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Re: bipolar disorder in adolescent females

Posted by Elizabeth on May 5, 1999, at 23:12:46

In reply to Re: bipolar disorder in adolescent females, posted by Sean on May 5, 1999, at 16:21:02

I notice you're in Australia. I don't know what drugs you have there offhand, but here are some ideas. I'm assuming this is a full-blown manic (not hypomanic) episode without mixed features.

Has she had a serum cbz level? Some people need higher doses. On the other hand, that one may be less useful for pure mania than for mixed states. (It also has some of the same disadvantages as Li+ and valproate.)

Sean mentioned lamotrigine and gabapentin. These are both relatively experimental, but they're remarkably lacking in side effects compared to some of the older mood stabilizers. They can be combined - gabapentin seems to have no interactions with other AEDs.

Atypical antipsychotics - olanzapine, risperidone, etc. - are another idea. However, adolescent girls tend to worry a lot about weight gain, which is a concern with these drugs. One of the older antipsychotics, molindone, supposedly doesn't cause weight gain, but of course it carries an increased risk of EPS.

Another thing you could consider is a calcium channel blocker like verapamil or nimodipine. These have been known to work on mania
- watch for switching to depression, though.

I think my choice in this situation would probably be lithium combined with an antipsychotic (possibly try tapering the antipsychotic once remission is achieved). Can I ask what your particular concern is with Li+?




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