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Running head: UNIT 5 ASSIGNMENT 1

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Unit 5 Assignment 1 Michael Harmon Capella University Evidence Based Research Methods DHA8011 Jason Zerwekh February 10, 2017

UNIT 5 ASSIGNMENT 1

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In bipolar patients, there is one main path to help those who are experiencing symptoms of the bipolar disorder. This is typically handled through mood stabilizers. The mood stabilizers have effectiveness for a variety of mixed symptoms which include depression, anxiety, and irritability (B. Espinoza, personal communication, February 3, 2017). The mood stabilizer has two paths for medication; primary and secondary mood stabilizers (B. Espinoza, personal communication, February 3, 2017). The medication for the primary stabilizers includes Lithium, Tegretol, and Depakoate. Secondary mood stabilizers include Zyprexa, Seroquel, Saphris, and Latuda. Once a psychiatrist determines that the primary and secondary are not working, the last medication option available is Clozaril. This drug is a highly regulated drug in which it is only available from a certified pharmacist which has been registered to a special program ("What is Clozaril?," n.d.). This is typically the last step available for patients experiencing bipolar. The question we need to ask ourselves is where do we go from here? Patients who are not experiencing positive results from the medication need an alternative so that they are able to experience a quality life. These alternatives includes Electroconvulsive Therapy(ECT) or Transcranial Magnetic Stimulation(TMS) (B. Espinoza, personal communication, February 3, 2017). This project can have a vast number of benefits to the patients. If we can show the benefit to using these alternatives to medications, we can improve the quality of life the bipolar patients are experiencing and hopefully show the benefit to the use of these therapies. ECT is a type of procedure which is usually done while under anathesia. During the procedure minute amounts of electrical currents will pass through the brain to give a small seizure (Mayo Clinic Staff, 2015). ECT will cause changes in the brain and can reverse bipolar symptoms in a matter

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of just a few weeks (Mayo Clinic Staff, 2015). The problem with ECT is that there is a negative stigma which has been allocated to this procedure since the release of “One Flew over a Cuckoo’s Nest”. This type of therapy is used primarily for severe depression, treatment resistant depression, severe mania, catatonia, and the agitation and aggression that is seen in these types of patients (Mayo Clinic Staff, 2015). There are some side effects with this type of therapy. The downside is that it can cause temporary memory loss (May Clinic Staff, 2015). There is a video presented by Dartmouth School of Medicine which gives a good description of why it should be used and the use of it (Dartmouth School of Medicine, n.d.). Transcranial Magnetic Stimulation (TMS) is another therapy similar to ECT, however it is said to have less side effects. The biggest problem is that while it is said to have an 80% remission rate, it has not been approved for bipolar patients by the FDA (Partridge, 2009). The research into ECT and TMS use will allow patients and their families to see the benefits of such a program. If it can be proven to be affective in both types of therapies it is my hope that both programs can be approved for bipolar disease, not just for depression.

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Clozaril. (n.d.). Retrieved from https://www.drugs.com/clozaril.html Dartmouth School of Medicine. (n.d.). Electroconvulsive Therapy (ECT) [Video file]. Retrieved from http://geiselmed.dartmouth.edu/mood/services/ect/ Mayo Clinic Staff (2015). Test and Procedures Electronconvulsive therapy (ECT). Retrieved from http://www.mayoclinic.org/tests-procedures/electroconvulsivetherapy/basics/definition/prc-20014161 Partridge, M. (2009, November 4). rTMS may be effective in patients With treatment-resistant bipolar depression. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/articles/rtms-may-be-effective-patients-treatmentresistant-bipolar-depression(Partridge, 2009)...