Mood Stabilizers Research Articles

Suicidality Is Most Centrally Situated Within Network of Depression Symptom Criteria in Unipolar Depression Patients With Mood Stabilizer in Asia

Lithium and mood stabilizers are considered effective augmentation agents of antidepressants for treatment-resistant depression. Thus, this study aimed to estimate the network structure of depression symptom criteria among unipolar depression patients with mood stabilizers, using data from the Research on Asian Psychotropic Prescription Patterns for mood stabilizers (REAP-MS). We estimated a network of the 9 depression symptom criteria among 411 unipolar depression patients in Asia. Each of the depression symptom criteria was considered to be a dichotomous categorical variable. Suicidality (suicidal ideation or attempt) was the most centrally situated within the network of depression symptoms, followed by depressed mood, loss of energy, anhedonia and weight loss or gain. Contrastingly, concentration problem was the least interconnected. The depression symptom criteria were organized into 4 clusters by the community detection method. The findings suggest that suicidality may be one of the significant therapeutic target symptoms in unipolar depression patients with mood stabilizers.

Are circadian rhythms more favorable with lithium than with other mood stabilizers? An exploratory actigraphy study in euthymic bipolar disorder type 1

BackgroundBipolar Disorder (BD) is associated with alterations of circadian rhythms of activity (CRA). Experimental research suggests that lithium (Li) modifies CRA, but this has been rarely explored in BD using actigraphy. MethodsThe sample comprised 88 euthymic BD-I cases with 3 weeks of actigraphy. We used a Principal Component Analysis (PCA) to generate CRA dimensions. We then used linear regression analyses to compare these dimensions between groups of individuals defined according to prescribed mood stabilizers: Li monotherapy (“Li” group, n = 28), anticonvulsant or atypical antipsychotic monotherapy (“AC or AAP” group, n = 27) or combined treatments (“Li+AC or Li+AAP” group, n = 33). Analyses were adjusted for potential confounders (gender, age, body mass index, depressive symptoms, co-prescribed benzodiazepines and antidepressants, smoking status and past alcohol use disorder). ResultsThe PCA identified two dimensions: “robust CRA” (high amplitude and interdaily stability, with low intradaily variability) and “late chronotype”. Univariate analyses showed higher scores for “robust CRA” in the “Li” versus the “AC or AAP” (p = 0.021) or “Li+AC or Li+AAP” groups (p = 0.047). These findings remained significant after adjustments (respectively p = 0.010 and p = 0.019). Post-hoc analyses suggested lower variability, higher stability and higher amplitude of CRA in the “Li” group. Medication groups were similar for the “late chronotype” dimension (p = 0.92). ConclusionsThis actigraphy study is the first to show more favorable CRA in BD-I individuals receiving a Li monotherapy when compared with those receiving other classes or combinations of mood stabilizers. Replications in larger samples are required. Prospective studies are also warranted to elucidate whether the introduction of Li or other mood stabilizers might influence CRA in BD-I.

Antipsychotics vs. Mood Stabilizers for Acute Mania in Youth

Antipsychotics vs. Mood Stabilizers for Acute Mania in Youth

Tramadol-Induced Mania: A Case Report

This case report describes a rare occurrence of tramadol misuse resulting in a manic episode in a patient without a history of psychiatric disorders. The patient had used tramadol off-label for premature ejaculation. Following discontinuation of tramadol and initiation of mood stabilizer treatment, the manic symptoms resolved. Tramadol, despite its potential antidepressant properties, also poses a risk of inducing psychiatric disturbances. Diagnosis can be challenging and necessitates a thorough examination. Management involves immediate cessation of tramadol and administration of mood stabilizers. Clinicians should exercise caution and closely monitor patients when prescribing tramadol, particularly for off-label indications.

Prolonged transcranial magnetic stimulation in a pregnant patient with treatment-resistant depression: a case report

IntroductionPerinatal depression is a serious and highly prevalent medical condition in the USA. Nearly 85% of individuals with perinatal depression go untreated, leading to significant morbidity and mortality. There is an urgent need to develop and advance safe and effective treatments for perinatal depression. Transcranial magnetic stimulation is an established intervention for depression in non-pregnant individuals yet is not well studied in perinatal depression.Case presentationA 33-year-old pregnant Latina female presented with severe, recurrent, treatment-resistant depression and suicidal ideation. The patient had previously trialed psychotherapy, multiple antidepressants, and mood stabilizers and had achieved remission with lithium prior to pregnancy. Due to pregnancy and fetal safety concerns, the patient discontinued lithium and consequently suffered progressive worsening of perinatal depression. At 24 weeks gestation and after additional failed medication trials, a prolonged course of transcranial magnetic stimulation was initiated. Following 46 transcranial magnetic stimulation treatments over 9 weeks using two protocol types (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation), she achieved near-remission of perinatal depression and resolution of suicidal ideation. There were no identified maternal or fetal adverse events at 6 weeks post-delivery.ConclusionTo our knowledge, this is the first published case of a pregnant individual with perinatal depression who received and tolerated a prolonged transcranial magnetic stimulation course with two distinct protocols (repetitive transcranial magnetic stimulation and intermittent theta burst stimulation) with clinically significant response. Transcranial magnetic stimulation is a well-tolerated and effective intervention that warrants further investigation for use in treatment-resistant perinatal depression.

Risk of physical health comorbidities in autistic adults: clinical nested cross-sectional study.

Physical health conditions are more common in individuals with autism. Some, like epilepsy, have considerable evidence supporting their increased prevalence, but many diseases lack literature to make strong conclusions. To investigate the prevalence of physical health comorbidities in autism. We undertook a nested cross-sectional study, using a sample from the National Centre for Mental Health database. It included participants from England and Wales who reported a clinician-made diagnosis of autism (n = 813), and a control sample without autism or mental illness (n = 2781). Participants had provided a medical history at enrolment. Analysis was carried out by binomial logistic regressions controlling for age, gender, smoking status, and antipsychotic and mood stabiliser use. A subanalysis of individuals with concurrent intellectual disability (n = 86) used binomial logistic regression with the same control variables. Many physical health conditions were significantly more common in autism. Sixteen out of 28 conditions showed increased odds, with the highest odds ratios observed for liver disease, chronic obstructive pulmonary disease, kidney disease, osteoporosis and rheumatoid arthritis. A subanalysis demonstrated a similar pattern of physical health in individuals with autism with and without concurrent intellectual disability. Some conditions, including osteoporosis, hyperthyroidism, head injury and liver disease, had larger odds ratios in individuals with concurrent intellectual disability. Physical health conditions occur more commonly in individuals with autism, and certain conditions are further increased in those with concurrent intellectual disability. Our findings contribute to prior evidence, including novel associations, and suggest that people with autism are at greater risk of physical health problems throughout adulthood.

DESAFIOS DO MANEJO DO LÍTIO NO PACIENTE PSIQUIÁTRICO: ESTRATÉGIAS PARA GARANTIR A SEGURANÇA E EFICÁCIA DO TRATAMENTO

Although lithium has been used for decades, its management remains a clinical challenge, since it is a drug with narrow therapeutic indices and with possible adverse effects. Therefore, this study aims to present evidence and clinical challenges of lithium management in psychiatry, in order to contribute to a better understanding of the use of this drug and the conscious management of patients who use this medication. This is a retrospective, documental Integrative Literature Review about the challenges of lithium management in psychiatric patients. For the development of this work, the following steps were followed: 1) Construction of the theme and the guiding question; 2) Establishment of inclusion and exclusion criteria; 3) Collection of studies in the scientific bases; 4) Evaluation of the selected abstracts; 5) Evaluation and categorization of studies in full; 6) Analysis and interpretation of the results. Lithium, as a mood stabilizer, was a great historical discovery and its importance lies in its effectiveness in controlling the symptoms of bipolarity, being considered a first-line mood stabilizer for the treatment of bipolar disorder and other psychopathologies. It is concluded, therefore, that the management of lithium in the treatment of psychiatric disorders requires a careful and individualized approach, taking into account the efficacy of the drug, patient safety and possible drug interactions and clinical conditions. Knowledge of the common and rare side effects of lithium is essential to ensure successful and safe treatment.

Is There such a Thing as Post-Viral Depression?: Implications for Precision Medicine.

Viral infections are increasingly recognized as triggers for depressive disorders, particularly following the SARS-CoV-2 pandemic and the rise of long COVID. Viruses such as Herpes Simplex Virus (HSV), Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Human Immunodeficiency Virus (HIV) are linked to depression through complex neurobiological mechanisms. These include immune system dysregulation, chronic inflammation, and neurotransmitter imbalances that affect brain function and mood regulation. Viral activation of the immune system leads to the release of pro-inflammatory cytokines, resulting in neuroinflammation and associated depressive symptoms. Furthermore, specific viruses can disrupt neurotransmitter systems, including serotonin, dopamine, and glutamate, all of which are essential for mood stabilization. The unique interactions of different viruses with these systems underscore the need for virus-specific therapeutic approaches. Current broad-spectrum treatments often overlook the precise neurobiological pathways involved in post-viral depression, reducing their efficacy. This review emphasizes the need to understand these virus-specific interactions to create tailored interventions that directly address the neurobiological effects induced by each type of virus. These interventions may include immunomodulatory treatments that target persistent inflammation, antiviral therapies to reduce the viral load, or neuroprotective strategies that restore neurotransmitter balance. Precision medicine offers promising avenues for the effective management of virus-induced depression, providing patient-specific approaches that address the specific biological mechanisms involved. By focusing on the development of these targeted treatments, this review aims to pave the way for a new era in psychiatric care that fully addresses the root causes of depression induced by viral infections.

Lymphocyte-derived and lipoprotein-derived inflammatory ratios as biomarkers in bipolar disorder type I: Characteristics, predictive values, and influence of current psychopharmacological treatments

Purpose of this researchThe purpose of this research was to investigate peripheral inflammation by analyzing lymphocyte and lipoprotein-derived inflammatory ratios in patients with bipolar disorder type I (BD-I) and healthy controls (HCs), considering mood stabilizer drug treatments, sex and clinical trajectories. MethodsThis was a cross-sectional case-control study of BD-I patients (n=252) and healthy controls (n=62). We investigated peripheral inflammation biomarkers through blood count values (CBCs), lipoproteins and a complex panel of inflammatory ratios, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-HDL ratio (NHR), monocyte-to-HDL ratio (MHR), platelet-to-HDL ratio (PHR) and lymphocyte-to-HDL ratio (LHR). Furthermore, we examined the effects of sex, drug treatment and clinical outcome on the inflammatory profile. ResultsWe found that the monocyte-to-lymphocyte ratio (MLR) and lipoprotein-derived inflammatory ratio (NHR, MHR, PHR, and LHR) were significantly greater in BD-I patients than in control individuals. The monocyte-to-HDL ratio (MHR) showed acceptable accuracy as a disease predictor. Logistic regression analysis adjusted for sex, age and BMI indicated that the risk of having a BD-I diagnosis was greater for participants with MHR levels in quartiles 3 (OR= 5.2, p=0.001) and 4 (OR=13, p<0.001). There was a strong association between lithium treatment and increased inflammation represented by elevated lymphocyte-derived inflammatory ratios (NLR, MLR, PLR, SII, and SIRI) in lithium-treated BD-I patients compared to those in lithium-free or lithium treatment-naïve BD-I patients. The main limitations are the cross-sectional nature of the study and limited sample size of HCs. Major conclusionsSeveral CBCs, lipoproteins, and a complex panel of inflammatory ratios, including lymphocyte-derived inflammatory ratios (NLR, MLR, PLR, SII, and SIRI) and lipoprotein-derived inflammatory ratios (NHR, MHR, PHR, and LHR), are altered in individuals diagnosed with BD-I. The monocyte-to-HDL ratio (MHR) emerged as a disease predictor in our BD-I sample. A remarkable finding is the association of lithium and valproate treatment with the inflammatory state. Considering the study limitations, our results underscore the importance of pharmacological treatments when researching inflammation markers in mood disorders. Lymphocyte-derived and lipoprotein-derived inflammatory ratios are easy-to-implement and relevant biomarkers in BD-I patients.

Exploring Effective Interventions for Postpartum Blues: A Review of Current Literature

Postpartum blues, or "baby blues," is a common condition affecting 50-80% of new mothers, marked by mood swings, tearfulness, anxiety, and fatigue. It typically emerges within the first two weeks postpartum and can impact mother-infant bonding and maternal well-being. Left untreated, it may escalate into more severe postpartum mood disorders. This review aims to assess the efficacy, accessibility, and feasibility of various interventions for postpartum blues, synthesizing current research to inform clinical practices and future studies. A systematic review of peer-reviewed articles from 2010 to 2024 was conducted using PubMed, CINAHL, and PsycINFO databases. Articles were selected based on relevance, methodological rigor, and focus on postpartum blues interventions. After screening, 72 articles met the inclusion criteria and were included in the final analysis. The review identified several effective interventions across different domains: Psychosocial intervention particularly peer support programs and cognitive-behavioral therapy (CBT) were most effective in reducing postpartum blues symptoms; Hormonal and pharmacological interventions, including neuroactive steroids and selective serotonin reuptake inhibitors (SSRIs), showed mixed but promising results; Nutritional interventions, particularly omega-3 supplementation, demonstrated significant preventive effects; Mind-body interventions, such as mindfulness-based therapies, were effective in improving mood stability; Technology-based interventions, including mobile health applications and AI-driven support, showed potential for scalable and accessible solutions. Psychosocial interventions provide the strongest evidence for managing postpartum blues, while emerging research on hormonal, nutritional, and technology-based interventions offers promising new directions. A personalized, multimodal approach integrating these strategies is recommended for improving maternal mental health during the postpartum period.

Bipolar disorder and early childhood trauma

Case Background There is a reported 48.8 million case of bipolar disorder (BD) world- wide. It can also be one of the most challenging disorders to manage clinically as patients often have poor medical compliance and numerous relapses throughout their lifetime. The etiology of this illness is still poorly understood, but it is recognized to compromise both genetic and environmental factors. Regarding the latter, abuse and instability in childhood and adolescence was reported as an important area of consideration in regard to the development and prognosis of bipolar disorder. We report here the case of a female who exemplifies the significance of early childhood experience in this disorder. Case Presentation Isabelle is a 21 year old, female, with a background history of bipolar disorder. She presented to the Cork University Hospital accident and emergency 2 weeks after discharge after a 4 week admission for a depressive episode. Isabelle was referred from the home-based team with an acute episode of mania and was detained involuntarily under the Mental Health Act. Her history is significant for childhood neglect, physical, emotional and sexual abuse, along with multiple foster care placements. She was managed as an inpatient with antipsychotics and a mood stabilizer before being discharged after a lengthy, arduous, admission. Conclusion Childhood trauma is an important consideration in BD. Therefore, practitioner awareness of the role of such trauma with regard to its etiology and prognosis is of great importance. It is also essential to the practice of preventive medicine. Patient Consent Obtained: Yes

Delays in bipolar depression treatment in primary care vs. integrated behavioral health and specialty care

IntroductionWhile bipolar disorder is not uncommon in primary care, collaborative care models for bipolar depression treatment are underdeveloped. Our aim was to compare initial pharmacological treatment patterns for an episode of bipolar depression in different care models, namely primary care (PC), integrated behavioral health (IBH), and mood specialty clinic (SC). MethodsA retrospective study of adults diagnosed with bipolar disorder who received outpatient care in 2020 was completed. Depressive episodes were captured based on DSM-5 criteria, ICD codes, or de novo emergent symptom burden (PHQ-9 ≥ 10). Pharmacological strategies were classified as 1) continuation of current regimen, 2) dose increase or 3) augmentation 4) switch to monotherapy or 5) a combination of more than two different strategies. Logistic regression was applied. ResultsA total of 217 encounters (PC = 32, IBH = 53, SC = 132) representing 186 unique patients were identified. PC was significantly more likely to continue the current regimen, while combination strategies were significantly more likely recommended in IBH and SC. Mood stabilizers were significantly more utilized in IBH and SC. There were no significant group differences in antidepressant use. LimitationsRetrospective study design at a single site. ConclusionsThis study provides evidence of delays in depression care in bipolar disorder. This is the first study to compare treatment recommendations for bipolar depression in different clinical settings. Future studies are encouraged to better understand this gap and to guide future clinical practice, regardless of care model, emphasizing the potential benefits of decision support tools and collaborative care models tailored for bipolar depression.

Biomarkers of cognitive and memory decline in psychotropic drug users.

Psychotropic drugs are vital in psychiatry, aiding in the management of mental health disorders. Their use requires an understanding of their pharmacological properties, therapeutic applications, and potential side effects. Ongoing research aims to improve their efficacy and safety. Biomarkers play a crucial role in understanding and predicting memory decline in psychotropic drug users. A comprehensive understanding of biomarkers, including neuroimaging, biochemical, genetic, and cognitive assessments, is essential for developing targeted interventions and preventive strategies. In this narrative review, we performed a comprehensive search on PubMed and Google using review-specific terms. Clinicians should use a multifaceted approach, including neurotransmitter analysis, neurotrophic factors, miRNA profiling, and cognitive tasks for early intervention and personalized treatment. Anxiolytics' mechanisms involve various neurotransmitter systems and emerging targets. Research on biomarkers for memory decline in anxiolytic users can lead to early detection and intervention, enhancing clinical practices and aligning with precision medicine. Mood stabilizer users can benefit from early detection of memory decline through RNA, neurophysiological, and inflammatory biomarkers, promoting timely interventions. Performance-enhancing drugs may boost athletic performance in the short term, but their long-term health risks and ethical issues make their use problematic. Long-term use of psychotropic performance enhancers in athletes shows changes in biomarkers of cognitive decline, necessitating ongoing monitoring and intervention strategies. Understanding these genetic influences on memory decline helps pave the way for personalized approaches to prevent or mitigate cognitive deterioration, emphasizing the importance of genetic screening and early interventions based on an individual's genetic profile. Future research should focus on refining these biomarkers and protective measures against cognitive deterioration. Overall, a comprehensive understanding of biomarkers in psychotropic drug users is essential for developing targeted interventions and preventive strategies.

What anesthesiologists need to know about Antidepressants and other Psychotropic Drugs

Psychotropic medications are widely prescribed and are a mainstay treatment for various mental health disorders. A significant portion of patients undergoing surgery or various procedures take these medications. With the rising prevalence of mental health conditions, anesthesiologists increasingly find themselves encountering patients who depend on these medications, making the understanding of potential interactions with anesthetic agents crucial during the perioperative period. Appreciating the adverse-effect profiles and familiarity with the clinically relevant drug interactions that may occur in the perioperative setting are imperative to ensure the best possible outcome in delivering patient care. This review focuses on various classes of psychotropic agents, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. It covers the pharmacodynamics and pharmacokinetics of these medication classes and their interactions with agents commonly used in anesthesia.

Dosing levels of antipsychotics and mood stabilizers in bipolar disorder: A Nationwide cohort study on relapse risk and treatment safety.

Finding effective treatment regimens for bipolar disorder is challenging, as many patients suffer from significant symptoms despite treatment. This study investigated the risk of relapse (psychiatric hospitalization) and treatment safety (non-psychiatric hospitalization) associated with different doses of antipsychotics and mood stabilizers in persons with bipolar disorder. Individuals aged 15-65 with bipolar disorder were identified from Finnish national health registers in 1996-2018. Studied antipsychotics included olanzapine, risperidone, quetiapine, aripiprazole; mood stabilizers lithium, valproic acid, lamotrigine, and carbamazepine. Medication use was divided into three time-varying dose categories: low, standard, and high. The studied outcomes were risk of psychiatric hospitalization (relapse) and the risk of non-psychiatric hospitalization (treatment safety). Stratified Cox regression in within-individual design was used. The cohort included 60,045 individuals (mean age 41.7 years, SD 15.8; 56.4% female). Mean follow-up was 8.3 years (SD 5.8). Of antipsychotics, olanzapine and aripiprazole were associated with a decreased risk of relapse in low and standard doses, and risperidone in low dose. The lowest adjusted hazard ratio (aHR) was observed for standard dose aripiprazole (aHR 0.68, 95% CI 0.57-0.82). Quetiapine was not associated with a decreased risk of relapse at any dose. Mood stabilizers were associated with a decreased risk of relapse in low and standard doses; lowest aHR was observed for standard dose lithium (aHR 0.61, 95% CI 0.56-0.65). Apart from lithium, high doses of antipsychotics and mood stabilizers were associated with an increased risk of non-psychiatric hospitalization. Lithium was associated with a decreased risk of non-psychiatric hospitalization in low (aHR 0.88, 95% CI 0.84-0.93) and standard doses (aHR 0.81, 95% CI 0.74-0.88). Standard doses of lithium and aripiprazole were associated with the lowest risk of relapse, and standard dose of lithium with the lowest risk of non-psychiatric hospitalization. Quetiapine was not associated with decreased risk of relapse at any dose.

Hypomanic symptoms in major depressive disorder: Prognostic impact and treatment issues

BackgroundMixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts. MethodsWe analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods. ResultsHypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71–0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00–1.03) and MDD recurrence (O.R. 0.47–0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003). LimitationsThe study lacked prospective clinical assessments and treatment randomization. ConclusionHypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.

Synaptophysin and GSK-3beta activity in the prefrontal cortex may underlie the effects of REM sleep deprivation and lithium on behavioral functions and memory performance in male rats

Rapid-eye movement (REM) stage of sleep serves a critical role in processing cognitive and behavioral functions. Evidence shows that REM sleep deprivation (REM SD) strongly affects the mood state and cognitive abilities. However, there are many inconsistent reports. Although the exact molecular mechanisms underlying REM SD effects have not well been discovered, however, molecular factors including those affected synaptic plasticity and mood state may be involved. There are two important molecular factors that have not been well studied: synaptophysin and glycogen synthase kinase-3 beta (GSK-3beta). The present study aimed to investigate the role of synaptophysin and GSK-3beta in the modulation of memory and behavioral changes induced by REM SD and lithium (as a potent GSK-3beta inhibitor and mood stabilizer). Multiple platform apparatus was used to induce REM SD for 48 h. Lithium was injected at the dose of 50 mg/kg, intraperitoneal (i.p.). Locomotor activity, anxiety-like behavior, pain threshold, novel object recognition memory, and synaptophysin and GSK-3beta level in the prefrontal cortex were evaluated. Results showed REM SD increased locomotor activity, decreased pain threshold, impaired novel object recognition memory, decreased synaptophysin and increased GSK-3beta levels. Lithium reversed these effects. Anxiety-like behavior was unaffected. For the first time, the present study showed that GSK-3beta and synaptophysin may be involved in the modulation of behavior and cognition induced by REM SD and lithium. In conclusion, we suggested that GSK-3beta upregulation and synaptophysin downregulation may underlie the deleterious effects of REM SD, while lithium may counteract REM SD effects via restoring the level of both.

Prescribing patterns for older-age bipolar disorder patients discharged from two public mental hospitals in Taiwan, 2006-2019.

Older-age bipolar disorder (OABD) is commonly defined as bipolar disorder in individuals aged 60 or more. There have been no studies to examine temporal trends in the pharmacological treatment of OABD. We aimed to investigate prescription changes among OABD patients discharged from two public mental hospitals in Taiwan from 2006 to 2019. OABD patients discharged from the two study hospitals, from 1 January 2006 to 31 December 2019 (n = 1072), entered the analysis. Prescribed drugs at discharge, including mood stabilisers (i.e., lithium, valproate, carbamazepine, and lamotrigine), antipsychotics (i.e., second- and first-generation antipsychotics (SGAs and FGAs)), and antidepressants, were investigated. Complex polypharmacy was defined as the use of three or more agents among the prescribed drugs. Temporal trends of each prescribing pattern were analyzed using the Cochran-Armitage Trend test. The most commonly prescribed drugs were SGAs (72.0%), followed by valproate (48.4%) and antidepressants (21.7%). The prescription rates of SGAs, antidepressants, antidepressants without mood stabilisers, and complex polypharmacy significantly increased over time, whereas the prescription rates of mood stabilisers, lithium, FGAs, and antidepressants plus mood stabilisers significantly decreased. Prescribing patterns changed remarkably for OABD patients over a 14-year period. The decreased use of lithium and increased use of antidepressants did not reflect bipolar treatment guidelines. Future research should examine whether such prescribing patterns are associated with adverse clinical outcomes.

The importance of oxidative stress in the pathogenesis and treatment of bipolar affective disorder: a review of the literature

Introduction: Bipolar affective disorder (BD), also known as manic-depressive illness, is a chronic and recurrent psychiatric disorder characterised by significant mood disturbances. It is one of the leading causes of disability worldwide and is associated with a high risk of suicide. Recent studies highlight the role of oxidative stress (OS) in the pathogenesis of BD. The body's pro/antioxidant imbalance adversely affects cellular and molecular processes. Aim: The aim of this review is to synthesise the current state of knowledge on the role of OS in the aetiology and course of BD, including key biomarkers and potential therapeutic interventions. Methods: A review of the scientific literature was conducted, including articles published between 2000 and 2024. Searches were conducted in PubMed, Scopus and Web of Science databases, using the following keywords: 'bipolar disorder', 'oxidative stress', 'antioxidants', 'biomarkers', 'mitochondrial dysfunction', 'redox homeostasis', 'treatment'. Results: Results indicate that patients with BD have elevated levels of OS markers, including increased lipid peroxidation, altered antioxidant enzyme activity and impaired redox homeostasis. Treatment with lithium and other mood stabilisers may modulate levels of OS markers, which is one potential mechanism of drug action. However, inconclusive data suggest the need for further research to clarify the relationship between OS and BD. Conclusions: OS plays an important role in the pathophysiology of BD, offering potential directions for therapeutic interventions. Understanding the complex interactions between OS and BD may lead to the development of more targeted therapies aimed at reducing oxidative damage and improving patient health. Keywords: oxidative stress, bipolar affective disorder, redox, lipid peroxidation, protein damage, antioxidants, lithium

Metabolic adverse drug reactions related to psychotropic drugs

Metabolic adverse drug reactions (mADR) related to psychotropic drugs have significant health-related effects including weight gain, impaired glucose tolerance, diabetes mellitus and dyslipidemia as well as economic relevance. Nearly all antipsychotics (AP) and many antidepressants (AD) and mood stabilisers may induce weight gain. Weight development in the first weeks or months after the beginning of the therapy is the strongest predictor for weight gain related to AP and AD. The most important risk factors for mADR are antagonistic effects at H1-, 5-HT2C- und M3-receptors and antidopaminergic effects. However, several other systems are also relevant. Systematic monitoring of metabolic parameters is recommended in all patients treated with substances that are associated with an increased risk of mADR. Lifestyle modification, dietary measures, exercise therapy, dose reduction, change and discontinuation of the substance, and additional treatment with metformin and topiramate are evidence-based treatment options for AP-associated weight gain. GLP-1 receptor agonists such as liraglutide are also promising.