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Letters   |    
First Manic Episode Due to Discontinuation of Valproic Acid in a Patient With Epilepsy
Ayhan Köksal, M.D.; Ayten Ceyhan Dirican, M.D.; Yavuz Altunkaynak, M.D.; Ejder Akgün Yıldırım, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E60-E61. doi:10.1176/appi.neuropsych.13050117
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The authors report no financial relationships with commercial interests.

Dept. of Neurology, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey

Dept. of Psychiatry, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey

Send correspondence to Dr. Köksal; e-mail: ayhankoksal@yahoo.com

Copyright © 2014 by the American Psychiatric Association

Extract

To the Editor: Valproic acid (VA) is one of the most widely used antiepileptic drugs (AED), which is effective for the treatment of both focal and generalized seizures. It is also used extensively to treat multiple nonepileptic disorders such as migraine, neuropathic pain, and some psychiatric diseases. Bipolar disorder is one of the psychiatric diseases for which VA is used commonly as a mood stabilizer. Its use during pregnancy is limited due to high teratogenic risks. At the same time, however, discontinuation of the mood stabilizer during pregnancy carries a high risk for a new episode in women with bipolar disorder.1

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References

Viguera  AC;  Whitfield  T;  Baldessarini  RJ  et al:  Risk of recurrence in women with bipolar disorder during pregnancy: prospective study of mood stabilizer discontinuation.  Am J Psychiatry 2007; 164:1817–1824, quiz 1923
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Battino  D;  Tomson  T:  Management of epilepsy during pregnancy.  Drugs 2007; 67:2727–2746
[CrossRef] | [PubMed]
 
Tomson  T;  Battino  D:  Teratogenic effects of antiepileptic drugs.  Lancet Neurol 2012; 11:803–813
[CrossRef] | [PubMed]
 
Johannessen Landmark  C:  Antiepileptic drugs in non-epilepsy disorders: relations between mechanisms of action and clinical efficacy.  CNS Drugs 2008; 22:27–47
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Mula  M;  Marotta  AE;  Monaco  F:  Epilepsy and bipolar disorders.  Expert Rev Neurother 2010; 10:13–23
[CrossRef] | [PubMed]
 
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