26. EFFECTIVENESS OF POSSIBLE MOOD STABLIZERS Acute Acute Acute Maint- Mania Mixed Rapid enance States Cyclers Lithium Yes No? No? Yes Valproate Yes Yes Yes Yes Carbamazepine (Yes) Yes Yes Yes Olanzapine/ Yes Yes Yes Pending* Clozapine * Open extension data positive for olanzapine
27.
28. PRECIPITATION OF MOOD EPISODES Mania Depression Lithium No No Valproate No No Carbamazepine No No Olanzapine/ No No Clozapine Antidepressants Yes No Typial antipsychotics No Probable
29. EASE OF USE OF MOOD STABILIZERS Simple Frequent Lab Prescribing Monitoring Lithium No Yes Valproate Somewhat Somewhat Carbamazepine No Yes Olanzapine/ Yes No Clozapine No Yes
30. SIDE EFFECTS OF MOOD STABILIZERS Lithium Weight gain, tremor, Gl symptoms, thyroid function, cognitive complaints Valproate Weight gain, ( thyroid function), Gl upset, pancreatitis, ? Polycystic ovaries Carbamazepine WBC, rashes, nausea Olanzapine/ Weight gain, sedation ? Hyperglycemia Clozapine Weight gain, sedation, agranulocytosis, salivation, ? hyperglycemia
59. History of Anxiolytic Development ALCOHOL 1903 - BARBITURATES 1950’s – NON BARBITURATES (Meprobamate) LATE 50’s - BENZODIAZEPINES NONBENZODIAZEPINE HYPNOTICS GABA MIMETICS SELECTIVE GABA A TARGETS
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82. BZD-2 receptors (Omega-2) - caudate putamen, olfactory bulb, cerebral cortex, hippocampus and dentategyrus Related to cognitive, memory and psychomotor function. BZD-3(Omega-3) are not directly associated with GABA receptors or with chloride channels . They may regulate the synthesis of neuroactive steroids. BENZODIAZEPINE RECEPTOR