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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




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