Psycho-Babble Medication | about biological treatments | Framed
This thread | Show all | Post follow-up | Start new thread | List of forums | Search | FAQ

Re: New Mood Stablizers /another ? » JaneB

Posted by Ritch on May 27, 2002, at 12:08:44

In reply to Re: New Mood Stablizers /another ?, posted by JaneB on May 27, 2002, at 11:17:13

> If the second line mood stabilizers don't require blood testing does that mean they aren't as harmful? and if so why not start 2nd line first?
> JaneB

Jane,

The newer anticonvulsants generally *are* much less *toxic*. Lithium and Tegretol are probably the most potentially toxic antimanic agents. The upper end of their effective blood levels can be close to toxic levels. Depakote blood monitoring is probably done most often when patients are being treated with very high doses to get their mania under control. I have never had a Depakote blood test-but I have never needed more than 500mg/day, so the likelihood of my Depakote levels being toxic are very small (in fact they would likely be "sub-therapeutic" for someone needing to be treated for an acute manic episode). Pdocs like to prescribe the "newer" meds (antidepressants included), because they *do* tend to have much lower risk of death associated with overdose. You can easily chuck down too much lithium or tricyclics (which includes carbamazepine) or MAOI's and quickly be in very dire circumstances, whereas it would be nearly impossible to die from an overdose on Neurontin (due to its fast elimination and dose-dependent absorption). I suppose if symptoms are mild and relatively non-life threatening a "2nd-line" med being used first would be OK, IF it works! What if it doesn't? Then that person could continue to worsen (lose their job-or worse). Even if the the 2nd-line drug being used first failed, and then a 1st-line drug being used later did in fact work-your time certainly got wasted. However, I don't feel any more comfortable now about the big boxed warning about liver failure on the Depakote insert than when I first saw it years ago-so I understand your concern-I am concerned too!

Mitch


Share
Tweet  

Thread

 

Post a new follow-up

Your message only Include above post


Notify the administrators

They will then review this post with the posting guidelines in mind.

To contact them about something other than this post, please use this form instead.

 

Start a new thread

 
Google
dr-bob.org www
Search options and examples
[amazon] for
in

This thread | Show all | Post follow-up | Start new thread | FAQ
Psycho-Babble Medication | Framed

poster:Ritch thread:107689
URL: http://www.dr-bob.org/babble/20020525/msgs/107732.html