Posted by Ritch on November 15, 2002, at 9:42:37
In reply to Hypomania from the withdrawal of the Mood Stab? » Ritch, posted by Jumpy on November 14, 2002, at 23:14:39
> > Paul, the folks that "went on to hypomania after 4 months", were they *switched* from lithium or depakote to lamictal or was it just an add-on? (that is what it sounds like) It is very likely that the *absence* of the med they were on prior to lamictal is what caused the hypomania, not the *presence* of lamictal itself. Lamictal + little bit of a stout antimanic, would then make perfect sense.--Mitch
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> Hey Mitch,
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> I am not sure ... I watched the video on my dial up connection ... so his wording was kinda choppy and my memory is not great now anyways.
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> But during the talk, he said when lamotrigine came out, he tried several patients on it ... I am not sure if he switch them to lamotrigine or added it on to there current meds. But he did say that most went on to hypomania after 4 months and that he had to add a second mood stablizer (didn't say which one though).
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> He later went on to say that Dr Calabrese's study didn't demonstrate any signficant switches to hypomania (one of the few double blinded studies with lamictal, were about 57% of patient were *improved* with their bipolar depression).
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> Well, I bet Dr Gershon treats very treatment resistant patients and those who have more extreme mood swings and instability. So I can see Lamictal switching those patients into hypomania. But like you mentioned, it could be secondary to tapering off a potential mood stablizer that they were on previously. I also know for study purposes, many doctors take patient with less severe disease, and this may explain why Dr Calabrese did not note any switches.
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> Also, two doctors might have different opinions about whether a patient truly switched into hypomania. Maybe an activated patient in a strict study would have to meet DSM criteria for mania before Dr Calabrese would say they switched, where as Dr Gershon treating as a private doctor would see a change toward hypomania in his well known patients and act quicker to temper the activation.
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> Actually Dr Gershon mentioned that too, the question of whether the high energy, type A personalities with bipolar features should be treated. He said that these people should be treated and that the behavior is abnormal ... like being married multiple times, making and losing tremendous amounts of money, switching from job to job to job. So he personally may have a lower threshold to treat high energy - hyperthemic - cyclothemic patients.
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> Paul
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> PS Sorry for all the long post and extra info, I am going stir crazy in my apartment for this week. Sorry again.Oh, that's cool I know "stir crazy" all too well! There is a good clue in your post: "....and that he had to add a second mood stablizer (didn't say which one though)." That means they were only on one MS (lamotrigine) to start with. I suppose if the "2nd" mood stabilizer quelled the mania, then one could probably safely say that adding lamictal (to a bipolar depressed person whose hypomanias were under control) would be unlikely to cause switches as long as the primary mood stabilizer was maintained. Thanks for the response.
poster:Ritch
thread:127617
URL: http://www.dr-bob.org/babble/20021108/msgs/127748.html