70 We are otherwise unaware of any reports or studies of neuropsychiatrie effects of these medications; as clinical and research experience with these agents grows, further neuropsychiatrie consequences of their use (beneficial or adverse) may become apparent. Bottom line: ACE inhibitors and angiotensin II receptor antagonists are associated with low rates of neuropsychiatrie

side effects, though mood symptoms, psychosis, and delirium have been reported. Therapeutically, there is little Inhibitors,research,lifescience,medical data, though there is some suggestion that captopril might improve depressive symptoms. Calcium channel blockers Calcium channel blockers (CCBs) are associated with relatively low rates of adverse neuropsychiatrie consequences. Fatigue (and associated sedation) occurs at rates greater Inhibitors,research,lifescience,medical than placebo, but it is an uncommon side effect that rarely limits therapy.71-73 Although CCBs theoretically have cognitive benefits, these agents have on occasion been associated with delirium; verapamil and diltiazem have been named in single case reports, and nicarpidine has been associated with confusion among patients undergoing opiate withdrawal.74-76 However, CCBs may have several beneficial neuropsychiatrie effects. For example, these agents have been reported to have favorable effects

in patients Inhibitors,research,lifescience,medical with mood disorders. There have been multiple reports that described the use of verapamil for the treatment of acute mania. Several early case reports suggested that verapamil was effective in the treatment of mania,77,78 and small Veliparib concentration trials have suggested that verapamil may be as effective as lithium in the treatment of mania,79-82 For example, in a trial comparing Inhibitors,research,lifescience,medical verapamil and lithium in the treatment of 20 patients with mania, Garza-Trevino and colleagues79 found Inhibitors,research,lifescience,medical that both treatments were effective, with no significant differences between lithium and verapamil. More recent trials have found lithium to be more effective than verapamil (in a

single-blind trial)83 and no more effective than placebo (in a small, double-blind trial),84 and interest in its use in acute mania has generally waned. However, given the relative safety of verapamil in pregnancy and the encouraging initial results with its use, a recent study of the use of verapamil in the treatment of both pregnant and nonpregnant women these with bipolar disorder was conducted.85 The authors found that verapamil was effective in the treatment of acute mixed and manic states. In contrast to the studies of verapamil, there has been little study of other CCBs for acute mania; diltiazem was associated with the development of mania in one case report.86 Verapamil and other CCBs have also been used as maintenance treatment for patients with bipolar disorder.