Posted by med_empowered on August 18, 2005, at 5:08:55
In reply to Re: What is the most effective mood stablizer?, posted by willyee on August 17, 2005, at 22:41:03
The term "mood-stabilizer" is kind of vague, and the "most effective mood-stabilizer" varies depending on all kinds of factors, especially the kind of mood shifts you experience and other meds that are co-prescribed. If you need a strong anti-manic med, lithium and depakote are hard to beat...they can control mania, including manic psychosis. If you tend more towards hypomania and depression, they may be overkill. Lithium is best reserved for severe unipolar depression and "classical" bipolar I (euphoric mania, depression, good recovery between epsiodes, no rapid cycling or mixed-episodes). When mixed-episodes, rapid cycling, and psychosis and panic are part of the picture, depakote is preferred. Neuroleptics are also an option--the new ones can do both mania control and depression control, but I personally dont like them all that much. Tegretol and trileptal are both good for all kinds of conditions--schizoaffective, bipolar disorders with "odd" features and lots of panic, etc. I'd recommend Trileptal--less toxicity and no blood tests. Then there's lamictal...good for depression, not so good for (hypo)mania. And Keppra...if it works for you, it can control the mood swings and anxiety with minimal negative effects on cognition and very few drug-drug interactions. There is the possibility of drug-induced depression and it hasn't been studied enough to really be considered first-line. Benzos can also be good mood-stabilizers...Klonopin in particular is used for this effect, but higher-dose Ativan can be useful in cases of florid psychosis (bipolar or schizophrenic) for behavioral control and anxiety reduction. You can also try the old-school anti-convulsants...dilantin, that kind of thing. That should probably be a last-resort though. And Surmontil and Asendin, old tricyclic antidepressants, may have antipsychotic effects that would make them (potentially) useful for bipolar disorder.
poster:med_empowered
thread:543158
URL: http://www.dr-bob.org/babble/20050816/msgs/543332.html