Antipsychotic Maintenance: How Long is Enough?

Topics: Antidepressant Augmentation | Antidepressants | Antipsychotics | Bipolar Disorder | Deprescribing | Depression | Depressive Disorder | Mania | Metabolic syndrome | Mood Stabilizers | olanzapine | Psychopharmacology | Psychopharmacology Tips | Risperidone | Side Effects | Tardive dyskinesia

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

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Clinical Update

Oxcarbazepine: Close, but no Cigar

Topics: Bipolar Disorder | Carbamazepine | Free Articles | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

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

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Expert Q&A

Psychopharmacology in 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

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Highlight From This Issue

Topics: Bipolar Disorder | Carbamazepine | Mania | Mood Stabilizers | Oxcarbazepine | Pharmacology | Psychopharm Myths | Psychopharmacology

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

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Does Mania Follow the Sun?

Topics: Bipolar Disorder | Free Articles | Mania

TABLE : SPRINGTIME MANIA Click here for the full PDF table showing sunlight peaks.   If dark nights can treat mania, can too much sunshine destabilize it? Yes and no. Mania is linked to rapid changes in sunlight, but not to the amount of light itself. Mania peaks in early spring when there’s a steep rise in sunlight. By the time the longe

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