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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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<strong>COSIG</strong> Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006<br />

Generic Name<br />

Gabapentin<br />

Lamotrigine<br />

Topiramate<br />

Oxcarbazepine<br />

Zonisamide<br />

Anticonvulsant Meds.<br />

Trade Name<br />

Neurontin<br />

Lamictal<br />

Topamax<br />

Trileptal<br />

Zonegran<br />

Use/Utility<br />

Adjunct for<br />

insomnia, anxiety,<br />

agitation, pain<br />

Maintenance for<br />

acute depression<br />

Adjunct for obesity<br />

Acute mania,<br />

maintenance?<br />

Adjunct for obesity<br />

Atypical Anti-psychotic<br />

medications in treating Bipolar<br />

Advantages over anti-convulsant treatment<br />

• Do not have significant side-effect burdens of<br />

other mood stabilizers<br />

• Polypharmacy: safer with meds. from different<br />

classes (e.g. atypical + anticonvulsant)<br />

• Can treat symptoms of psychosis as well other<br />

symptoms of mania (as seen in Bipolar, Type I)<br />

• Each atypical has unique pharmacological profile<br />

Atypical Anti-psychotic<br />

medication in treating Bipolar<br />

Disadvantages vs. anti-convulsants<br />

• Weight gain/obesity<br />

• Metabolic syndrome ( insulin resistance/<br />

diabetes; lipid level increases; obesity;<br />

cardiovascular conditions)<br />

• Hyperprolactinemia<br />

• Elongated QTc interval<br />

Recommendations for<br />

Treating Bipolar<br />

• Avoid antidepressant monotherapy in Bipolar Type I<br />

• Initiate Depakote in Bipolar Type I & Lamictal (or<br />

Symbyax) in Bipolar Type II<br />

• Move rapidly to add-on therapy if needed<br />

– Atypical anti-psychotic<br />

– Second mood stabilizing anti-convulsant<br />

• Choosing Depakote or Lamictal over Lithium due to<br />

enhance efficacy and tolerability<br />

Bowden, C (2004) Early intervention to reduce depression in bipolar disorder.<br />

Program & Abstracts of the International Congress of Biological<br />

Psychiatry, Feb. 9-13: Sidney, Australia, Symposium 40<br />

Other uses being explored for<br />

Mood Stabilizers<br />

• In addition to Bipolar Affective Disorder,<br />

Schizophrenia/Schizoaffective disorder and<br />

seizure disorders, mood stabilizers are being<br />

investigated for<br />

– Decrease substance abuse<br />

– Use as alternative to BZDS in alcohol<br />

withdrawal<br />

– Aggressive behavior<br />

– Binge Drinking<br />

– Pain management<br />

– Anxiety disorders<br />

Lithium, Mood Stabilizers and<br />

MISA<br />

•Lithium/mood stabilizers are<br />

consistent with MISA best practice.<br />

However:<br />

– In bipolar & depression must look for<br />

• suicidal ideation<br />

• history of attempts, etc. especially during<br />

substance withdrawal<br />

– Liver problems not as much of a<br />

concern as kidney<br />

7

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