Bipolar Disorder Uncovered

Understanding And Treating Bipolar Disorders

Understanding And Treating Bipolar Disorders

Are You Extremely Happy One Moment and Extremely Sad The Next? Are You On Top Of The World Today And Suddenly Down In The Doldrums Tomorrow? Is Bipolar Disorder Really Making Your Life Miserable? Do You Want To Live Normally Once Again? Finally! Discover Some Highly Effective Tips To Get Rid Of Bipolar Disorder And Stay Happy And Excited Always! Dont Let Bipolar Disorder Ruin Your Life Anymore!

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Married To Mania

This eBook is the key to knowing if you are married to a bipolar spouse, and gives you the keys to what to do about it. Often, being married to a bipolar spouse can be one of the hardest things you go through in your life because emotions in your house can change drastically, and completely without warning. This book gives you the tools to deal with unexpected anger outbursts and guilt that many spouses feel. This book will teach YOU how to deal with feelings of guilt that you may feel towards yourself, even though you have done everything you possibly can to make your marriage work. When you get this eBook, you can order a physical copy of the book and get FREE shipping. Also, you get two bonus eBooks when you order: The Spouse's Guide to Bipolar Disorder Vocabulary, which give you the tools you need to talk to doctors and psychiatrists, and The Bipolar Disorder Rolodex which gives you the latest in bipolar disorder research. It is hard to go through a bipolar marriage without help; now you don't have to.

Married To Mania Summary

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Stop With Bipolar Disorder

This ebook guide teaches you how to keep your symptoms of bipolar disorder under control and have a manageable, excellent life even with bipolar symptoms. You will be able to stop engaging in destructive behavior, get your emotions under control, and handle stress in the way that you usually envy everyone else doing. It is not fair that you are afflicted with this; bipolar disorder is under-diagnosed and tends to affect your live and lives of those you love in a powerful, often negative way. You can put that behind you now. You no longer have to live that way. This ebook guide teaches you how to tell your negative symptoms to take a hike, and MAKE them do so. You do not have to feel guilt over your disorder. You cannot help it. But now, we can help you control it, and manage your symptoms so you can have the normal life you deserve. Continue reading...

Bipolar Disorder Stop Summary

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Author: Tito
Official Website: bipolardisorderstop.com
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General Information

The effectiveness of gabapentin has been studied in 22 patients with bipolar disorder who had an incomplete response to other mood stabilizers (5). Somnolence was common (six patients) adverse events that occurred in two patients each included irritability, memory impairment, headache, and tremor. One patient dropped out because of a mild rash.

Placebocontrolled studies

Lamotrigine has been used as maintenance monother-apy for rapid-cycling bipolar disorder in 324 patients (open label) and 182 patients (double-blind) with rapid-cycling bipolar disorder (5). In all, 265 patients reported adverse events during the open phase. The most common adverse events (over 10 ) were headache, infection, influenza, nausea, abnormal dreams, dizziness, and rash. During the double-blind phase 122 patients reported adverse events, equally with lamotri-gine and placebo.

Commonly abused prescription Drugs

Antidepressants are prescription medications used to treat depression, a disease affecting more than 19 million Americans, according to The State of Depression in America, 2006, from the Depression and Bipolar Support Alliance (DBSA). Some of the original antidepressants were Nardil, Tofranil and Elavil. Although not technically an antidepres-sant, lithium, which is used to treat bipolar disorder, is often included in this group. The side effects of prolonged and excessive use of these drugs include excessive urination or thirst, diarrhea, vomiting, drowsiness, dizziness, or muscle weakness. Some newer antidepressants are Wellbutrin, Prozac, and Zoloft. There are fewer side effects with these medications. In 2004 the U.S. Food and Drug Administration advised that antidepressants prescribed to children might initially worsen depression and increase the risk of suicide and called for warning labels and further investigation, particularly into the possibility of similar effects in adults.

Etiological Risk Factors

Converging evidence from adoption, twin, and family studies point to a significant genetic contribution, although specific markers have yet to be identified (Johansson et al., 2001). Meta-analytic studies of twins identify an overall her-itability of 37 percent with no effect of a shared environment and a 63 percent effect of the unique environment suggesting complex interactions between genes and environment (Sullivan et al., 2000). Linkage studies, however, have yet to define candidate genes, in contrast to the many linked thus far to bipolar disorder. Association studies examining polymorphisms in genes related to monoamine function, on the other hand, have identified several potential targets. One of the most promising is the insertion deletion polymorphism in the promoter region of the serotonin transporter 5-HTT (Murphy et al., 2001). While the homozygous short allele version of this gene (s s 5-HTTLPR) has been linked to depression, the association is not disease...

Newer Anticonvulsants

Several drugs that have been approved by the FDA as anticonvulsants have been studied as possible mood stabilizers or antimanic drugs (lamotrigine, gabapentin, and topiramate). In spite of extremely limited data on short- or long-term efficacy, their use for the treatment of bipolar disorder and refractory depression in the United States has become widespread. Lamotrigine is the best studied of the newer anticonvulsants. While showing efficacy for treatment of depression and for maintenance treatment in bipolar patients, it may be less efficacious in the treatment of acute mania (Leadbetter et al., 2002 American Psychiatric Association, 2002). Along with many open-label studies, there is one large multisite placebo-controlled trial of lamotrigine monotherapy for treatment of depression in outpatients with bipolar disorder (Calabrese et al., 1999). In this study, 200 mg day of lamotrigine demonstrated significant antidepressant effects in over 50 percent of these patients without...

Table 84 Common auras associated with migraine headache

Common precipitants of migraine headache include alcohol use, emotional distress, and menstruation. It is interesting to note that migraine headache frequency appears to decline during pregnancy and menopause, supporting the notion that hormonal factors have an impact on migraine headache. However, hormone therapy during menopause can prolong the migraine condition even after menopause (Epstein et al. 1975). Certain psychiatric disorders (e.g., childhood somnambulism) may possibly predict adulthood migraine headache. Other common psychiatric comorbidities among migraineurs include depression, anxiety disorders (e.g., generalized anxiety and panic disorder), and bipolar disorder (particularly bipolar II disorder) (Breslau et al. 2003 Fasmer 2001 Zwart et al. 2003).

Autism Is A Genetic Syndrome

The RELN gene encodes a protein called reelin. This gene is also located on the long arm of chromosome 7. Reelin is a key protein in the development of laminar structure in cerebral cortex, hippocampus, cerebellum and several nuclei of the brainstem. Mutant mice for this gene have abnormal migration of neurons in cortex and cerebellum, leading to disorders in locomotion. Interestingly, people with schizophrenia, bipolar disorder or major depression have a decrease of reelin level in blood (Fatemi et al., 2001). An association study showed a higher number of GGC repeat upstream to the reelin gene in some autistic patients (Persico et al., 2001). This increase may modify the transcription of the RELN gene and change the neuronal network in autism. Despite some difficulties in replication of this association study (Krebs et al., 2002), these results are really promising and should be consider for future association studies in other group of patients.

Approved Anticonvulsant Drugs

Gabapentin is structurally related to GABA (Figure 2) and is indicated for use as adjunctive therapy for refractory partial seizures in adults. It had modest efficacy as monotherapy. There is considerable interest in its mechanism of action as the majority of prescriptions for gabapentin are for off-label use including neuropathic pain, migraine, and bipolar disorder, markets that are larger than epilepsy (see 6.14 Acute and Neuropathic Pain). Thus second-generation NCEs, like pregbalin (see below) are being aggressively sought. Gabapentin, despite its structural similarity to GABA, has no effect on GABAergic systems despite early reports that it modulated GABAb receptor function.39 Findings that it selectively interacts with the a2S subunit of the Cav2.2 channel remain the subject of debate.40'41 Side effects of gabapentin include transient somnolence, dizziness, fatigue, and modest weight gain, but the compound is generally considered to have a wide margin of human safety....

Treatment Options for Anxiety

Antipsychotics These medications are generally used to treat the hallucinations, delusions, and disorganized thinking in schizophrenia and bipolar disorder, and, if present, in depression. They can be helpful when severe anxiety overwhelms your ability to think clearly. They work within an hour or two, are not habit-forming, and can be used intermittently. Their side effects can be quite unpleasant, however, in

Yohimbe And Yohimbine

Precautions It should not be used by those with an allergy to yohimbine or any of the Rauwolfia alkaloids, angina pectoris, hepatitis, hypoglycemia, blood pressure disorders, ulcers, diabetes, kidney disease, liver disease, heart disease, panic attacks, bipolar disorder, or schizophrenia. Those suffering from or being treated for depression, any psychiatric disorder, any other allergy, or those taking any drugs that interfere with norepinephrine's neuronal uptake or metabolism (including Selegiline) should use yohimbe only under a physician's guidance in fact, many herbalists caution that the potent herb should never be used without the advice of a physician or herbalist.

Carbamazepine

Treat pain associated with tic douloureux (trigeminal neuralgia) and glossopharyngeal neuralgia. Non-FDA Approved Uses Bipolar disorders, unipolar depression, schizoaffective illness, resistant schizophrenia, dyscontrol syndrome associated with limbic system dysfunction, intermittent explosive disorder, PTSD, atypical psychosis. Management of alcohol, cocaine, and benzod-iazepine withdrawal symptoms. Restless leg syndrome, nonheredi-tary chorea in children. Contraindications History of bone marrow depression. Hypersen-sitivity to drug or tricyclic antide-pressants. Lactation. In clients taking MAO inhibitors. Use for relief of general aches and pains. Special Concerns Safety and effectiveness have not been established in children less than 6 years of age. Use with caution in glaucoma and in hepatic, renal, CV disease, and a history of hematologic reaction. Use with caution in clients with mixed seizure disorder that includes atypical absence seizures (carbamazepine is not effective...

Atomoxetine

PRECAUTIONS Warning Rarely, atomoxetine can cause liver failure. Also rarely, some people experience suicidal thoughts on atomoxetine. Use extra caution if you have Bipolar disorder, as atomoxetine can exacerbate mood swings cardiovascular disease, hypertension, or tachycardia, as atomoxetine can raise your heart rate and blood pressure glaucoma, as atomoxetine can exacerbate the symptoms liver problems, as atomoxetine can build up in your system to excessive levels low blood pressure, as atomoxetine can cause dizziness or fainting prostatic hypertrophy or urinary retention, as atomoxetine may worsen urinary retention schizophrenia or other psychotic disorders, as atomoxetine can worsen psychotic symptoms. Tests before starting None. Alcohol The simultaneous use of atomoxetine and alcohol causes no specific adverse consequences, but alcohol should be avoided because it can impair attention and concentration, decreasing the effectiveness of atomoxetine.

Citalopram

Dangerous alterations in pulse, blood pressure, hyperactivity, and mental status changes (see chapter 19). Rarely, citalopram can cause hyponatremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as citalo-pram can cause a manic episode epilepsy, as citalopram may increase the frequency of seizures a psychotic disorder, as citalopram can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of citalopram and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriages, heart defects, and intestinal defects in the babies of women who take citalopram during pregnancy.

Duloxetine

PRECAUTIONS Use extra caution if you have Bipolar disorder, as duloxetine can cause a manic episode epilepsy, as duloxetine may increase the frequency of seizures glaucoma, as duloxetine can worsen the symptoms high bloodpressure, as duloxetine can increase blood pressure kidney or liver disease, as levels of duloxetine can build up too high in your system and can cause further liver damage a psychotic disorder, as duloxetine can worsen psychotic symptoms. Tests needed before starting None. Alcohol Duloxetine can cause liver damage in people who drink substantial amounts of alcohol. On its own, alcohol can worsen anxiety and depression. Alcohol should be avoided entirely. Use in pregnancy Some babies exposed during pregnancy to medications similar to duloxetine (such as SSRIs) have developed significant problems upon birth that could be due to the medication or its discontinuance. Reactions can include breathing problems, temperature instability, metabolic abnormalities, seizures,...

Escitalopram

PRECAUTIONS Warnings When taken with other serotonin reuptake inhibitors, escitalopram can cause the serotonin syndrome, which consists of potentially dangerous alterations in pulse, blood pressure, hyperactivity, and mental status changes (see chapter 19). Rarely, escitalopram can cause hypona-tremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as escitalopram can cause a manic episode epilepsy, as escitalopram may increase the frequency of seizures a psychotic disorder, as escitalopram can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of escitalopram and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriages, heart defects, and intestinal defects in the babies of women who take escitalopram during pregnancy.

Fluphenazine

GENERAL Preparations Generic and brand name Prolixin in pills and liquid form brand name only in long-acting injectable concentrate. Class Standard an-tipsychotic of the phenothiazine group. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety). Mechanism of action Blocks postsynaptic dopamine receptors.

Isocarboxazid

PRECAUTIONS Warnings Isocarboxazid can cause a hypertensive crisis in which your blood pressure rises to a dangerously high level, putting you at risk for a brain stroke, brain damage, and death. This reaction is unlikely to occur on its own, but is possible if used in combination with foods or medicines that contain tyramine or substances similar to epinephrine. The following medications must be avoided while you are on isocarboxazid and for two weeks following its cessation in order to avoid a hypertensive crisis Prescription medications antiasthmatics that contain epinephrine or epinephrine-like compounds, most antidepressants, antihypertensives, antiparkinsonian agents, barbiturates, buspirone (Buspar), carba-mazepine (Tegretol), disulfiram, diuretics, narcotics, stimulants over-the-counter medications decongestants, dextromethorphan, tryptophan, hay fever medications, sinus medications, appetite suppressants recreational drugs amphetamines, cocaine, hallucinogenics, heroin or...

Maprotiline

PRECAUTIONS Warnings Seizures can occur with the use of maprotiline. They are more likely if you also use phenothiazines, exceed the usual dosage, or rapidly taper a benzodiazepine. Use extra caution if you have Bipolar disorder, as maprotiline may cause a manic episode heart disease or if you recently had a heart attack, as maprotiline may dangerously affect heart function hyperthyroidism, as maprotiline may cause irregular heart rhythms asthma, low blood pressure, congestive heart failure, edema, epilepsy, glaucoma, enlarged prostate, or urinary retention, as maprotiline may worsen the symptoms a psychotic disorder, as maprotiline may make psychotic symptoms worse. Tests needed before starting None. Alcohol Should be avoided as the simultaneous use of maproti-line and alcohol can increase the risk of seizures, lower blood pressure significantly, and cause confusion. Also, alcohol worsens anxiety and depression and impairs insight and judgment.

Paroxetine

PRECAUTIONS Warnings When taken with other serotonin reuptake inhibitors, paroxetine can cause the serotonin syndrome, which consists of potentially dangerous alterations in pulse, blood pressure, hyperactivity, and mental status changes (see chapter 19). Rarely, paroxetine can cause hyponatremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as paroxetine can cause a manic episode epilepsy, as paroxetine may increase the frequency of seizures a psychotic disorder, as paroxetine can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of paroxetine and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriage, heart defects, and intestinal defects in the babies of women who take paroxetine during pregnancy.

Perphenazine

GENERAL Preparations Generic and brand name Trilafon in pills and liquid form. Class Standard antipsychotic of the phenothiazine group. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety). Mechanism of action Blocks postsynaptic dopamine receptors.

Sertraline

PRECAUTIONS Warnings When taken with other serotonin reuptake inhibitors, sertraline can cause the serotonin syndrome, which consists of potentially dangerous alterations in pulse, blood pressure, hyperactivity, and mental status changes (see chapter 19). Rarely, sertraline can cause hyponatremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as sertraline can cause a manic episode epilepsy, as sertraline may increase the frequency of seizures a psychotic disorder, as sertraline can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of sertra-line and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriages, heart defects, and intestinal defects in the babies of women who take sertraline during pregnancy.

Topiramate

GENERAL Preparations Generic and brand name Topamax. Class Mood stabilizer. Used in Binge-eating disorder, bipolar disorder. Mechanism of action Topiramate has at least three different effects on the brain, but it is unknown precisely how it affects mood and appetite. PRECAUTIONS Use with extra caution if you have Kidney or liver impairment, as the metabolic breakdown of topiramate will be reduced, increasing the intensity and duration of its effects kidney stones, as topiramate may increase their frequency. Tests before starting None. Alcohol Should be avoided because it may impair the effectiveness of topiramate and because it can worsen depression in bipolar disorder. DOSING Adults The usual starting dose is 50 mg daily. Increases of 50 mg daily each week up to a maximum of 200 mg twice daily is the highest dose found to be helpful for seizures, but the maximum dose useful for bipolar disorder has not been established. Children Same as adults. The elderly Same as adults.

Tranylcypromine

Amounts of caffeine-containing beverages (more than one or two, although some people are more sensitive than others) like coffee, tea, sodas, and hot chocolate. Don't use if you have Congestive heart failure, as it may make the symptoms worse high blood pressure, as tranylcypromine may make the symptoms worse pheochromocytoma, as it may cause a hypertensive crisis. Use extra caution if you have Bipolar disorder, as tranylcypromine can cause a manic episode epilepsy, as tranylcypromine may increase seizure frequency low blood pressure, as tranylcypromine may make symptoms worse a psychotic disorder, as tranyl-cypromine can worsen psychotic symptoms. Tests needed before starting None. Alcohol Alcohol should be avoided because it worsens anxiety and depression. Beer, wine, Chianti, sherry, and liqueurs, whether they contain alcohol or not, can cause a hypertensive crisis. Hard liquor has no specific adverse consequences, but should be avoided because it can worsen anxiety, depression,...

Trimipramine

PRECAUTIONS Don't use if you have Heart block (an abnormal heart rhythm) or if you recently had a heart attack, as trimipramine may worsen heart block and dangerously affect heart function. Use extra caution if you have Bipolar disorder, as trimipramine may cause a manic episode epilepsy, as tri-mipramine may increase the frequency of seizures glaucoma, as trimipramine can worsen the symptoms of untreated angle closure glaucoma low blood pressure, as trimipramine may lower blood pressure further a psychotic disorder, as trimipramine may make psychotic symptoms worse hyperthyroidism, as tri-mipramine may cause irregular heart rhythms prostatic hypertrophy or urinary retention, as trimipramine may worsen urinary retention. Tests needed before starting An electrocardiogram (EKG) if you are over 35, to ensure you do not have any form of heart block. Alcohol Should be avoided, as the simultaneous

Venlafaxine

PRECAUTIONS Use extra caution if you have Bipolar disorder, as ven-lafaxine can cause a manic episode epilepsy, as venlafaxine may increase the frequency of seizures high blood pressure, as venlafaxine can increase blood pressure a psychotic disorder, as venlafaxine can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of venlafax-ine and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression.

Genetics

In interpreting this section, it is important to keep in mind the general caveats of genetic association studies, which are fraught with poor reproducibility due to population stratification artifacts. However, recent genetic evidence are supportive of a role of GSK-3 in the pathophysiology of the disorder. GSK-3a and P are mapped to human 19q13.1-13.2 and 3q13.3-21.1, respectively 118,119 . Bipolar disorder linkage studies have suggested some degree of linkage to both regions 120 , though these findings do not approach criteria for genome-wide significance 121 . A common GSK-3P promoter polymorphisms, (-50 T C 122 ), has been studied in patients with bipolar disorder. While an initial family-based association study (transmission disequilibrium test) was negative 123 , evidence suggests that GSK-3 polymorphisms may be associated more strongly with bipolar disorder endophenotypes 12,124,125 . Benedetti and colleagues reported that this polymorphism is associated with response to...

M2 Receptors

An initial study based on 760 subjects reported an association of a A1890T SNP (rs8191992) in the 3'UTR of the CHRM2 with major depression in women but not men (Comings et al. 2002). An association of intronic SNPs from the CHRM2 has also been reported with alcoholism and major depressive syndrome based on the COGA study (2,310 subjects from 262 families) (Wang et al. 2004). While one of these SNPs (rs1824024) was associated with both conditions, several others were associated with one but not the other. However, a later case-control study with 1,420 cases and 1,624 controls failed to confirm an association with depression, including the rs1824024 SNP (Cohen-Woods et al. 2009). Similarly, a study with 474 subjects from 152 families did not detect an association with bipolar disorder with any of 13 SNPs including rs1824024 and rs8191992 (Shi et al. 2007). Within a single study of 406 subjects, rs8191992 did not associate with visual attention or working memory, but significantly...

Mood Disorders

BIPOLAR DISORDER Bipolar disorder, previously termed manicdepressive illness, is characterized by the ocurrence of mania. A full manic syndrome is one of the most striking and distinctive conditions in clinical practice. The essential disturbance in mood is one of elation or irritability. Manics feel on top of the world, expansive, energetic, and precarious but may quickly become argumentative, hostile, and sarcastic, especially when their plans are thwarted. The vegetative signs of mania are a decreased need for sleep, increased activity, rapid pressured speech, and racing thoughts. Manics may have grandiose ideas, such as unrealistic plans to start a business or run for public office, and if the grandiosity reaches delusional proportions, such patients may believe themselves to be famous, fabulously wealthy, or blessed with special powers and abilities. Poor judgment in spending money and sexual behavior may lead to problems that prompt manics' families to seek treatment for them,...

Thioridazine

GENERAL Preparations Generic and brand name Mellaril in tablets and liquid form. Class Standard antipsychotic of the phenothiazine group. Used in Psychotic disorders (Alzheimer's disease, severe anxiety, severe ADHD, bipolar disorder, developmental disorders, insomnia). Mechanism of action Blocks postsynaptic dopamine receptors.

Clomipramine

PRECAUTIONS Do not use if you have Heart block (an abnormal heart rhythm) or if you recently had a heart attack, as clomipramine may worsen heart block and dangerously affect heart function. Use extra caution if you have Bipolar disorder, as clomipramine may cause a manic episode epilepsy, as clomipramine may increase the frequency of seizures glaucoma, as clomipramine can worsen the symptoms of untreated angle closure glaucoma low blood pressure, as clomipramine may lower blood pressure further a psychotic disorder, as clomipramine may make psychotic symptoms worse hy-perthyroidism, as clomipramine may cause irregular heart rhythms prostatic hypertrophy or urinary retention, as clomipramine may worsen urinary retention. Tests needed before starting An electrocardiogram (EKG) if you are over 35, to ensure that you do not have any form of heart block. Alcohol Should be avoided, as the simultaneous use of clomipramine and alcohol can lower blood pressure significantly and cause...

Imipramine

PRECAUTIONS Don't use if you have Heart block (an abnormal heart rhythm) or if you recently had a heart attack, as imipramine may worsen heart block and dangerously affect heart function. Use extra caution if you have Bipolar disorder, as imipramine may cause a manic episode epilepsy, as imipramine may increase the frequency of seizures glaucoma, as imipramine can worsen the symptoms of untreated angle closure glaucoma low bloodpres-sure as imipramine may lower blood pressure further a psychotic disorder, as imipramine may make psychotic symptoms worse hyperthyroidism, as imipramine may cause irregular heart rhythms prostatic hypertrophy or urinary retention, as imipramine may worsen urinary retention. Tests needed before starting An electrocardiogram (EKG) if you are over 35, to ensure that you do not have any form of heart block. Alcohol Should be avoided, as the simultaneous use of imipramine and alcohol can lower blood pressure significantly and cause confusion. Also, alcohol...

Trifluoperazine

GENERAL Preparations Generic and brand name Stelazine in pills and liquid form. Class Standard antipsychotic of the phenothiazine group. Used in Psychotic disorders, bipolar disorder (Alzheimer's disease, severe anxiety, severe ADHD, developmental disorders). Mechanism of action Blocks postsynaptic dopamine receptors.

Haloperidol

GENERAL Preparations Generic in pills. Brand name Haldol in liquid and long-acting injectable concentrate. Class Standard antipsychotic. Used in Bipolar disorder, developmental disorders, psychotic disorders (Alzheimer's disease, severe anxiety, severe ADHD). Mechanism of action Blocks postsynaptic dopamine receptors.

Chlorpromazine

GENERAL Preparations Generic and brand name Thorazine in pill and liquid form. Class Standard antipsychotic of the phenothiazine group. Used in Psychotic disorders, bipolar disorder (Alzheimer's disease, severe anxiety, severe ADHD, developmental disorders, insomnia). Mechanism of action Blocks post-synaptic dopamine receptors.

Mood Stabilizers

Some patients who have depression also have episodes of elevated mood and erratic, uncontrolled behavior. These patients are diagnosed with bipolar disorder, formerly known as manic-depression. The underlying cause for this disorder is unknown, but there is a strong genetic predisposition. Evidence suggests the condition is due to overactivity of the neurotransmitters. Treatment for bipolar disorder consists of mood-stabilizing drugs. These drugs control not only the highs but also the episodes of depression.

Mirtazapine

PRECAUTIONS Warnings Mirtazapine can cause agranulocytosis, a severe reaction that is potentially fatal (see chapter 19). Use extra caution if you have Bipolar disorder, as mirtazapine may cause a manic episode epilepsy, as mirtazapine may increase the frequency of seizures low blood pressure, as mir-tazapine may lower it further a psychotic disorder, as mirtazapine may make psychotic symptoms worse. Tests needed before starting An electrocardiogram (EKG) if you are over 35, to ensure you do not have any form of heart block. Alcohol Should be avoided because it may cause excessive sedation and low blood pressure and cause confusion. Alcohol also worsens anxiety and depression.

Nefazodone

These disorders bipolar disorder, as nefazodone may cause a manic episode apsy-chotic disorder, as nefazodone may make psychotic symptoms worse. Tests needed before starting None. Alcohol Should be avoided as the simultaneous use of nefazodone and alcohol can lower blood pressure significantly and cause confusion. Also, alcohol worsens anxiety and depression and impairs insight and judgment.

Oxcarbazepine

GENERAL Preparations Brand name Trileptal only in pills and liquid. Class Mood stabilizer. Used in Bipolar disorder. Mechanism of action Oxcar-bazepine has many actions in the brain on receptors, neurotransmitter concentrations, ion channels, and second messenger systems, but it is unknown which effect stabilizes mood. PRECAUTIONS Warnings Oxcarbazepine can cause serious skin reactions that are potentially fatal, though quite rare. Oxcarbazepine causes hyponatremia in about 1 percent of people who take it. Hyponatremia means a low sodium level in the blood. It is a serious abnormality that requires immediate medical attention. Use extra caution if you have Kidney or liver disease, as they may slow the rate of metabolism glaucoma, as oxcarbazepine can worsen the symptoms. Tests needed before starting Blood electrolytes. Alcohol It should be avoided, as it may impair the effectiveness of oxcarbazepine. Alcohol should also be avoided because it can worsen depression and cause confusion...

Valproate

GENERAL Preparations Generic, brand names Depakote and Depakote ER (extended release) in pills and sprinkles, and Depakene in liquid form. Class Mood stabilizer. Used in Bipolar disorder. Mechanism of action Valproate has many actions in the brain on receptors, neurotransmitter concentrations, ion channels, and second messenger systems, but it is unknown which effect stabilizes mood. PRECAUTIONS Warnings Rarely, liver failure, pancreatitis (inflammation of the pancreas), and thrombocytopenia (low blood platelets, which are necessary for blood clotting) can be caused by valproate. These conditions are potentially life-threatening (see chapter 19). Use extra caution if you have Glaucoma or polycystic ovary syndrome, as valproate can worsen the symptoms. Tests needed before starting Complete blood count (CBC), liver function tests. Alcohol Should be avoided as it may impair the effectiveness of valproate. Alcohol should also be avoided because it can worsen depression in bipolar...

Bupropion

PRECAUTIONS Don't use if you have Epilepsy, as bupropion may increase the frequency of seizures. Use extra caution if you have Anorexia or bulimia, as there is a higher incidence of seizures if you take bupropion bipolar disorder, as bupropion can cause a manic episode Parkinson's, as bupropion may worsen agitation and lead to confusion a psychotic disorder, as bupropion can worsen psychotic symptoms. Tests needed before starting None. Alcohol Should be avoided because its use with bupropion puts you at higher risk for seizures. Also, alcohol worsens anxiety and depression.

Fluoxetine

Rarely, fluoxetine can cause hyponatremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as fluoxetine can cause a manic episode diabetes, as fluoxetine may alter control of sugar epilepsy, as fluoxetine may increase the frequency of seizures a psychotic disorder, as fluoxetine can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of fluoxetine and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriages, heart defects, and intestinal defects in the babies of women who take fluoxetine during pregnancy.

Risperidone

GENERAL Preparations Brand name Risperdal in pills and liquid form, long-acting injectable Risperdal Consta, and orally disintegrating Risperdal M-tabs. Class Atypical antipsychotic. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety, developmental disorders). Mechanism of action Blocks a subset of dopamine and serotonin receptors.

Olanzapine

GENERAL Preparations Brand name Zyprexa and orally disintegrating Zyprexa Zydis. Class Atypical antipsychotic. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety, developmental disorders). Mechanism of action Blocks a subset of dopamine and serotonin receptors.

Fluvoxamine

PRECAUTIONS Warnings When taken with other serotonin reuptake inhibitors, fluvoxamine can cause the serotonin syndrome, which consists of potentially dangerous alterations in pulse, blood pressure, hyperactivity, and mental status changes (see chapter 19). Rarely, fluvoxamine can cause hyponatremia, or low sodium in your blood. Use extra caution if you have Bipolar disorder, as flu-voxamine can cause a manic episode epilepsy, as fluvoxamine may increase the frequency of seizures a psychotic disorder, as fluvoxamine can worsen psychotic symptoms. Tests needed before starting None. Alcohol The simultaneous use of fluvoxamine and alcohol causes no specific adverse consequences, but alcohol should be avoided because it worsens anxiety and depression. Use in pregnancy There is a higher rate of miscarriages, heart defects, and intestinal defects in the babies of women who take fluvoxamine during pregnancy.

Candidate Genes

Gbeta3 polymorphism was associated with response to AD treatment in 88 depressive patients (10 bipolar disorder, 78 major depression) compared with 68 schizophrenic patients and 111 healthy controls. A statistical significant association was found between TT homozygosity and response to various AD treatments after four weeks (Zill 2000). In our centre we could replicate this finding in a sample of 490 subjects, bipolars and major depressives, treated with SSRIs fluvoxamine and paroxetine. Subjects with Gbeta3 T T variants showed better response to treatment (p 0.009) and this effect was independent from analysed demographic and clinical variables (Serretti 2003). These are to our knowledge the first studies investigating association between a polymorphism in a molecule involved in intracellular signal transduction pathway and AD action.

Trazodone

PRECAUTIONS Warnings Priapism, which is a sustained erection of the penis not due to sexual arousal, can be caused by trazodone. Priapism can damage the penis and calls for immediate intervention. Treatment generally consists of an injection into the penis. Though uncomfortable, there are no long-lasting effects. Rarely, surgical intervention has been required, with the result of impotence. Use extra caution if you have Asthma, low blood pressure, congestive heart failure, edema, epilepsy, glaucoma, heart disease, hyperthyroidism, enlarged prostate, or urinary retention, as trazodone can worsen the symptoms bipolar disorder, as tra-zodone may cause a manic episode a psychotic disorder, as trazodone may make psychotic symptoms worse. Tests needed before starting None. Alcohol Should be avoided, as the simultaneous use of trazodone and alcohol can lower blood pressure significantly and cause confusion. Also, alcohol worsens anxiety and depression and impairs insight and judgment.

Ziprasidone

GENERAL Preparations Brand name Geodon only in pills and short-acting injectable. Class Atypical antipsychotic. Used in Bipolar disorder, psychotic disorders (Alzheimer's disease, severe anxiety, developmental disorders). Mechanism of action Blocks a subset of dopamine and serotonin receptors.

Phenelzine

Bologna, corned beef, hot dogs, liverwurst, pepperoni, salami, sausage broad bean pods (fava beans) sauerkraut pickles soy sauce licorice, caviar, anchovies, dried fruits (raisins, prunes), figs, raspberries, chocolate bananas, pickled herring excessive amounts of caffeine-containing beverages (more than one or two, although some people are more sensitive than others) like coffee, tea, sodas, and hot chocolate. Don't use if you have Congestive heart failure, as it may make the symptoms worse high blood pressure, as phenelzine may make the symptoms worse pheochromocytoma, as it may cause a hypertensive crisis. Use extra caution if you have Bipolar disorder, as phenelzine can cause a manic episode epilepsy, as phenelzine may increase seizure frequency low blood pressure, as phenelzine may make symptoms worse a psychotic disorder, as phenelzine can worsen psychotic symptoms. Tests needed before starting None. Alcohol Beer, wine, Chianti, sherry, and liqueurs, whether they contain alcohol...