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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ed_uk on December 22, 2004, at 17:18:57
Hi!
Have you had success with a calcium channel blocker for your bipolar? ... or did you try it and it didn't make any difference?
Calcium Channel Blockers are also called Calcium Antagonists. Examples include..... amlodipine, verapamil, felodipine, nimodipine, lercanidipine, lacidipine, diltiazem, nicardipine, isradipine, nifedipine etc. Verapamil has been studied in mania, its effectiveness is controversial.
Nimodipine may also be useful in bipolar disorder, especially for rapid-cycling................
Psychiatry Res. 1993 Dec;49(3):257-72.
Preliminary controlled trial of nimodipine in ultra-rapid cycling affective dysregulation.
Pazzaglia PJ, Post RM, Ketter TA, George MS, Marangell LB.
Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892.
We report the initial results of the first controlled double-blind trial of nimodipine, a calcium channel antagonist, in the acute and prophylactic treatment of patients with treatment-refractory affective dysregulation. Active drug nimodipine (A) was substituted for placebo (B) in 12 patients. Patients were studied in a B-A-B design, with 3 of the 12 patients rechallenged with active drug in a B-A-B-A design (patients 9, 10, and 11). Five of the nine patients who completed the drug trial responded. One of three patients suffering from ultra-ultra-rapid (ultradian) cycling bipolar II disorder (patient 6) showed an essentially complete response; the other two ultradian patients (patients 4 and 9) showed evidence of a partial response on manic and depressive oscillations, one of which was confirmed in a B-A-B-A design. Only one of five less rapidly, but continuously cycling patients showed an excellent response (patient 10), and this was confirmed in a B-A-B-A design. The one patient who had recurrent brief depression (patient 11) showed a complete resolution of severe depressive recurrences, with response re-confirmed in an extended prophylactic trial with a B-A-B-A design. In the eight patients who completed self-ratings, nimodipine was associated with a significant reduction in the magnitude of mood fluctuations compared with the baseline placebo condition. Further clinical study of nimodipine, a calcium channel blocker with a unique profile of behavioral and anticonvulsant properties, appears warranted in patients with treatment-refractory affective illness characterized by recurrent brief depression and ultradian cycling.
Posted by linkadge on December 22, 2004, at 17:24:18
In reply to Calcium Channel Blockers in Bipolar Disorder, posted by ed_uk on December 22, 2004, at 17:18:57
I was under the impression that the sodium channel was more relavent in bipolar mania. I don't know if this is true or not.
Linkadge
Posted by dove on December 23, 2004, at 8:31:27
In reply to Re: Calcium Channel Blockers in Bipolar Disorder, posted by linkadge on December 22, 2004, at 17:24:18
This was the first med I ever took that gave me hope and sent me searching for help against my depression. I was given Verapamil to alleviate my classic migraine headaches with auras and discovered a whole wide world of emotional and mental equilibrium. Verapamil had such a profound effect on me that I began searching for answers (after talking to my Internist who explained that the change was merely due to the fact that I wasn't having migraines anymore) and found Dr. Bob and Psychobabble around 1997-98.
I'm not dxed as bipolar, although *I* was sure I must be after my initial reaction to Verapamil--LOL! I am dxed with severe major depression, with atypical features manifesting every few years; in addition to ADD (severe ADHD as a child and teen), PTSD, remittent panic disorder, and GAD. I have a past riddled with alcohol abuse and self-injury which has caused me to procure DBT and CBT as well as hospitalization on occasion.
However, it has been the meds that have made the most rigorous distinction in my struggle. I've tried other "classic" bipolar meds without any beneficial results. Furthermore, they actually seemed to make both the depression and ADD much much worse. Verapamil quieted my mind and soothed my inner self-destructive beast. Unfortunately, I was switched to Amitriptyline because of severe low blood-pressure and some other inane reason which I can't remember anymore. Consequently, when I tried Verapamil again, it still had the same negative effects on my preexisting low blood-pressure accompanying the same positive effects on my mood.
dove
Posted by ed_uk on December 23, 2004, at 8:51:45
In reply to Re: Calcium Channel Blockers in Bipolar Disorder, posted by dove on December 23, 2004, at 8:31:27
Hi Dove,
Your post was very interesting. Have you tried any other calcium channel blockers such as nimodipine? Many people who get side effects from verapamil can tolerate other calcium channel blockers. Alternatively, you could consider taking verapamil in combination with additional medication to raise your blood pressure.
Ed.
Posted by KikiCabell on December 24, 2004, at 9:17:18
In reply to Calcium Channel Blockers in Bipolar Disorder, posted by ed_uk on December 22, 2004, at 17:18:57
Ed:
I have a friend who is mostly manic, not too much trouble with depression, and she takes Verapamil along with Depakote. I believe she's had a bit of success with its addition and I don't recall her mentioning any side effects.
- Kiki
> Hi!
>
> Have you had success with a calcium channel blocker for your bipolar? ... or did you try it and it didn't make any difference?
>
> Calcium Channel Blockers are also called Calcium Antagonists. Examples include..... amlodipine, verapamil, felodipine, nimodipine, lercanidipine, lacidipine, diltiazem, nicardipine, isradipine, nifedipine etc. Verapamil has been studied in mania, its effectiveness is controversial.
>
> Nimodipine may also be useful in bipolar disorder, especially for rapid-cycling................
>
> Psychiatry Res. 1993 Dec;49(3):257-72.
>
> Preliminary controlled trial of nimodipine in ultra-rapid cycling affective dysregulation.
>
> Pazzaglia PJ, Post RM, Ketter TA, George MS, Marangell LB.
>
> Biological Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892.
>
> We report the initial results of the first controlled double-blind trial of nimodipine, a calcium channel antagonist, in the acute and prophylactic treatment of patients with treatment-refractory affective dysregulation. Active drug nimodipine (A) was substituted for placebo (B) in 12 patients. Patients were studied in a B-A-B design, with 3 of the 12 patients rechallenged with active drug in a B-A-B-A design (patients 9, 10, and 11). Five of the nine patients who completed the drug trial responded. One of three patients suffering from ultra-ultra-rapid (ultradian) cycling bipolar II disorder (patient 6) showed an essentially complete response; the other two ultradian patients (patients 4 and 9) showed evidence of a partial response on manic and depressive oscillations, one of which was confirmed in a B-A-B-A design. Only one of five less rapidly, but continuously cycling patients showed an excellent response (patient 10), and this was confirmed in a B-A-B-A design. The one patient who had recurrent brief depression (patient 11) showed a complete resolution of severe depressive recurrences, with response re-confirmed in an extended prophylactic trial with a B-A-B-A design. In the eight patients who completed self-ratings, nimodipine was associated with a significant reduction in the magnitude of mood fluctuations compared with the baseline placebo condition. Further clinical study of nimodipine, a calcium channel blocker with a unique profile of behavioral and anticonvulsant properties, appears warranted in patients with treatment-refractory affective illness characterized by recurrent brief depression and ultradian cycling.
>
Posted by JackD on December 28, 2004, at 19:11:29
In reply to Calcium Channel Blockers in Bipolar Disorder, posted by ed_uk on December 22, 2004, at 17:18:57
Here's something:
------<Modulation of calcium and potassium currents by lamotrigine.
Grunze H, von Wegerer J, Greene RW, Walden J.
Psychiatrische Klinik der Universitat, Munchen, Deutschland. grunze@psy.med.uni-muenchen.de
Actions of the new antiepileptic drug lamotrigine (LTG) were characterized using extracellular and whole cell patch clamp recordings from rat CA1 and CA3 pyramidal cells in vitro. The results suggest that LTG, beside its previously described effect on the fast sodium inward current, also modulates - presumably voltage-gated - calcium currents and the transient potassium outward current ID. These may be effective mechanisms to inhibit pathological excitation in epilepsy and may be of potential benefit in treating underlying cellular disturbances in bipolar disorder.
PMID: 9778600 [PubMed - indexed for MEDLINE]
-----<
Eh, this one's KINDA relevant
-----<Voltage-activated calcium channels: targets of antiepileptic drug therapy?
Stefani A, Spadoni F, Bernardi G.
IRCCS Ospedale S. Lucia and Clinica Neurologica, Universita di Tor Vergata, Rome, Italy.
Voltage-gated calcium currents play important roles in controlling neuronal excitability. They also contribute to the epileptogenic discharge, including seizure maintenance and propagation. In the past decade, selective calcium channel blockers have been synthesized, aiding in the analysis of calcium channel subtypes by patch-clamp recordings. It is still a matter of debate whether whether any of the currently available antiepileptic drugs (AEDs) inhibit these conductances as part of their mechanism of action. We tested oxcarbazepine, lamotrigine, and felbamate and found that they consistently inhibited voltage-activated calcium currents in cortical and striatal neurons at clinically relevant concentrations. Low micromolar concentrations of GP 47779 (the active metabolite of oxcarbazepine) and lamotrigine reduced calcium conductances involved in the regulation of transmitter release. In contrast, felbamate blocked nifedipine-sensitive conductances at concentrations significantly lower than those required to modify N-methyl-D-aspartate (NMDA) responses or sodium currents. Aside from contributing to AED efficacy, this mechanism of action may have profound implications for preventing fast-developing cellular damage related to ischemic and traumatic brain injuries. Moreover, the effects of AEDs on voltage-gated calcium signals may lead to new therapeutic strategies for the treatment of neurodegenerative disorders.
Publication Types:
* Review
* Review, Tutorial
PMID: 9579933 [PubMed - indexed for MEDLINE]------<
Regarding all of my rantings about pain, and I think I remember amitriptyline also being mentioned in several posts that I skimmed, I thought this one might be of interest to you guys as well. Just food for thought.
------<Anticonvulsants in central pain.
Finnerup NB, Gottrup H, Jensen TS.
Department of Neurology and Danish Pain Research Centre, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark. finnerup@akhphd.au.dk
Treatment of central neuropathic pain (CP) following lesions of the CNS is a great challenge to the clinician. Preclinical and clinical studies indicate that neuronal hyperexcitability in damaged areas of the central nervous system plays a major role in the development of CP. Anticonvulsants are thought to act by increasing gamma-aminobutyric acid-mediated inhibition, decreasing abnormal neuronal hyperexcitability by modulating sodium and calcium channels or by inhibiting excitatory amino acid actions. The resulting inhibition of excess neuronal activity is thought to be the basis for the use of anticonvulsants in epilepsy as well as neuropathic pain. Both first-generation anticonvulsant drugs (e.g., phenytoin, benzodiazepines, valproate and carbamazepine) and second-generation anticonvulsant drugs (e.g., lamotrigine, gabapentin and topiramate) are used in CP conditions. However, few randomised controlled trials on the treatment of this condition have been published. Present suggestions for anticonvulsant treatment of CP are lamotrigine as the first choice, followed by gabapentin or carbamazepine/oxcarbazepine. These compounds are considered as effective as the antidepressant amitriptyline.
Publication Types:
* Review
* Review, Tutorial
PMID: 12387687 [PubMed - indexed for MEDLINE]
Posted by dove on December 29, 2004, at 11:09:55
In reply to Re: Calcium Channel Blockers in Bipolar Disorder » dove, posted by ed_uk on December 23, 2004, at 8:51:45
> Have you tried any other calcium channel blockers such as nimodipine? Many people who get side effects from verapamil can tolerate other calcium channel blockers. Alternatively, you could consider taking verapamil in combination with additional medication to raise your blood pressure.
>No other CCB's gave me the same mood beneficial effects, bizarrely enough. Moreover, I have a heart murmur, which apparently was aggravated by Verapamil, although my doc said this side effect was quite rare. I'm still trying to figure out the mystery of it all.
Happy day to all!
dove
Posted by Ritch on December 29, 2004, at 13:03:37
In reply to Re: Calcium Channel Blockers in Bipolar Disorder, posted by dove on December 29, 2004, at 11:09:55
> No other CCB's gave me the same mood beneficial effects, bizarrely enough. Moreover, I have a heart murmur, which apparently was aggravated by Verapamil, although my doc said this side effect was quite rare. I'm still trying to figure out the mystery of it all.
>
> Happy day to all!
>
> doveDid you ever get any tremor or muscle weakness when you took verapamil? I get beneficial effects by taking some verapamil (when I'm in an angry or mixed state), but my muscles feel "springy" and weak, and I feel "shaky" but I'm not nervous. I also had one experience with verapamil where I felt this intense agitation and sense of doom and within a couple of hours of taking it (no other meds at the same time), everything just "cleared up" and the doom went away-very weird experience.
Posted by ed_uk on December 29, 2004, at 15:09:43
In reply to Re: Calcium Channel Blockers in Bipolar Disorder, posted by dove on December 29, 2004, at 11:09:55
Hi Dove,
Have you seen a cardiologist to find out whether it might be possible to take verapamil again?
Ed.
This is the end of the thread.
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