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Lorazepam tablets 2mg /ml). The dose used to treat acute agitation or anxiety was 1 mg/kg/day i.p. The dose used to treat major symptom of bipolar disorder in humans was 250mg/day i.p. [14], in combination with a mood stabilizer. In another study, patients with bipolar disorder on lithium therapy experienced a significant increase in the mean plasma norepinephrine level at the first postbasal test day. This effect was seen most strongly with doses greater than 4mg/kg and lasted for 1-3 days. This study did not find a dose-response relationship, but patients treated with higher doses had more pronounced elevations [15]. Other studies have shown that doses of 5mg/kg/day to 20mg/kg/day produce significant increases in norepinephrine levels the blood of bipolar patients. In a meta-analysis of 12 double-blind controlled trials, the mean change in plasma norepinephrine concentrations was 11% higher with doses of niacin compared to placebo. The studies showed no significant difference in mean change plasma epinephrine concentrations, with the exception of one study in which the mean plasma epinephrine concentration showed a slight elevation with 5mg/kg/week versus placebo [16]. Other studies have demonstrated increased norepinephrine levels in patients receiving niacin versus placebo. In one double-blind trial of 8 bipolar patients being treated with niacin and a mood stabilizer, there was marked elevation of mean norepinephrine lorazepam .5 mg ativan levels after niacin administration (P =.008), but no change in mean epinephrine (P =.59). In another double-blind double-dummy study, the mean change in plasma norepinephrine level after a 10-day course of niacin in patients with bipolar disorder was 14% higher than in patients treated with placebo (P =.0016) [17]. Niacin has also been shown to reduce plasma epinephrine levels in patients with bipolar disorder [18,19]. A double-blind, placebo-controlled study found that a dose of 4.7mg/kg/day niacin for 8 weeks increased plasma epinephrine levels by 12% versus placebo (P <.001) in patients with bipolar disorder. These data suggest that the use of high doses niacin may result in higher plasma epinephrine levels bipolar patients. Bipolar Disorder Treatment Using a Low-Dose Scheduling (LSCT) The treatment of bipolar disorder using a low-dose treatment schedule for the maintenance of bipolar disorder was first described by Riedel [20] in the 1970s. 1980s, Low-Dosing Maintenance of Bipolar Disorder (LDM) protocol was developed independently in the USA and Britain to address the treatment of bipolar depression by a low-dose treatment schedule (LDMS) [21] that did not meet the criteria for major depressive disorder (MDD) in the criteria and clinical guidelines of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV-TR) [6]. In the 1970s and 1980s, LDMS was used mostly to treat patients with major depression. It has since become a treatment modality with several different uses [9,22]. In the present study, we used LDMS to treat patients with bipolar disorder. This protocol has been shown to be efficacious and safe in the treatment of patients with bipolar depression and can be used to treat bipolar depression in adults [23]; however, it has not been studied as a treatment modality for patients with bipolar disorder. The LDMS has been shown to be effective in bipolar disorder, but its clinical efficacy and tolerability are unclear [24,25]. Several limitations to the current LDMS include lack of standardized doses, high cost, a rate of discontinuation due to toxicity, and an ongoing need for a drug-drug interaction study [26] in patients at risk for drug–drug interactions. Niacin for Bipolar Disorder (BD) is the most common psychiatric disorder in adults and the fifth most frequently occurring psychiatric illness in adults. The incidence of bipolar disorder in adults is estimated to be 3.7 cases per 100,000 in the USA and 4.2 cases per 100,000 in UK [27]. the UK, age range considered by the Bipolar Support Efficacy Trial Research Network to be at highest risk of developing bipolar disorder is from 18 to 35 years [28]. There is a substantial difference in the incidence and prevalence of bipolar disorder by sex [29]. In women the UK, bipolar disorder is more likely to become symptomatic than in men. The incidence of bipolar disorder with manic and episodes in women is approximately 1% while the incidence with hypomanic and mixed episodes is about 14% [30]. In the USA, incidence of bipolar disorder is 2.8% in women and 1.

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