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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by phidippus on April 14, 2012, at 21:35:32
I run into too many bipolar people who do not take a mood stabilizer. This really gets to me. Why don't you guys take mood stabilizers?
Ericc
Posted by bleauberry on April 15, 2012, at 14:51:38
In reply to Bipolar? Do you take a mood stabilizer?, posted by phidippus on April 14, 2012, at 21:35:32
It is not uncommon for bipolars or schizophrenics to choose not to take meds regularly. I think it is a combination of 2 reasons. First, the meds often do not present the desired outcome. Second, side effects are sometimes perceived as worse than the original symptoms. Mood stabilizers basically flatten out emotions and it doesn't feel right. The desired outcome is that the person will feel smooth and normal with few side effects but that doesn't happen as often as we would hope. In terms of quality of life and ability to manage life day to day, the disease is sometimes easier than the meds.
Another problem is that it can take a lot of time and experimentation to find the right med, the right dose. There can be a lot of failures and set backs along the way. Unless the person has a really good doctor who can keep the faith up and keep good ideas flowing, the person might just drop out and say screw it.
In my own travels I have discovered that some of the best mood stabilizers are not classified as such, and some are not prescription meds. I have also discovered, or come to believe, is that many of the bipolars actually have an identifiable treatable biological reason for the symptoms. Many bipolars find ways to manage their disease through diet, training, and supplements that is more acceptable to them than meds.
Posted by linkadge on April 15, 2012, at 19:02:53
In reply to Re: Bipolar? Do you take a mood stabilizer?, posted by bleauberry on April 15, 2012, at 14:51:38
I agree. They don't always work for people, and they can certainly leave some people feeling very flat.
Linkadge
Posted by phidippus on April 15, 2012, at 20:31:27
In reply to Re: Bipolar? Do you take a mood stabilizer?, posted by bleauberry on April 15, 2012, at 14:51:38
"Many bipolars find ways to manage their disease through diet, training, and supplements that is more acceptable to them than meds."
I've met those bipolars. No thanks.
Eric
Posted by phidippus on April 15, 2012, at 20:33:27
In reply to Re: Bipolar? Do you take a mood stabilizer?, posted by linkadge on April 15, 2012, at 19:02:53
Every bipolar I meet who's not on a mood stabilizer is constantly battling symptoms. Tortured is a good way to refer to them.
Eric
Posted by SLS on April 16, 2012, at 1:42:15
In reply to Bipolar? Do you take a mood stabilizer?, posted by phidippus on April 14, 2012, at 21:35:32
> I run into too many bipolar people who do not take a mood stabilizer. This really gets to me. Why don't you guys take mood stabilizers?
>
> EriccHi Eric.
I am taking lithium 300 mg and Lamictal 200 mg. Lamictal is more of an antidepressant for me than it is an anti-manic or mood stabilizer. In fact, I experienced a manic reaction to Nardil which Lamictal 300 mg did not prevent. The low dosage of lithium has helped somewhat with depression and has exhibited the capacity to greatly reduce diurnal and weekly fluctuations in depression severity. I know that you are at a full therapeutic dosage of lithium. I think Trileptal would be a better first choice than Depakote as an adjunct to lithium. It does not tend to flatten affect the way that Depakote can, and is in many ways preferable to Tegretol. This is not to say that valproate would not ultimately prove effective in your case, though. I would not exclude it from consideration. However, there seems to be more data suggesting that Lamictal is more effective than valproate in treating bipolar depression. If affective instability is the feature of your illness that you are currently addressing, Lamictal may not be helpful. The only way to know for sure is through trial-and-error. You might want to make a list of treatment alternatives sorted in order of preference and begin conducting trials, even if a trial is nothing more than a dosage adjustment.
As I mentioned in another post, you would not be combining mood stabilizers as if they were somehow redundant. A combination of Lithium and Lamictal is no more redundant than a combination of a Wellbutrin and Zoloft. "Mood stabilizer" is a conceptional term given to drugs of various mechanisms of action. They don't all inhibit sodium channels. Even if they did, each would remain set apart from the others by its other unique mixture of properties.
A recent study compared the efficacies of lithium monotherapy, valproate monotherapy, and combination therapy in the treatment of Bipolar I. Valproate was clearly inferior to lithium. The combination of lithium and valproate was not significantly more efficacious than lithium monotherapy. This is only one study, of course. The NIMH has been combining these two drugs for years when confronted with difficult cases of bipolar disorder. So, too, have they used the combination of Tegretol and lithium.
With high-dosage lithium, you need to worry about kidney and thyroid function. With valproate, liver function is a concern and should be tested for several times during the first 6 months and annually thereafter. With Trileptal, hyponatremia is a possible side effect. Increasing salt intake helps. With Tegretol, agranulocytosis occurs often enough to require periodic blood tests. With Topamax, cognitive impairments can occur, but are likely avoided by starting at 25 mg and increasing by 25 mg per week to a test dosage of 100 mg. Kidney stones are a concern with Topamax, but the risk can be minimized by drinking lots of water. Gabitril is a weird one. Some people experience a calming effect while others become very agitated. I vaguely remember someone reporting that Zonegran helped them, but I really don't think it has demonstrated sufficient efficacy as a mood stabilizer to place it high on your list. Neurontin and Lyrica are worth considerating, but I would not place them at the top of the list, except, perhaps, if anxiety is present. Cognitive impairments are possible with these two drugs, although uncommon. I think it depends upon how one reacts to inhibitors of the alpha2delta subunit of the calcium channel. Both drugs wreck me. Keppra, you already know.
And that's all I have to say about that.
- Scott
Posted by b2chica on April 16, 2012, at 12:12:24
In reply to Re: Bipolar? Do you take a mood stabilizer? » phidippus, posted by SLS on April 16, 2012, at 1:42:15
then theres a few of us that pdocs dont count as bipolar as we only have had a couple hypomanic accounts and that was due to certain meds.
for about the last 6 years or so pdocs have cut out bipolar dx(given a few times they counted possible 'mixed' episodes) but otherwise if cycled between psychotic depression, aggitated depression and just MDD.
Even i hesitate, though i do feel i am mixed many times i dont know if what i feel would be called Mixed episode or aggitated depression brought on by severe anxiety.also every 'mood stabilizer' ive been on Makes me feel bipolar in that my moods tend to cycle every three days or so down up, etc.
ive long since given up on dx and just deal with symptoms.
i know i struggle most with anxiety, next depression. i hardly Ever deal with hypomanic issues.************************
and as one with a mental illness i would agree and say sometimes its just not worth it and go off a med due to side effects whatever they may be. hoping for at least a slight reprieve before i have to try a new medication.
i've already been on 30 meds for whatever reason were stopped. most meds just dont work well for me.the few that have poop out after about a year.and its only been 9 years since dx.
Posted by Raisinb on April 16, 2012, at 13:05:18
In reply to Bipolar? Do you take a mood stabilizer?, posted by phidippus on April 14, 2012, at 21:35:32
I doubt there are bipolars who took a mood stabilizer, found it helped and was tolerable, and then just decided not to take it.
I've tried lithium and trileptal. Trileptal did nothing and lithium did not help my depression, but the side effects were horrible. Couldn't work and the acne and constipation we're unreal, and my blood level was only .8. And yes, I gave it an adequate trial: three months.
Posted by phidippus on April 16, 2012, at 15:41:52
In reply to Re: Bipolar? Do you take a mood stabilizer?, posted by Raisinb on April 16, 2012, at 13:05:18
You have several others left to try!
Carbamazapine
Sodium Depakote
Zonegran
Keppra
LamictalEric
Posted by phidippus on April 16, 2012, at 15:56:33
In reply to Re: Bipolar? Do you take a mood stabilizer?, posted by b2chica on April 16, 2012, at 12:12:24
>i struggle most with anxiety, next depression.
My concerns are that these symptoms are a manifestation of your mood cycling and that if you were on the right mood stabilizer, you would not be having these symptoms.
Eric
Posted by bleauberry on April 16, 2012, at 18:20:19
In reply to Re: Bipolar? Do you take a mood stabilizer? » bleauberry, posted by phidippus on April 15, 2012, at 20:31:27
> "Many bipolars find ways to manage their disease through diet, training, and supplements that is more acceptable to them than meds."
>
> I've met those bipolars. No thanks.
>
> EricJust trying to answer the question not pass judgement.
Posted by B2chica on April 17, 2012, at 8:52:53
In reply to Re: Bipolar? Do you take a mood stabilizer? » b2chica, posted by phidippus on April 16, 2012, at 15:56:33
probably true my friend. but i'm not yet in a place where i feel comfortable switching things up too much.
i guess i feel better the devil you know, for right now.thanks for all your input.
btw, thanks for list
zonegran
keppra and others.
good to have in hand.b2c
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