Posted by SLS on October 3, 2012, at 22:43:51
In reply to Re: Zyprexa is a mood stabilizer?, posted by Christ_empowered on October 3, 2012, at 19:29:04
> At least the benzos weren't this bad. If you read animal studies, zyprexa causes just as much dopamine 2 receptor upregulation as haloperidol.
Here's a very recent, and quite interesting, study that refutes the studies you allude to:
http://www.ncbi.nlm.nih.gov/pubmed/22927669
If you really want to debate whether or not olanzapine is a mood stabilizer, then you need to separate side effects from observed therapeutic effects. Then you can present a benefit vs risk assessment. Personally, I am undecided at this point.
The starting point is to first define what constitutes a "mood stabilizer".
Lithium is the current standard of mood stabilizer by which other drugs are compared. It is probably the only true mood stabilizer currently available if one uses the following definition of a mood stabilizer:
"A true mood stabilizer will work in acute manic episodes without inducing depression, acute bipolar depression without inducing mania, and protect the patient from future episodes of mania or depression."
This quote is contained in the article that Phiddipus drew his post from. The article purports that it was Lilly's definition, but I think it is a pretty good one. It is certainly iconic, but is it applicable if one considers that mood disorders are heterogeneous in nature? Lithium isn't much of a mood stabilizer to someone for whom it doesn't treat acute mania or prevent relapse into depression.
There is actually quite a bit of debate as to what should constitute a mood stabilizer. According to some definitions with strict criteria, even lithium doesn't qualify as a mood stabilizer.
http://www.ncbi.nlm.nih.gov/pubmed/14702242
QUESTIONS:1. What are the criteria by which one judges a drug to be a mood stabilizer?
2. In what ways is lithium a mood stabilizer?
3. In what ways is olanzapine NOT a mood stabilizer?
4. What other drugs fit the definition of mood stabilizer?I have reservations about calling olanzapine a mood stabilizer because it sometimes, albeit infrequently, induces mania. Otherwise, I think it comes pretty close. For some people, olanzapine treats depression better than does lithium. For others, olanzapine treats mania better than does lithium.
If I had to choose one drug to be called a true mood stabilizer, it would be lithium. This becomes especially evident when using it to treat bipolar I disorder. However, one size does not fit all, and it is obvious to me that some people do better with olanzapine than with lithium. For me, lithium 1200 - 1500 mg/day at therapeutic blood levels is worthless as an antimanic and prophylactic. It actually makes my depression worse. When I have become manic in the past, olanzapine or valproate, but not lithium, have treated me successfully. Some people report that olanzapine is much more effective than lithium when treating suicidality. The salient question is whether or not olanzapine acts as a propylactic against relapse.
It is unfortunate that olanzapine carries with it a liability to produce metabolic effects and diabetes. Otherwise, it is one of our most efficacious drugs when treating bipolar disorder and schizophrenia.
Lithium is no bargain when it comes to side effects and potentially fatal toxicity. It can destroy kidneys and thyroid glands.
So which of the two drugs being discussed should be chosen first?
Neither drug is globally effective against all cases of bipolar disorder. Fortunately, there are other drugs to work with. No one drug might be a "true" mood stabilizer, but if one allows themselves the alternative of polypharmacy, a combination of non-mood stabilizers can effectively stabilize mood.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1027134
URL: http://www.dr-bob.org/babble/20121001/msgs/1027517.html