Posted by SLS on October 11, 2010, at 1:34:11
In reply to going back to bipolar medications, posted by linkadge on October 10, 2010, at 18:29:52
> ok, so I don't know if I am bipolar or not.
What makes you think that you have bipolar disorder?
> mood stabilizers like lithium and tegretol have been helping me more than other treatments lately.
You have some experimenting to do, then. Tegretol can produce some cognitive impairment, unlike its cousin drug, Trileptal. Tegretol has, of course, been studied more with evidence demonstrating its effectiveness. However, I have seen Trileptal be just as effective in treating aggression and impulsivity. I don't know about mania. For depression, I felt that Trileptal gave me more energy and reduced negative thinking. Unfortunately, these effects were far from being robust enough to justify its continuation.
Combining lithium with valproate might fit the bill. Valproate can be calming. I would add lithium first as monotherapy to evaluate its clinical effect and dosage range. Once you have found a dosage that suits you - hopefully between 300-600mg You can then add valproate in several ways. You can start low and go slow, start right at the target dosage, or start above the target dosage using loading doses. I lithium and valproate provide a hint of improvement, I would then add Trileptal. If these three drugs don't work, I would then swap valproate for lamotrigine. You can combine valproate with lamotrigine, but using only half the dosage of lamotrigine when used as monotherapy. I think that valproate inhibits the glucuronidation of lamotrigine. To confound the evaluation of lamotrigine further, Tegretol accelerates the metabolism of lamotrigine, thus shortening its half-life. I don't know what would be the net effect on lamotrigine kinetics when Tegretol and valproate are both added.
Don't neglect Topamax. If you start real low and go real slow, you can actually prevent the occurrence of cognitive impairments. Maybe titrate starting at 25mg. I liked the idea of being at 100mg rather than 200mg because 200mg provided no greater benefit than 100mg. In addition, the risk of forming kidney stones is reduced at the lower dosage (carbonic anhydrase inhibition). The most robust and consistent clinical response I have seen to Topamax was to bring to remission a woman with mixed-state mania (or manic dysphoria). She discontinued it for reasons of insufficient finances and relapsed until the Topamax was restarted. It was a striking response.
Gabitril - I don't like this drug as it can be unpredictable and produce dysphoria and seizures.
Keppra - I'm not sure about this drug. It has a high therapeutic index to play with, but it seems to have little or no evidence for effectiveness in bipolar disorder. Kenneth Kaufman at Robert Wood Johnson Medical Center wrote up a case history, if you are interested. The only other case I know of where Keppra proved helpful was with a friend of mine who has an ultra-rapid cycling bipolar II presentation.
- ScottThe measure of achievement lies not in how high the mountain,
but in how hard the climb.The measure of success lies only in how high one feels he must
climb to get there.
poster:SLS
thread:965275
URL: http://www.dr-bob.org/babble/20101009/msgs/965313.html