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Re: Bipolar? Do you take a mood stabilizer? phidippus

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?
> Ericc

Hi 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

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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