Can Depakote, An Antipsychotic Drug with a Bad Rap Change a Teenager’s Life?
Help! The emergency 911 call goes “My child is having one of his psychotic episodes and I don’t know what to do!” A mother’s plea for help as she watches her teenage son’s manic episodes unfold; what is a mother to do? Since then, the teenager has been prescribed several antipsychotic drugs such as Aripiprazole (Abilify), thereafter, Risperidone (Risperdal) and a sleuth of others, but none curtails or controls his mood disorder until he is prescribed Depakote. Confused and perplexed, Depakote is an anti-seizure and an anti-psychotic drug that works by increasing the amount of a special neurotransmitter in the brain (drugwatch.com, nd).
Psychotic episodes stream
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Isolation
5. Poor coping strategies and problems adjusting to life stresses
Another name for Depakote which is typically known for is divalproex sodium and valproic acid. These two medications are used to treat a variety of seizures and mood disorders, as well as a preventative for migraines. The downside is that the side effect to this antipsychotic drug is linked to suicide, liver toxicity, pancreatitis and a variety of birth defects, including cardiovascular malformations, neural tube defects and facial deformities (drugwatch.com, nd).
Background
The U.S. Food and Drug Administration (FDA) approved Depakote in 1983 for epilepsy treatment, in 1995 for bipolar disorder, and in 1996 for the prevention of migraine headaches. Sold by Abbott Laboratories, the drug comes in a variety of forms: Depacon injections (valproate sodium), Depakote, Depakote CP and Depakote ER (divalproex sodium) and Depakene and Stavzor (valproic acid). The liquid form, Depacon, is less popular as it tends to make users nauseous (drugwatch.com, nd).
Depakote has been approved for use in adults and children 10 and older for seizure treatment and age 16 and older for migraine prevention. However, it is not approved to treat bipolar conditions in children, despite that it has been known to be used in this off-label manner. In 2008, the FDA approved the first generic version of Depakote. In recent years, Abbott Laboratories has faced federal charges of illegal marketing of Depakote to
risperidone whereas in this one there was a fixed dose to limit breach in blinding and to facilitate comparison between similar groups, also having this fixed dosage helped prevent bias because when using a titrating schedule of dosing in a randomized trial, it tends to show bias toward a desired goal. Risperidone in this study was well tolerated and there weren’t significant differences in weight gain or sedation(13). One of the main things disliked about risperidone is its tendency to increase the incidence of dyskinesia and other extrapyramidal side effects. In this study only mild and transient dyskinesias were seen in only 3 children, however that could be due to the low fixed dosage(13) of the study.
Treatment for epilepsy is often focused on controlling the seizures with the least amount of medication as possible. Antiepileptic drugs (AEDs) are the class used to accomplish this. Some of the AEDs that are used most often are Clonazepam, Diazepam, Divalproex, Gabapentin, and Phenytoin. The most common side effects of these medications include nausea, vomiting, sedation, fatigue, and lethargy. (Kwan,1; Benbadis, 3-5; Huethers,637)
Psychotropic medications, also referred to as psychiatric or psychotherapeutic medications, are used to treat psychiatric disorders, such as: depression, bipolar disorder, schizophrenia, anxiety disorders, and attention deficit-hyperactivity disorder (ADHD). They have been used for many years and oftentimes come with dangerous side effects. The side effects that often occur in children taking these medications can include: fainting, blurred vision, vomiting, extreme weight gain, and even death ("Seroquel information,” n.d.). The use of psychotropic medication to treat mental disorders in children and adolescents is highly controversial because of ethical viewpoints (i.e. parents “drugging” their children to calm them down) and potentially
Americans must wait up to 19 years after a discovered treatment before they can participate in benefits of a new medication (Philipson & Sun, 2008). The regulatory process drug manufacturers need to endure before releasing potentially life-saving medication is an extremely expensive, time-consuming process. The Center for Drug Evaluation and Research (CDER) is the main department of the Food and Drug Administration (FDA) responsible for the safety of drugs (both prescription and over-the-counter) sold in the United States (Food and Drug Administration, 2011). This department scrutinizes the testing of new drugs and
Risperdal (Risperidone) has been used for a number of different mental health disorders. It has been used for Schizophrenia, Bipolar I disorder, and to help with irritability in children with Autism. There are a number of different things that will be covered in this paper such as the chemical makeup of the medication, the appearance, side effects, off label use, side effects, administration, and how it works, with other additional information.
The use of Olanzapine is contraindicated in patients with diseases such as dementia or diabetes mellitus. Caution should also be taken when administering olanzapine to patients with cardiac defects, liver problems and patients with a history of seizures. If allergic to any of the ingredients within the drug or if the individual is pregnant it should also not be administered. The dosage of the drug may need to be altered if the individual smokes and the consumption of alcohol is not also not advised when taking the drug (Keefe, R. S., et al (2014), (Heres, S., et al
Jann States that sufferers of BPD are three times more likely to suffer a depressive episode than a manic or hypomanic episode. (Jann, 2014) The Joanna Briggs institute Identified that the suicide rate for bipolar suffers are 15 times higher than that of non-affected individuals of the same age and sex. Eighty percent of these suicides occur during a depressive episode. (Hung Chu, 2016). Therefore appropriate pharmacological therapy not only during the maintenance period to reduce reoccurrence but also during these acute episodes is highly important. Pharmaceutical treatment includes the use of medication such as mood stabilizers, anti-psychotics and anti-depressants. The Joanna Briggs institute recommends that combination therapy involving both mood stabilizers such as Sodium valproate or lithium valproate and antipsychotics risperidone, olanzapine, quetiapine and haloperidol is best to treat acute mania associated with Bipolar. As it increases adherence to medication regime. (Tufanaru, 2016) The same institute encourages the use Olanzapine as a monotherapy or in combination with fluoxetine in the treatment of Depression associated with Bipolar disorder. (Hung chu, 2016) Lithium continues to be the first line mood stabilizer under current guidelines but may be used in conjunction with Carbamazepine where depression is evident. (Hung chu, 2016) The Australian and New Zealand Journal of Psychiatry 2015 also shows preference for combination therapy
In 1955, antipsychotic medications were introduced to help mental disorders. These medications are usually taken orally in which help relieve symptoms for periods of days. The misuse or abuse of the medications are low. There are three generations of antipsychotic medications. The first generation is known for reducing hallucinations and delusions, but not affecting problems like disorientation or depression. An example would be chlorpromazine, brand name being Thorazine. Some negative side effects of taking the first generation drugs are Parkinson’s-like symptoms, tardive dyskinesia, and weight gain. Next, the second generation drugs minimized the outcome of the individual getting Parkinson’s-like symptoms. An example of this generation would be Clozaril. “A unique feature of Clozaril is the 1 to 2 percent chance of developing a potentially lethal blood disease called agranulocytosis” (Levinthal 282). This disease decreases white blood cells and affects the immune system. If early signs of this disease start to appear the patient will stop taking Clozaril and recover. Lastly, the third generation has shown to be the most effective on schizophrenia. Abilify is an example of this generation drug. It does not have a risk of Parkinson’s, tardive dyskinesia, or diabetes. Abilify blocks specific serotonin receptors in which prevents negative side effects from happening. These different
Antipsychotic drugs such lithium is one that is commonly prescribed to help reduce anger, threatening behavior, outbursts, and combativeness in ASPD. It alters sodium transport and inhibits neuronal signaling that dials down the activity of hyperactive circuits involved in producing mania (Vallerand, Sanoski, & Deglin, 2017). Lithium dosage is PO in tablets or capsules at 300-600mg TID for adults but precise dosing is based on serum lithium levels. Side effects include polyuria, polydipsia, diarrhea, mild ataxia, leukocytosis, renal toxicity, drowsiness, and weight gain.
Currently, Stan is on Depakote, Divalproex sodium, which is an antipsychotic medication used for treating Bipolar disorders (Grilly, 2012). It is a second generation medication and has been proven to be effective treatment. With the proper dosage, Depakote can reduce manic episodes and shorten hospital stay. Depakote can also help prevent future manic episodes and helps patients to live a productive life in the community. The recommended daily dose is 750 mg divided into two doses (Preston, O’Neal, & Talaga, 2010). Depakote can be administered thru a time release tablet or sprinkle. Depakote also is not known to be an addictive medication.
This includes bupropion (Wellbutrin), which is also a smoking cessation aid and a norepinephrine and dopamine reuptake inhibitor (NDRI), desipramine (norpramin), which is also prescribed for nerve pain, maprotiline (Ludiomil), mirtazapine (Remeron), and trazodone (Desyrel), which is also used as a sedative. The side effects of these medications are increased or decreased appetite, nausea, vomiting, indigestion, constipation, headache, dry mouth, insomnia, increased sweating, nervousness, reduced sexual desire, difficulty reaching sexual climax, and erectile dysfunction.
Bipolar disorder is a mental health issue that affects millions of people worldwide. It is typically treated with a combination of mood stabilizers and antidepressants. It can take a patient and their doctor a long time to find the right combination of medications to effectively treat their bipolar disorder. Some individuals do not find much comfort in any level of the traditional medications and continue to struggle with their depression. Recently, scientists have been looking into newer ways to help treat bipolar disorder. Two of these new treatments for helping people suffering from bipolar depression are the use of ketamine and olanzapine.
Antipsychotics are classified as major tranquilizers that are used to treat mental health illnesses such as schizophrenia, bipolar disorder, and other mental illnesses. They can also treat severe depression and severe anxiety. These antipsychotics drugs reduce or increase the effect of neurotransmitters in the brain to regulate levels that help transfer information throughout the brain. The neurotransmitters that are affected are the serotonin, dopamine, and noradrenaline.
In the United States, a drug can only be advertised legally after being approved by the Food and Drug Administration (FDA). Once attaining at least one FDA-approved use, physicians can prescribe a drug for other unapproved uses, based on their clinical judgment; this is referred to as “off-label use” (McCambridge, 2008). In general, marketing drugs for off-label uses is illegal; however, pharmaceutical companies have gone to various lengths within their legal rights to accomplish exactly that.
Lilly must position Cymbalta in a competitive market to ensure they don’t lose share after the Prozac patent expires. They have three options: (1) prove the drug can treat MDD with QD dosing, (2) seek MDD and pain relief indications using BID dosing, and (3) delay submission to the FDA until both pain and MDD relieving properties can be tested. We recommend option 2.