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Re: Seroquel for hypo-mania?

Posted by Cam W. on October 6, 2001, at 17:07:01

In reply to Re: Seroquel for hypo-mania? » Cam W., posted by jay on October 6, 2001, at 7:43:28

Jay - Most of the scientific information of late has tended to say that, after the hypomanic episode is over, there is usually no need to continue an antipsychotic. The antipsychotic can be reinstituted if the hypomanic episode returns, but otherwise, it is not usually needed continuously.

There has been concerns raised about using antidepressants in BPII. While, often it is unavoidable, perhaps increasing divalproex or lithium doses (if possible) should be the first step. Next, try to add on to existing therapy, on of the new mood stabilizers, like Lamictal™ (lamotrigine), Topamax™ (topiramate), or perhaps even Neuronton™ (gabapentin), to try to ease the depression, with triggering mania.

The above is an idealized (ie. Pleasantville, early in the movie) treatment plan. We shouldn't use antipsychotics once the hypomanic episode passes. but we do. We shouldn't use antidepressants in any bipolar disorders, but we do.

Actually, some recent evidence points to one's stability on the mood stabilizer, as to whether an antidepressant can be added. If one is within the therapeutic window of divalproex, adding an antidepressant seems to come with a lower risk of manic switch.

Antipsychotics do have their place in the first line of bipolar treatment, especially in emergency situations. After the risk of harm has past, mood stabilizers should be initiated, and any left over mood incongruent activity should be control with an antipsychotic, until the mood stabilizer is up and running. If there are still left over symptom, they should be dealt with by trying to fit in other mood stabilizers, and perhaps some anxiolytics, into the equation.

I dunno what the right answer is; everyone is individual, so every tratment should be individual. - Cam




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