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Oxcarbazepine is thought of as a kinder, gentler cousin of carbamazepine, but it brings new safety issues of its own and does not fully escape the drug interactions that hinder carbamazepine. We pull on the published and unpublished trials to figure out where this anticonvulsant stands in bipolar disorder.
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Bipolar II is a different illness from Bipolar I, but it’s in Bipolar I that most of the psychopharmacology research was undertaken. Dr. Kelly walks us through some of the nuances in applying that knowledge to Bipolar II, and shows us how to recognize the subtle traces of hypomania and mixed features that go along with Bipolar II depression.
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The antipsychotic lumateperone (Caplyta) and the hypnotic lemborexant (Dayvigo) are the newest in their class. Both of them claim to improve on the safety of older medications, and we look at the data to see how those claims hold up.
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More is not necessarily better in psychopharmacology. Some medications have plateau effect, while others follow a “U-shaped curve,” causing more problems as the dose goes too high. This metaanalysis looked at 77 dose-response trials with antidepressants to quantify their optimal therapeutic window.
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Dr. Aiken is the Editor in Chief of The Carlat Psychiatry Report; director of the Mood Treatment Center in North Carolina, where he maintains a private practice combining medication and therapy along with evidence-based complementary and alternative treatments; and Assistant Professor NYU Langone Department of Psychiatry. He has worked as a research assistant at the NIMH and a sub-investigator on clinical trials, and conducts research on a shoestring budget out of his private practice. Follow him on Twitter and find him on LinkedIn.
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