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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 tendency on May 25, 2005, at 18:40:12
im looking for a synopsis on the generally recognized symptoms / brain areas that various mood stabilizers target. for instance:
currently i'm on 75mg topamax and have found it quite effective for:
- controlling temproal lobe issues
- preventing dyshphoric manialamictal:
- seems to be generally accepted as being good for rapid cycling and depression
- not so good for controlling maniahow about:
depakote?
tegretol?
trileptal?
lithium?
others?
Posted by Maxime on May 25, 2005, at 19:04:15
In reply to which mood stabilizers do what?, posted by tendency on May 25, 2005, at 18:40:12
This site is very helpful.
http://www.psycheducation.org/depression/meds/moodstabilizers.htm#symptomsMAxime
> im looking for a synopsis on the generally recognized symptoms / brain areas that various mood stabilizers target. for instance:
>
> currently i'm on 75mg topamax and have found it quite effective for:
> - controlling temproal lobe issues
> - preventing dyshphoric mania
>
> lamictal:
> - seems to be generally accepted as being good for rapid cycling and depression
> - not so good for controlling mania
>
> how about:
>
> depakote?
> tegretol?
> trileptal?
> lithium?
> others?
>
>
Posted by tendency on May 25, 2005, at 19:13:51
In reply to Re: which mood stabilizers do what?, posted by Maxime on May 25, 2005, at 19:04:15
> This site is very helpful.
> http://www.psycheducation.org/depression/meds/moodstabilizers.htm#symptoms
>
> MAxime
>thanks for the link. ive seen that one and im not particularily impressed. the gist of most of the reasons to use each med is (ok, little tongue in cheek)
- you're manic
- you cycle
- you're probably depressedum, yeah. lol. looking for something with a little more detail but thanks for the pointer.
Posted by tendency on May 25, 2005, at 19:18:37
In reply to which mood stabilizers do what?, posted by tendency on May 25, 2005, at 18:40:12
> im looking for a synopsis on the generally recognized symptoms / brain areas that various mood stabilizers target. for instance:
suppose some more details might be helpful..really looking for detailed specifics like i mentioned in my topamax description. thanks again!
Posted by Maxime on May 26, 2005, at 18:59:49
In reply to Re: which mood stabilizers do what?, posted by tendency on May 25, 2005, at 19:18:37
try using medscape and do a search on each mood stabiliser. I don't know if you are going to find what you want in one document.
Maxime
> > im looking for a synopsis on the generally recognized symptoms / brain areas that various mood stabilizers target. for instance:
>
>
> suppose some more details might be helpful..
>
> really looking for detailed specifics like i mentioned in my topamax description. thanks again!
Posted by cache-monkey on May 27, 2005, at 13:31:52
In reply to which mood stabilizers do what?, posted by tendency on May 25, 2005, at 18:40:12
I'm looking at the list of meds you've provided:
[topamax]
[lamictal]
> depakote?
> tegretol?
> trileptal?
> lithium?
> others?I'm wondering about your definition of "mood stablilizer"... I suppose it depends on what you're trying to accomplish.
If the goal is treating acute mania, Depakote, Lithium, Tegretol, and possibly Trileptal would all be good agents, depending on your symptoms/chemistry. Tegretol and Depakote are generally believed to be better for mixed states and rapid cycling, while Lithium is better for traditional BP I mania. (But I think the evidence to back up this distinction is conflicting...)
If the goal is treating acute bipolar depression, Lithium and Lamictal are the only ones that are reconized to do this. Lamictal can, however, be too activating for someone with anxiety+depression. (It was for me.)
If the goal is maintenance, again it's Lithium and Lamictal that have been shown to prevent relapse to both poles. Lithium is stronger on the relapse into mania, and I'm not sure about Lamictal's relative strength.
So, in terms of clinical evidence Tegretol and Depakote are really acute anti-manics, while Lithium is a mood stabilizer at all ends and Lamictal is a mood stabilizer from below. (I spend most of my time in depression -- I'm not even sure I have BP; if I do it's very soft. So putting me on Depakote just made me more depressed.) However, many psychiatrists believe that since Tegretol and Depakote "probably" prevent relapse into mania, this "probably" reduces the fall out of mania into depression.
I notice that you've left the atypical APs off your list. These all (Abilify, Geodon, Risperdal, Seroquel, Zyprexa) are approved for acute mania.
Risperdal, Seroquel, and Zyprexa have been shown in clincal studies to benefit acute bipolar depression, with Seroquel by far the most potent. There are also case studies on the other atypical APs that indicate that they might also be good for the depressive side of things.
Zyprexa has also been shown to prevent relapse (more strongly against mania), making it a true all-around mood-stabilizer like Lithium. I would not be surprized if similar results obtained with Seroquel, given its similar profile and chemical structure to Zyprexa. (And some of the other atypical APs may also very well end up being shown to prevent relapse.)
These atypical APs have differing profiles of effects/side-effects. E.g. Zyprexa and Seroquel can be very sedating, while Abilify is quite activating. There's also the weight gain issue, which Zyprexa is most notorious for. Most worrisome is the increased risk of Type II diabetes that runs across the class, although this might be less of an issue for Abilify and Geodon. (And, although the evidence is discordant, Zyprexa is believed to be the worst offender.)
Hope this helps a little.
Best,
cache-monkey
Posted by tendency on May 27, 2005, at 16:09:46
In reply to Re: which mood stabilizers do what? » tendency, posted by cache-monkey on May 27, 2005, at 13:31:52
> I'm looking at the list of meds you've provided:
>
> [topamax]
> [lamictal]
> > depakote?
> > tegretol?
> > trileptal?
> > lithium?
> > others?
>
> I'm wondering about your definition of "mood stablilizer"...yes, what i meant was the anticonvulsant family of mood stabilizers..(non psychotic ones).
thanks for the info.
Posted by BIGDaddyachmed69 on May 28, 2005, at 1:52:52
In reply to Re: which mood stabilizers do what? » tendency, posted by cache-monkey on May 27, 2005, at 13:31:52
Depakote made you more depressed? I've never been diagnosed as having Bipolar Disorder, or exhibiting signs of acute mania. I'm already on an antidepressant, but I'm afraid if I go off of the Depakote I'll feel worse. The problem is I'm depressed to begin with...I asked my psychiatrist if Depakote could worsen my depressive symptoms and he responded with a flat-out "no". I have noticed I'm better able to control my temper and my anxiety level is down, but I feel very apathetic...I don't know what to do.
Posted by cache-monkey on May 31, 2005, at 16:38:25
In reply to Re: which mood stabilizers do what? » cache-monkey, posted by BIGDaddyachmed69 on May 28, 2005, at 1:52:52
I've been actually playing around with my dose of Depakote. At doses of 750 mg+ (ER) it was definitely depressiogenic for me. This is not uncommon with Depakote -- I asked the pharmacist about it and he said that it happened frequently and would most likely go away with time.
I think this has to do with the fact that GABA (which Depakote increases) inhibits dopamine release. That can lead to lower mood and less joy, possibly the apathy you describe. But the GABA increase can be very good for anxiety and agitation (which could represent a "mixed state" -- hence the benefit from a mood stabilizer. I'm not sure if this is directly due to the GABA, or whether excessive dopamine can cause those.
For me cutting back all the way to zero left me with more agitation, for sure. I think that I might have a sweet spot in my Depakote dose that's somewhere between 250 and 500 mg (again ER), and that gets some efficiency against anxiety but isn't depressiogenic.
So, you might want to play around with your dose to see if you can find one that benefits your anxiety/temper and yet doesn't cause apathy.
Good luck,
cache-monkey> Depakote made you more depressed? I've never been diagnosed as having Bipolar Disorder, or exhibiting signs of acute mania. I'm already on an antidepressant, but I'm afraid if I go off of the Depakote I'll feel worse. The problem is I'm depressed to begin with...I asked my psychiatrist if Depakote could worsen my depressive symptoms and he responded with a flat-out "no". I have noticed I'm better able to control my temper and my anxiety level is down, but I feel very apathetic...I don't know what to do.
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