Which medications should be avoided when treating bipolar disorder?

In this video from NP Institute 2023 in Boston, Massachusetts, Psych Congress Network Bipolar Disorder Excellence Forum Section Editor Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, clinical professor at the University of Illinois at Chicago, shed some light on instances where evidence doesn't support use of specific medications for bipolar disorder. Join Dr Carbray as she dissects the efficacy landscape of certain medications, uncovers contraindications and considerations for certain populations, and why these drugs might not be the go-to choices as first-line mood stabilizers.

Dr Carbray discussed this and other topics at the 2023 Psych Congress NP-Institute in Boston, Massachusetts. Save the date for next year's NP Institute In-Person, March 20-23, 2024, in San Diego, California! For more information, visit the meeting website. Keep up with pre-conference meeting coverage in our newsroom. 

Read the Transcript:

Psych Congress Network: In what instances does the evidence not support the use of certain medications in treating patients with bipolar disorder?

Julie Carbray, PhD: As you know, bipolar disorder treatment does have this arena of mood stabilizers. Most came from anti-convulsant medications. And so one might suspect that some of these medications would have efficacy in the treatment of bipolar disorder. It's really not the case. There are a few medications that are really lacking in evidence, both for reducing mania as well as depressive episodes or promoting mood stability. Some of those drugs that we wish had better efficacy might be something like oxcarbazepine or Topiramate, really not showing the evidence that we need to go to them as first line mood stabilizers. In addition, some of these mood stabilizers might be contraindicated in certain populations, and I'm thinking specifically about valproic acid and use in women of childbearing age.

For instance, in the United Kingdom, persons 55 years and under have to actually go through a very rigorous process to be prescribed valproic acid because valproic acid not only can contribute to polycystic ovarian syndrome in women of childbearing age, particularly younger women, but also if a woman should become pregnant, there are serious adverse events that can happen for the developing fetus, something that's called fetal valproic syndrome, which is really a syndrome that looks very much like fetal alcohol syndrome, significant neural defects in the developing fetus. And so really, make a good case for using valproic acid if you're going to be looking at using it in this population.

Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana.