Posted by SLS on August 15, 2012, at 13:40:18
In reply to Re: Mixed states! Is anybody in desperation now? » Slabicki, posted by phidippus on August 15, 2012, at 12:47:27
> I don't know how helpful ECT is going to be for mixed states.
> Have you ever tried Depakote?
That's a good idea, especially for bipolar II mixed-states.
I'm not absolutely sure that ECT would be helpful in treating a mixed-state, however, it has been used to treat acute mania with some success. My guess is that it would be. I'm not in favor of using ECT except when all other evidence-based treatments have failed and there is an urgent need for relief. Zyprexa and Depakote would probably work faster than ECT. Of course, if those drugs have already been tried without success, ECT might look more attractive.
Do you think Klonopin would serve some purpose in a situation like this? It would certainly work fast enough. It had been used quite often in conjunction with lithium to treat this sort of thing prior to the availability of Depakote.
With Depakote, one can administer loading doses of 1000 mg or more, even if the target dose is to be significantly lower. When I needed quick relief of a mixed-state, I used two loading doses of 1000 mg each on the first day. I was okay within 48 hours, after which I maintained a dosage of 1000 mg/day.
Interestingly, I have seen Topamax 100 mg/day work to bring into remission a young woman who was experiencing a mixed-state. I wouldn't recommend it as an acute treatment because it takes too long to titrate, but it might be worth a try if other mood stabilizers have failed.
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw