharmaceutical Industry | Practice Tools and Tips | Psychopharmacology Tips | Women's Issues in Psychiatry

Research Update

Mood Stabilizer plus Antidepressant May Protect Against Mania

From The Carlat Psychiatry Report, Keeping up in Psychiatry

Topics: Bipolar Disorder | Mood Stabilizers | Research Updates

Article

Nuedexta for Pseudobulbar Affect

From The Carlat Psychiatry Report, Natural Treatments in Psychiatry

Topics: Mood Stabilizers | Natural Medications | Neuroscience in Psychiatry

Pseudobulbar affect (PBA), also known as pseudobulbar palsy, is a neurological condition in which patients have sudden outbursts of crying or laughing. While the episodes can be triggered by events that would ordinarily elicit genuine sadness or amusement, patients with PBA react with intense displays of emotion that they cannot control. The frequency o

Expert QA

Complementary and Alternative Medicine for Mood Disorders

From The Carlat Psychiatry Report, Natural Treatments in Psychiatry

Topics: Mood Stabilizers | Natural Medications | Women's Issues in Psychiatry

Article

Sleeping Pills: Which Ones for Which Patients?

From The Carlat Psychiatry Report, Insomnia

Topics: Antidepressants | Antipsychotics | Benzodiazepines | Hypnotics | Mood Stabilizers

Insomnia is one of the most common comorbidities you’ll see in your depressed and anxious patients (Becker PM and Sattar M, Curr Treat Options Neurol 2009;11(5):349–357). But it is often misunderstood. Over the last several years there has been a shift in how we conceptualize insomnia co-occurring with psychiatric disorders. While the common view is

Article

The Carlat Guide to Medications Used for Insomnia

From The Carlat Psychiatry Report, Insomnia

This handy table lists the medications most often used to treat insomnia. Click here to see table