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ESUOM41: Management of aggression, agitation and behavioural disturbances in dementia: valproate preparations

Summary of the evidence on valproate preparations for managing aggression, agitation and behavioural disturbances in people dementia..

Evidence summary Published March 2015

Levetiracetam is not cost effective at June 2011 unit costs. Offerlevetiracetam, oxcarbazepine or sodium valproate (provided the acquisitioncost of levetiracetam falls to at least 50% of June 2011 value documented inthe National Health Service Drug Tariff for England and Wales) if carbamazepine and lamotrigine are unsuitable or not tolerated.

...levetiracetam, oxcarbazepine or sodium valproate (provided the acquisition cost of levetiracetam...levetiracetam, oxcarbazepine or sodium valproate (provided the acquisition cost of levetiracetam...levetiracetam, oxcarbazepine or sodium valproate (provided the acquisition cost of levetiracetam...

Do not do recommendation Published May 2017

Do not start valproate in primary care to treat bipolar disorder.

...Not Do Recommendation Do not start valproate in primary care to treat bipolar disorder...Details Recommendation: Do not start valproate in primary care to treat bipolar disorder. Interventions: Valproate Source guidance details Guidance...

Do not do recommendation Published June 2016

Do not routinely measure plasma valproate levels unless there is evidence of ineffectiveness, poor adherence or toxicity.

...Recommendation Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness...Recommendation: Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness...toxicity. Interventions: Measuring plasma valproate levels Source guidance details Guidance...

Do not do recommendation Published June 2016

Augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence for their use.

...carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as...carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as...carbamazepine*; lamotrigine*; valproate* Source guidance details Guidance: Depression...

Do not do recommendation Published June 2015

Only offer felbamate in centres providing tertiary epilepsy specialist care and when treatment with sodium valproate, lamotrigine, rufinamide and topiramate have proven ineffective or not tolerated.

...specialist care and when treatment with sodium valproate, lamotrigine, rufinamide and topiramate...specialist care and when treatment with sodium valproate, lamotrigine, rufinamide and topiramate...levetiracetam, oxcarbazepine or sodium valproate (provided the acquisition cost of levetiracetam...

Do not do recommendation Published June 2016

The following strategies should not be used routinely: augmentation of an antidepressant with a benzodiazepine for more than 2 weeks as there is a risk of dependence, augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use, augmentation of an antidepressant with pindolol* or thyroid hormones* as there is inconsistent evidence of effectiveness[16].

...carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for...carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for...carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as...

Do not do recommendation Published June 2016

Newly diagnosed seizures (focal and generalised) – monotherapy: How do the newer AEDs compare in efficacy to the standard anti-epileptic drugs (AEDs) in the treatment of newly diagnosed epilepsy? - Focal seizures: carbamazepine, eslicarbazepine acetate, lacosamide, lamotrigine, levetiracetam, pregabalin and zonisamide. - Generalised seizures: lamotrigine, levetiracetam, sodium valproate and zonisamide.

...lamotrigine, levetiracetam, pregabalin and zonisamide. - Generalised seizures: lamotrigine, levetiracetam, sodium valproate and zonisamide. Any explanatory notes(if applicable) Why this is important:- Levetiracetam and other anti-epileptic...

Research recommendation Published June 2015

Epilepsies: diagnosis and management (CG137)

Evidence-based recommendations on diagnosing, treating and managing epilepsy in children, young people and adults

Clinical guideline Published January 2012 Last updated February 2016

Bipolar disorder: assessment and management (CG185)

Evidence-based recommendations on assessing and managing bipolar disorder in children, young people and adults

Clinical guideline Published September 2014 Last updated February 2016

Antenatal and postnatal mental health: clinical management and service guidance (CG192)

Evidence-based recommendations on the recognition, assessment, care and treatment of antenatal and postnatal mental health problems in women

Clinical guideline Published December 2014 Last updated June 2015

Bipolar disorder

Bipolar disorder is a potentially lifelong and disabling condition characterised by episodes of mania (abnormally elevated mood or irritability and related symptoms with severe functional impairment or psychotic symptoms for 7 days or more) or

NICE Pathway Published September 2014 Last updated February 2017

Antenatal and postnatal mental health

This interactive flowchart covers the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth) and in women who are planning a pregnancy.

NICE Pathway Published November 2011 Last updated February 2017

Epilepsy

This pathway covers the diagnosis and management of the epilepsies in children, young people and adults in primary and secondary care.Epilepsy is a common neurological disorder characterised by recurring seizures. Different types of epilepsy have

NICE Pathway Published January 2012 Last updated January 2017

Retigabine for the adjunctive treatment of partial onset seizures in epilepsy (TA232)

Evidence-based recommendations on retigabine (Trobalt) for add-on (adjunctive) treatment of partial onset seizures (focal seizures) in epilepsy

Technology appraisal guidance Published July 2011

Autism spectrum disorder

This interactive flowchart covers identifying, diagnosing and managing autism in children, young people and adults.

NICE Pathway Published June 2012 Last updated June 2017

Dementia

This interactive flowchart covers supporting people with dementia and their carers in health and social care.Dementia is a progressive and largely irreversible clinical syndrome that is characterised by a widespread impairment of mental function.

NICE Pathway Published May 2011 Last updated March 2017

Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I disorder (TA292)

Evidence-based recommendations on aripiprazole (Abilify) for treating moderate to severe manic episodes in adolescents with bipolar I disorder

Technology appraisal guidance Published July 2013

Transcutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine (IPG552)

Evidence-based recommendations on transcutaneous stimulation of the cervical branch of the vagus nerve for cluster headache and migraine

Interventional procedures guidance Published March 2016

Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173)

Evidence-based recommendations on the pharmacological management of neuropathic pain in adults in non-specialist settings

Clinical guideline Published November 2013 Last updated February 2017

Depression in adults: recognition and management (CG90)

Evidence-based recommendations on identifying and managing depression in adults aged 18 and over in primary and secondary care

Clinical guideline Published October 2009 Last updated April 2016

Autism spectrum disorder in under 19s: recognition, referral and diagnosis (CG128)

Evidence-based recommendations on the recognition, referral and diagnosis of autism specturm disorder (ASD) in children and young people under 19

Clinical guideline Published September 2011

ESUOM40: Management of aggression, agitation and behavioural disturbances in dementia: carbamazepine

Summary of the evidence on carbamazepine for managing aggression, agitation and behavioural disturbances in people with dementia..

Evidence summary Published March 2015

Do not offer gabapentin or topiramate to treat bipolar disorder.

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not routinely measure plasma lamotrigine levels unless there is evidence of ineffectiveness, poor adherence or toxicity.

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not offer lamotrigine to treat mania

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer gabapentin...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not routinely continue antipsychotic treatment in young people for longer than 12 weeks.

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not start lithium to treat bipolar disorder in primary care for people who have not taken lithium before, except under shared-care arrangements.

...care to identify bipolar disorder in adults. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not start regular combined antipsychotic medication, except for short periods (for example, when changing medication)

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...to treat bipolar disorder. Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not use questionnaires in primary care to identify bipolar disorder in children or young people.

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

Do not use questionnaires in primary care to identify bipolar disorder in adults.

...before, except under shared-care arrangements. Do not start valproate in primary care to treat bipolar disorder. Do not offer lamotrigine...when changing medication) Do not routinely measure plasma valproate levels unless there is evidence ofineffectiveness, poor adherence...

Do not do recommendation Published June 2016

ESNM7: Partial-onset seizures in epilepsy: perampanel as adjunctive treatment

Summary of the evidence on perampanel for partial-onset seizures in epilepsy (in people aged 12 and over) to inform local NHS planning and decision-making

Evidence summary Published December 2012

Treatment of convulsive status epilepticus (that is, not just refractory):- What is the most effective and safest anti-epileptic drugs (AED) to treat: - established (usually lasting longer than 30 minutes) convulsive status epilepticus - refractory convulsive status epilepticus?

...of the risk of hypotension and cardiac arrhythmia. Sodium valproate and levetiracetam are potentially as effective and safer alternatives...randomised comparative trial of intravenous levetiracetam, sodium valproate and phenytoin in initial treatment of status epilepticus...

Research recommendation Published June 2015

Do not routinely vary the treatment strategies for depression described in this guideline either by depression subtype (for example, atypical depression or seasonal depression) or by personal characteristics (for example, sex or ethnicity) as there is no convincing evidence to support such action.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2016

Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk–benefit ratio is poor, but consider them for people with: a past history of moderate or severe depression or initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or subthreshold depressive symptoms or mild depression that persist(s) after other interventions.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2016

Do not use ECT routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2016

Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk benefit ratio is poor, but consider them for people with: A past history of moderate or severe depression or: Initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or Subthreshold depressive symptoms or mild depression that persist(s) after other interventions.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Do not use electroconvulsive therapy (ECT) routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Medication management as a separate intervention for people with depression should not be provided routinely by services. It is likely to be effective only when provided as part of a more complex intervention.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

When prescribing drugs other than serotonin reuptake inhibitors (SSRIs), dosulepin should not be prescribed.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Current evidence suggests that there are no major safety concerns associated with transcranial magnetic stimulation (TMS) for severe depression. There is uncertainty about the procedure s clinical efficacy, which may depend on higher intensity, greater frequency, bilateral application and/or longer treatment durations than have appeared in the evidence to date. TMS should therefore be performed only in research studies designed to investigate these factors.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Although there is evidence that St John s wort may be of benefit in mild or moderate depression, practitioners should not prescribe or advise its use by people with depression because of uncertainty about appropriate doses, persistence of effect, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants)

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Augmentation of an antidepressant with pindolol* or thyroid hormones* [should not be used routinely] as there is inconsistent evidence of effectiveness

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

Do not switch to, or start, dosulepin because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.

...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence...antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* as there is insufficient evidence for their use augmentation...

Do not do recommendation Published June 2015

How safe are drugs used to treat bipolar disorder in pregnancy and the postnatal period?

...drugs used to treat mental health problems may carry some risk for the woman, fetus and baby. For some drugs such as sodium valproate these risks are well described, but the data are drawn from epilepsy case registers. For others such as lithium, the data...

Research recommendation Published June 2015

ESNM37: Partial seizures in children and young people with epilepsy: zonisamide as adjunctive therapy

Summary of the evidence on zonisamide as adjunctive therapy for partial seizures in children and young people (aged 6–17 years) with epilepsy..

Evidence summary Published March 2014

ESNM17: Partial-onset seizures in epilepsy: zonisamide as monotherapy

Summary of the evidence on zonisamide as monotherapy for children and young people with epilepsy to inform local NHS planning and decision-making

Evidence summary Published April 2013