89 There have been three reports of nimodipine’s efficacy in bipolar illness,90-92 including a small but well-designed on-off-on trial90; however, the largest trial showed relatively modest results in monotherapy of patients with refractory bipolar affective illness. Finally, a retrospective study found that diltiazem was effective in the maintenance treatment of bipolar illness.93 Despite this somewhat encouraging data in both acute mania and maintenance treatment of bipolar illness, there have been no comprehensive trials of CCBs (combining adequate numbers of patients with a prospective, double-blind Inhibitors,research,lifescience,medical design) that would lead

practitioners to use these agents as front-line

treatment for patients with bipolar disorder at this juncture. CCBs have been studied in the treatment of depressive Inhibitors,research,lifescience,medical symptoms, with somewhat less encouraging results. Verapamil was found to be less effective than amitriptyline (a tricyclic antidepressant [TCA]) in a double-blind trial for depression,81 and ineffective for depression among patients refractory to TCAs.94 One trial found that, Inhibitors,research,lifescience,medical in patients receiving electroconvulsive therapy (ECT) there was greater mood improvement among those taking nicardipine Crizotinib compared with placebo (the study was originally designed to determine whether nicarpidine improved ECT-associated cognitive impairment; it did not).95 Furthermore,

because CCBs may be effective in the treatment of cerebrovascular disease, nimodipine has been used to augment antidepressant treatment of patients suffering from vascular depression- ie, new-onset depression in older adults associated with vascular Inhibitors,research,lifescience,medical lesions – in a pair of double-blind, placebocontrolled studies.96,97 Both studies found that nimodipine was superior Inhibitors,research,lifescience,medical to placebo in reducing the symptoms and lowering the rates of recurrence. There have been limited trials regarding the use of CCBs in the treatment of anxiety disorders. A double-blind trial revealed modest anxiolytic effects of verapamil among patients with panic disorder,98 and open trials of diltiazem and nimodipine for panic disorder also had positive results; a trial of nifedipine for free-floating anxiety and phobia had a negative result.99 Bottom line: CCBs may be associated with isothipendyl fatigue in some patients, but otherwise cause few neuropsychiatrie symptoms. Therapeutically, verapamil has been the moststudied agent in several trials of mania and bipolar disorder, and has had mixed but generally positive results; this agent may prove to be a viable option for patients with bipolar disorder who are pregnant or fail first-line therapies, though larger studies are needed. Diuretics Diuretics are generally associated with low rates of neuropsychiatrie adverse events.