Psycho-Babble Medication Thread 538236

Shown: posts 41 to 65 of 82. Go back in thread:

Re: Keppra (levetiracetam) for bipolar disorder? » zeugma

Posted by SLS on August 17, 2005, at 7:52:45

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 16, 2005, at 16:34:41

Hi Zeugma.
> > Pemoline?
>
> Tried it, worked great, was taken off it because of drastic weight loss.
> >
> > DA agonists?
> >
> I brought up bromocriptine to my pdoc. Do you consider modafinil an indirect DA agonist?
I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.
> > Abilify?
> Am I irrationally afraid of AP's?
It is not irrational to be concerned with the long-term risks of neuroleptics. I still have a few "irrational" cortical neural circuits that are uncomfortable with the idea, despite my decision to start taking them several years ago. I think there are subpopulations that are more vulnerable to the development of EPS with the atypicals. For instance, older persons, particularly those with dementia, are several times more liable.
> I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
The akathisia produced by Abilify is usually moderate and time-limited as a startup side effect. It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.
> Modafinil actually works for this problem,
That's interesting. Do you have any theories as to why?
Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".

- Scott

Re: Keppra (levetiracetam) for bipolar disorder? » SLS

Posted by zeugma on August 17, 2005, at 16:29:03

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45

Hi Scott.

>
> > > Pemoline?
> >
> > Tried it, worked great, was taken off it because of drastic weight loss.
> > >
> > >
> > >
> > Do you consider modafinil an indirect DA agonist?
>
> I am still undecided. So far, this drug has demonstrated increases in glutamatergic neurotransmission in at least two structures: the thalamus and the hypothalamus. Excitation of the neurons in the thalamus might stimulate DA neurons elsewhere in the limbic system such as the nucleus accumbans to produce reward. In the hypothalamus, certain nuclei are encouraged to secrete a substance called hypocretin, which when it reaches the cortex produces wakefulness. These are not necesarily dopaminergic. Modafinil has not been shown to be effective in treating ADHD.>
It is effective for my disorder, whatever its etiology, although it treats different symptoms than Ritalin. For example:
Color perception:
Improves on Ritalin dose-dependently, no effect from modafinil.
Physical coordination: Improves on modafinil, no effect or worsened on Ritalin.
Reaction time: improved on Ritalin, slowed on modafinil.
Pattern perception: improved on both, but more so on modafinil.
Organization: improved on modafinil, no effect or only slightly improved on Ritalin, and any improvement on Rit HIGHLY dose-dependent.
Color perception is known to be dopaminergically mediated, and this argues against a strong role for modafinil as dopaminergic.
Hypothalamically mediated parameter:
Appetite: Modafinil is the only drug on which I have an appetite. Modafinil is the only drug on which I have demonstrated weight gain. Appetite is known to be orexinergically (aka hypocretin) mediated- the word 'orexin' means 'appetite' in Greek. I have narcoleptic as well as appetitive problems, and both are orexinergically mediated and localized in the hypothalamus.
> >
>
>
>
> > I've heard that Abilify in particular is bad for akathisia, which I have endogeneously.
>
> It could conceivably stabilize DA synapses by acting as a patial agonist rather than a full antagonist as does the other neuroleptics.
Perhaps.
>
> > Modafinil actually works for this problem,
>
> That's interesting. Do you have any theories as to why?
I think the hypothalamus is concerned with the processing of interoceptive, particularly autonomic, stimuli. I think the same dysfunction that causes me to have no appetite also causes spasticity, of which akathisia is a manifestation. Modafinil has been reported to reduce spasticity in cerebral palsy. I consider myself to have some kind of movement disorder, related to hypothalamic dysfunction.
>
> Have you tried anticholinergic drugs like Akineton (biperidin)? They might suppress REM sleep.
>
I was on high doses of Cogentin when treated with an AP. I experienced unusually vivid dreaming during this time, secondary to neuroleptic administration.

> Maybe you can take pemoline and Zyprexa together. That might help with the weight loss issue and confer anxiogenic effects and enhance "clarity of thought".
>
That's an interesting idea. Do you think Zyprexa has cognotropic properties?

-z
>
> - Scott
>

Re: Keppra (levetiracetam) for bipolar disorder? » SLS

Posted by zeugma on August 17, 2005, at 16:46:54

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45

What benefits have you had from the addition of Abilify?
Have you ever tried gabapentin?
-z

Re: Keppra (levetiracetam) for bipolar disorder? » SLS

Posted by zeugma on August 17, 2005, at 17:33:47

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 7:52:45

by the way, exhaustive info about Keppra is now available at http://crazymeds.org/
I hope Keppra helps you.
-z

Re: Keppra (levetiracetam) for bipolar disorder? » zeugma

Posted by SLS on August 17, 2005, at 18:46:16

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by zeugma on August 17, 2005, at 16:29:03

Z.
It looks like you have established a hypocretin connection to your condition given the narcolepsy and appetitive depression you have observed and the way they are influenced by modafinil. You might want to begin looking at the way the X and Y clocks are synchronized and see if there is some way to cue or reset them using environmental stimuli like a light box or well-timed melatonin ingestion. From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
As far as Zyprexa is concerned, many people on PB have described it as producing or enhancing "clarity" of thought or thinking more clearly. I myself experienced this when I added it to help control an antidepressant-induced mania. I think Zyprexa has a positive influence on executive function in areas that might also contain hypocretin neurons such as PFC.
For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.

- Scott

Re: Keppra (levetiracetam) for bipolar disorder? » SLS

Posted by zeugma on August 18, 2005, at 7:16:39

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » zeugma, posted by SLS on August 17, 2005, at 18:46:16

>
>
> You might want to begin looking at the way the X and Y clocks are synchronized and see if there is some way to cue or reset them using environmental stimuli like a light box or well-timed melatonin ingestion.>>
Interestingly I was prescribed a light box many years ago after my first sleep study. Let's say 'compliance' was an issue. It was impossible for me to wake up before 2 pm on a consistent basis, much less at 6 am as the sleep doc advised. I used it intermittently over the years and unsurprisingly got no major benefit from it.
I wake up now fairly regularly by 6 am. I could retry it, as the thing takes up half my apartment (!).
<From what I understand, depression can affect adversely the periodicity of hypocretin secretion.
>
Do you have any thoughts then on why modafinil is not considered an effective AD? I seem to get an AD effect from it, but that could be because it reduces core symptoms of melacholia (agitation and lack of interest in food).
> As far as Zyprexa is concerned, many people on PB have described it as producing or enhancing "clarity" of thought or thinking more clearly. I myself experienced this when I added it to help control an antidepressant-induced mania. I think Zyprexa has a positive influence on executive function in areas that might also contain hypocretin neurons such as PFC.>
yes, that's on the right track. i have serious executive function issues. Notably, these are helped more by provigil than by ritalin, though I do derive some benefit from ritalin.

>
> For me, Abilify has increased motivation and mental energy. It has also protected me from suicidality by dissipating anxious catastrophic thinking.
>
It's well worth it then.
-z
>
> - Scott
>

Re: Keppra (levetiracetam) for bipolar disorder? » SLS

Posted by theo on August 18, 2005, at 16:41:57

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » theo, posted by SLS on August 16, 2005, at 8:05:38

Hey Scott,
What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
Ted

Re: Keppra (levetiracetam) for bipolar disorder? » theo

Posted by SLS on August 19, 2005, at 8:39:33

In reply to Re: Keppra (levetiracetam) for bipolar disorder? » SLS, posted by theo on August 18, 2005, at 16:41:57

> Hey Scott,
>
> What dose are you currently at with the Keppra? Are you feeling anything positive or negative?
>
> Ted
I began taking 500mg of Keppra on Sunday. I will be moving up to 1000mg today. So far, I haven't experienced any negative effects on mood or cognition. This alone is a positive outcome at this juncture. Keppra has been known to make depression worse in some people. One of the things I hate about starting a new drug is that I place so much hope in it so soon. I experienced a small improvement in energy over the past two days. So, my silly mind interprets this as evidence that the drug will ultimately bring me into complete remission. Why is that? After so many "false starts" and treatment-failures, you would think I should at least remain neutral in my outlook, if not demonstrate overt pessimism based on my treatment statistics.
I guess I really don't expect very much from Keppra. The NIMH hasn't seen it successfully treat severe depression. However, this was probably in the absence of antidepressants. My doctor doesn't think much of the drug. Ivan Goldberg wasn't terribly impressed either. No one here has reported a robust antidepressant response in the treatment of chronic depression. I had it on my list simply because it was so different from the other anticonvulsants I've tried. However, I haven't tried Topamax yet. I was hoping to stay away from that drug because of how easily these drugs affect negatively my cognition.
So, here I am.
Life is funny. The one Medline article that captured my interest was this one:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15582854&query_hl=1
When I decided to go for a second opinion consultation, I was recommended to see Dr. Kaufman. I had no idea he was the author of this article. I really didn't know anything about him. When I asked him what he thought of the idea of using Keppra, he smiled at me and asked me why I was interested in it. When he showed me a copy of the article abstract, I said, "Yeah, I read this." LOL. It was his suggestion that I give it a try. If it works, he would like to write me up. Hopefully, he'll have good reason to.

- Scott

-------------------------------------------
1: Epilepsy Behav. 2004 Dec;5(6):1017-20. Related Articles, Links

Monotherapy treatment of bipolar disorder with levetiracetam.
Kaufman KR.
Department of Psychiatry, UMDNJ-Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2200, New Brunswick, NJ 08901, USA. kaufmakr@umdnj.edu
Bipolar patients with early-onset, comorbid substance abuse, rapid cycling, and mixed episodes are difficult to treat and frequently require rational polypharmacy. When polypharmacy is unsuccessful, the clinician must consider the off-label use of newer psychotropics. Levetiracetam is a novel anticonvulsant with antikindling, inhibitory, and neuroprotective properties that is effective in an animal model of mania. This case report describes a patient with treatment-resistant rapid cycling bipolar disorder who failed 15 psychotropics, individually or in various combinations (maximum of 6), but ultimately responded to levetiracetam monotherapy and remained without bipolar features during 1 year of maintenance treatment, excluding 1 week during which the patient was medicine noncompliant. Further, methylphenidate used to treat comorbid attention deficit disorder did not precipitate manic features. Levetiracetam should be further studied for its potential use in the treatment of bipolar disorders.
Publication Types:
Case Reports
PMID: 15582854 [PubMed - indexed for MEDLINE]