Divalproex extended-release in acute bipolar II depression

Wang, Po; Nowakowska, Cecylia; Chandler, Rebecca A.; Hill, Shelley J.; Nam, Jennifer; Culver, Jenifer L.; Keller, Kristine L.; Ketter, Terence A.

doi:10.1016/j.jad.2009.10.021

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Combined, these data are consistent with VPA protecting DA neurons in lipopolysaccharide-induced neurotoxicity (Peng et al, 2005). In agreement, VPA was neuroprotective in experimental models of cerebral ischemia, Parkinson’s disease and glutamate-induced excitotoxicity via histone deacetylase inhibition (Monti et al, 2010; Monti et al, 2009; Ren et al, 2004; Wang et al, 2010; Chuang et al, 2009). …”

Section: Discussionsupporting

confidence: 54%

“…It is one of the most frequently used antiepileptic drugs, has mood-stabilizing properties in the treatment of acute mania (Bowden, 2009), and might be effective for the reduction of depressive symptoms of acute bipolar depression (Smith et al, 2010; Wang et al, 2010). Despite more than 40 years of clinical use, the mechanism(s) of action of VPA in bipolar disorder (BD) is still not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Chronic valproate treatment blocks D2-like receptor-mediated brain signaling via arachidonic acid in rats

et al. 2011

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Background and Objective Hyperdopaminergic signaling and an upregulated brain arachidonic acid (AA) cascade may contribute to bipolar disorder (BD). Lithium and carbamazepine, FDA-approved for the treatment of BD, attenuate brain dopaminergic D2-like (D2, D3, and D4) receptor signaling involving AA when given chronically to awake rats. We hypothesized that valproate (VPA), with mood-stabilizing properties, would also reduce the D2-like-mediated signaling via AA. Methods An acute dose of quinpirole (1 mg/kg) or saline was administered to unanesthetized rats that had been treated for 30 days with a therapeutically relevant dose of VPA (200 mg/kg/day) or vehicle. Regional brain AA incorporation coefficients, k*, and incorporation rates, Jin, markers of AA signaling and metabolism, were measured by quantitative autoradiography after intravenous [1-14C]AA infusion. Whole brain concentrations of prostaglandin (PG)E2 and thromboxane (TX)B2 also were measured. Results Quinpirole compared to saline significantly increased k* in 40 of 83 brain regions, and increased brain concentrations of PGE2 in chronic vehicle-treated rats. VPA treatment by itself reduced concentrations of plasma unesterified AA and whole brain PGE2 and TXB2, and blocked the quinpirole-induced increments in k* and PGE2. Conclusion These results further support our hypothesis that similar to lithium and carbamazepine, VPA downregulates brain dopaminergic D2-like receptor-signaling involving AA.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Chronic valproate treatment blocks D2-like receptor-mediated brain signaling via arachidonic acid in rats

et al. 2011

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“…The third‐line options include monotherapy with divalproex (level 4)258, 459, 461,462, 463, 464, 465, 466 fluoxetine (mainly for patients with pure depression) (level 3)467, 468, 469 tranylcypromine (level 3),278 or ziprasidone (solely for patients with depression and mixed hypomania) (level 3) 470, 471. Adjunctive agomelatine (level 4),472 bupropion (level 4)276 eicosapentaenoic acid (EPA) (level 4),473, 474, 475 N ‐acetylcysteine (level 4),476 pramipexole (level 3),274 or thyroid hormones (level 4)272 may also be considered.…”

Section: Bipolar II Disordermentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

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The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

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“…Two of the trials reported results separately for BD I and BD II, with one reporting greater improvement in patients with BD I than BD II (as outcomes for the BD II group showed no separation from placebo) (336), and the other reporting greater improvements in BD II than BD I (337). Additional, open-label data supporting the efficacy of divalproex ER in BD II depression, previously cited in abstract form, have now been published (338). Thus, the data in aggregate are mixed.…”

Section: Divalproexmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

et al. 2012

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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Beaulieu S, Alda M, O’Donovan C, MacQueen G, McIntyre RS, Sharma V, Ravindran A, Young LT, Milev R, Bond DJ, Frey BN, Goldstein BI, Lafer B, Birmaher B, Ha K, Nolen WA, Berk M.  Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013.  Bipolar Disord 2012: 00: 000–000. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd.The Canadian Network for Mood and Anxiety Treatments published guidelines for the management of bipolar disorder in 2005, with updates in 2007 and 2009. This third update, in conjunction with the International Society for Bipolar Disorders, reviews new evidence and is designed to be used in conjunction with the previous publications.The recommendations for the management of acute mania remain largely unchanged. Lithium, valproate, and several atypical antipsychotic agents continue to be first‐line treatments for acute mania. Monotherapy with asenapine, paliperidone extended release (ER), and divalproex ER, as well as adjunctive asenapine, have been added as first‐line options.For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, as well as olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first‐line options. Lurasidone monotherapy and the combination of lurasidone or lamotrigine plus lithium or divalproex have been added as a second‐line options. Ziprasidone alone or as adjunctive therapy, and adjunctive levetiracetam have been added as not‐recommended options for the treatment of bipolar depression. Lithium, lamotrigine, valproate, olanzapine, quetiapine, aripiprazole, risperidone long‐acting injection, and adjunctive ziprasidone continue to be first‐line options for maintenance treatment of bipolar disorder. Asenapine alone or as adjunctive therapy have been added as third‐line options.

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Divalproex extended-release in acute bipolar II depression

Cited by 12 publications

References 19 publications

Chronic valproate treatment blocks D2-like receptor-mediated brain signaling via arachidonic acid in rats

Chronic valproate treatment blocks D2-like receptor-mediated brain signaling via arachidonic acid in rats

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

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