If the person prefers, consider adding olanzapine (without fluoxetine) or lamotrigine to valproate. See update information for important safety advice from the MHRA on the use of valproate. See NICE's information on prescribing medicines. In September 2014 semi-sodium valproate had a UK marketing authorisation for the treatment of mania if lithium is not tolerated or is contraindicated this was an off-label use of sodium valproate, although its use was common in UK clinical practice. Follow the MHRA safety advice on valproate use by women and girls.Īlthough its use is common in UK clinical practice, in September 2014 this was an off-label use of lithium. Do not offer valproate to women or girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years) for long-term treatment or to treat an acute episode, unless other options are ineffective or not tolerated and the pregnancy prevention programme is in place. If adding lithium is ineffective, or if lithium is not suitable (for example, because the person does not agree to routine blood monitoring), consider adding valproate instead. Undertake a full psychiatric assessment, documenting a detailed history of mood, episodes of overactivity and disinhibition or other episodic and sustained changes in behaviour, symptoms between episodes, triggers to previous episodes and patterns of relapse, and family historyĪssess the development and changing nature of the mood disorder and associated clinical problems throughout the person's life (for example, early childhood trauma, developmental disorder or cognitive dysfunction in later life)Īssess social and personal functioning and current psychosocial stressorsĪssess for potential mental and physical comorbiditiesĪssess the person's physical health and review medication and side effects, including weight gainĭiscuss treatment history and identify interventions that have been effective or ineffective in the pastĮncourage people to invite a family member or carer to give a corroborative historyĭiscuss possible factors associated with changes in mood, including relationships, psychosocial factors and lifestyle changesġ.5.5 If an alternative antipsychotic is not sufficiently effective at the maximum licensed dose, consider adding lithium.
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