Mood-Stabilizers in Combination with Atypical Antipsychotics or Antidepressants

The clinical use of mood-stabilizers in combination with atypical antipsychotics or antidepressants for long-term treatment of bipolar affective disorder is quite common despite the fact that research on the added benefits and risks are limited. This is why drug therapy treatments regarding monotherapy with a mood stabilizer versus combination options are controversial. Some patients do not respond to monotherapy yet by adding adjunctive medications the risk for adverse effects and medication noncompliance is increased. This subject is important to RN’s because it is the nurses responsibility to monitor the client’s progress, report changes in mood and affect, educate clients’ on the medications being given to them and the expected outcomes. Nurses are also the first line of defense in monitoring for adverse effects to medications and would like to use the medications with the best effect and least adverse effects. I support the use of multiple drug therapies when the patient has proven nonresponsive to the various monotherapy treatments available. Tohen, Chenegappa, Suppes et al (2004) conducted an 18-month study of relapse prevention in bipolar I disorder comparing olanzapine plus either valproate or lithium to lithium or valproate alone. The results of this study showed that the combination therapy median time for symptomatic relapse was 163 days compared to only 42 days with the monotherapy. It does need to be noted that the subjects had all previously been on combination therapy and then some were switched to monotherapy for the study. Patients were also exclude from the study if they showed intolerance to olanzapine in the past. The results of this study support the benefits of combination therapy used as maintenance treatment for BAD.

Vieta, T’joen, McQuade et al (2008) conducted a study evaluating the safety and effectiveness of adjunctive aripiprazole to either lithium or valproate in bipolar mania patients who were partially