Posted by Theresa on February 19, 1999, at 11:51:03
In reply to Re: Alternative to Depakote, posted by Elizabeth on February 16, 1999, at 22:57:58
I know lithium is approved for bipolar disorder, but it only works in about 60% of patients. Also, it's not for patients with certain bipolar problems (I forget if it's mixed states or rapid cycling or both) that are common. Many people also don't like to take it because of the side effects that can occur with fluid balance, i.e., getting dehydrated if you get too hot. So I don't think lithium is a magic bullet by any means.
You're right about the drug companies approving anticonvulsants and then just letting patients be the "guinea pigs" for bipolar treatment. I have heard that Abbott is considering studying its newest anticonvulsant, tiagabine (Gabitril) for use in bipolar disorder, which would be a start, and would perhaps encourage other drug companies to sponsor trials of anticonvulsants for bipolar disorder. That way, we'd have a better grasp on efficacy, dosing, side effects, etc.
Some antispsychotics such as olanzapine (Zyprexa) are being studied for bipolar disorder for acute mania or mixed episodes, so that may be a start too.
I think it's important not to get discouraged. There are many drugs available in many combinations. some people have to try dozens of combinations before they find the right one. It's the pits, but right now, that's the best medicine has to offer. It's a shame when you consider all the advances in other diseases such as cancer and AIDS.
> >Tegretol was never approved for
> >bipolar disorder. It's used so often for that indication, though, that it's
> >hard to remember that.
>
> It is indeed, and very widely accepted. Although Peter Kramer relates a pretty funny story about how he decided to use Tegretol for a patient once (in _Moments of Engagement_).
>
> >As for Topamax causing weight loss, that's only
> >based on one small study that I know of (Dr. Susan McElroy, Cincinnati). I
> >think the APA meeting will have a lot more data presented on Topamax
> >for bipolar disorder that may clear that up.
>
> Gosh, I wasn't even talking so much in terms of data as just "I know a few people who...." :-) Didn't know anyone was serious about Topamax as a bipolar drug.
>
> >Someday perhaps we'll have a targeted drug just for
> >bipolar disorder (not approved for other indications) other than lithium!
> >Wouldn't that be wonderful! (Drug companies, are you listening?)
>
> Don't hold your breath. Right now they have something (or other) going with the AEDs, and I've at least heard the claim that it's easier to get something approved for epilepsy (especially as "adjunctive treatment") than it is for manic-depression, so they just do that and then let the patients be the guinea pigs for bipolar.
>
> Anyway, what do you think lithium is? :-) (Just for the record, I didn't gain weight on lithium.)
>
> -elizabeth
poster:Theresa
thread:2774
URL: http://www.dr-bob.org/babble/19990201/msgs/3063.html