57 Moreover, it. decreases levels of homocysteine, which is increased in bipolar patients with 17-AAG datasheet cognitive deficits and in those not recovering between episodes, as well as those being treated with valproate. As a. major cardiovascular risk factor in an illness with a significantly increased risk of myocardial infarction and stroke, perhaps homocysteine should be a routine target, of therapeutics with folate and other approaches. A mixed, but. generally positive, literature supports the effectiveness of omega-3 fatty acids in the treatment or prevention of depressive episodes.58 Even in a. negative

study of 6 g of eicosapentaenoic acid (EPA) per day in bipolar patients, younger patients did better on active treatment, Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical while older persons

did better on placebo.59 Given the growing recognition of childhood onset bipolar illness in the US, further study of this safe and generally well-tolerated strategy would have considerable merit. Another extremely promising augmentation strategy for residual depression, fatigue, and poor concentration in bipolar illness is that of modafinil. F’rye et al60 found highly significant, improvement, with modafinil compared with Inhibitors,research,lifescience,medical placebo on these symptom measures, and this was achieved without, an increase rate of switch into mania. Given the increasing evidence of the inadequacy of traditional antidepressant augmentation30 and the risks of associated switching,61 Inhibitors,research,lifescience,medical modafinil augmentation looks very promising. Moreover, exploration of its nonstimulant mechanism of action may also provide a new target of therapeutics. Agents targeted to the multiple comorbidities of bipolar illness The typical patient, with bipolar illness will have other Axis I and III comorbidities. Therapeutic approaches to these symptoms have been largely ignored, Inhibitors,research,lifescience,medical as many of the more common and complicated patients are excluded from the traditional randomized controlled trials. Nevertheless, therapies directed at these critical areas of symptomatology are necessary for

long-term remission and well-being. In contrast to lithium, the anticonvulsant mood stabilizers, valproate, lamotrigine, and carbamazepine, and the atypical antipsychotics are also effective in many of the anxiety disorder comorbidities and are useful “two-for-one” medication approaches to both biphasic mood and anxiety symptoms. On the other hand, some medications are not, effective antimanic treatments, but may be useful in treating comorbid disorders. This would include topiramate, DNA ligase which is likely effective in alcohol and cocaine abstinence, migraine prevention, post-traumatic stress disorder, bulimia, and weight, loss; and gabapentin, which is effective in social phobia and panic disorders, sleep disturbances, pain syndromes, and alcohol abstinence. Finding new approaches to the common comorbidities of bipolar illness, which would not, exacerbate primary mood symptoms, would thus be of considerable clinical interest, and benefit.