Which of the following is not recommended for use as a mood stabiliser?
Vigabatrin is a drug used in epilepsy but is not indicated in bipolar disorder.
Vigabatrin is a drug used in epilepsy but is not indicated in bipolar disorder.
Bipolar disorder (prophylaxis)
Prophylaxis
According to NICE guidelines, prophylaxis for bipolar disorder should be considered:-
- After a single episode of mania if associated with significant risk and adverse consequences
- In case of bipolar I illness, after 2 or more acute episodes
- In case of bipolar II illness, if there is significant functional impairment, frequent episodes, or a significant risk of suicide
Most of the evidence supports the use of lithium. Carbamazepine is considered less effective, and the long-term efficacy of valproate is uncertain. Evidence supports the use of both typical and atypical antipsychotics.
For prophylaxis, NICE recommend:-
- Lithium, olanzapine, quetiapine or valproate as first line
Discontinuation
Stopping lithium abruptly can precipitate a relapse. The risk of relapse may be reduced by decreasing the dose gradually over a period of at least a month (Maudsley, 2012).
Maudsley Guidelines (2012) 11th Edition p.163.
