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Re: lithium rjlockhart37

Posted by SLS on January 6, 2023, at 7:27:04

In reply to Re: lithium, posted by rjlockhart37 on January 5, 2023, at 21:36:30

Hi.

> but for right now im seeming to be ok

That's good. Every okay moment is a blessing.

Is hypomania your priority concern right now? Is your hypomania euphoric or dysphoric?

For a dysphoric hypomania, I have seen topiramate (Topamax) 200-400 mg/day worked wonders for a case of dysphoric / irritable hypomania. She might have been diagnosed as having Bipolar Disorder / Mixed state. I never asked her, but the symptomatology that she displayed was one of high-energy and anger. My guess is that topiramate is most effective when treating dysphoria or mixed-states in Bipolar Disorder. Its utility might be limited to a narrow spectrum of a Bipolar presentations.


If true hypomania is part of your condition, you have several choices that come to mind:

1. High-Dosage Lithium: 900-1500 mg/day.

2. Moderate Dosage Atypical Antipsychotic: Years ago, I would have recommended olanzapine (Zyprexa) if you tolerated it. However, olanzapine practically guarantees an insatiable appetite and a large increase in body weight. I think 10-20 mg/day would be appropriate. Since then, many more atypical antipsychotics have become available for which a large weight gain is not as much of a problem. If you never tried asenapine (Saphris), I would consider placing it towards the top of your list. It might reduce your hypomania and avoid or reduce depression. While taking asenapine, I experienced a significant antidepressant effect that lasted for about a week. For me, experiencing such an improvement is unusual. https://reference.medscape.com/drug/saphris-asenapine-999301. One drug that I am not sufficiently familiar with is lumateperone (Caplyta). Lumateperone might be a better choice for treating Bipolar Depression than is lurasidone (Latuda).

3. Moderate Dosage Anti-convulsant: Oxcarbazepine (Trileptal) would be my choice. It is a cousin of carbamazepine (Tegretol) for which agranulocytosis is not a side-effect. The only significant side effect of oxcarbazepine that I am aware of is hyponatremia (low sodium). https://pubmed.ncbi.nlm.nih.gov/19007842/ Other anticonvulants worth looking at are topiramate (Topamax), valproate (Depakote), lamotrigine (Lamictal). I don't have enough of a feel for the others to be able to comment on them.

4. Something suggested by others.


- Scott


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

The only thing necessary for the triumph of evil is that good men do nothing.

 

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poster:SLS thread:1121482
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