Mood Disorders

In treating bipolar depression with SSRI/SNRI, no dose increases before 4-6 weeks on current dose, to use lowest effective dose with least risk.

In the US, 50% of people attempt suicide attempt within 10 minutes of ideation, meaning the removal of firearms during this period are very important. 90% of people who attempt do NOT go on to die by suicide, so restoring firearms at a later date is possible.

Depakote use in woman of child bearing age who has child with NTD is indefensible, can lose your license. With men on depakote, the chance of having a child with a neurodevelopmental disorder is 1.5 times higher, so this needs to be included in counseling. Absolute risk is 2%.

Individuals with bipolar 1 disorder have a 300% higher risk of developing dementia. Lithium reduces the chance of dementia by 49% in the bipolar population. This is a very important talking point in the outpatient world.