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Re: New bipolar treatments Markwell

Posted by SLS on July 3, 2023, at 9:12:56

In reply to Re: New bipolar treatments, posted by Markwell on July 3, 2023, at 6:53:15

> I take 900 mgs of lithium. I tolerate it ok. I have a bipolar 1 diagnosis. I've tried every antipsychotic known I just don't tolerate them we'll. I guess my point is I'm using a medicine from the 1960's and there doesn't seem to be a novel medicine on the horizon. I guess my question is...is there a novel medicine on the horizon?

Hi, Markwell.

A few more questions:

1. Are you looking for a drug that prevents you from switching into mania?
2. Can you describe your worst manic episode?
3. Are you an ultra-rapid cycler without treatment - switching every few days to every few weeks? Months? Not at all?

If you are looking to stabilize your mood and prevent acute manic episodes, there are a few anticonvulsants that come to mind.

1. Oxcarbazepine (Trileptal). This drug is a sort of sister drug to carbamazepine (Tegretol). I would try oxcarbazepine first. It is not sedating like carbamazepine is, and does not carry the liability for a dangerous side effects called agranulocycis. Agranulocytcosis refers to a deficit of a type of white blood cell called granulocytes. With carbamazepine, blood tests are necessary to count of granulocytes. This side effect is not as frequent as first thought. Like with other potential side effects to be monitored, it's good to get a blood test before starting treatment in order to perform a comparison to subsequent tests. If agranulocytosis doesn't emerge by 6 months, it is unlikely to. Blood tests are no longer needed so frequently.

Oxcarbazepine has a side effect that should be monitored. It involves a condition known as hyponatremia - reduced sodium levels. It is recommended that one monitor blood levels of sodium regularly. Hyponatremia can be asymtomatic (causes no symptoms), but sometimes reaches a point of severity to cause damage to the nervous system. The incidence of this reaction is about 5 percent.

Other drugs that have mood-stablizing properties are calcium channel blockers.

"A systematic review of calcium channel antagonists in bipolar disorder and some considerations for their future development"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5030455/

In addition, sodium channel blockers can provide improvements in bipolar disorder. These include valproate (Depakote), topiramate (Topamax),and lamotrigine (Lamictal) are the first to come to mind.

From here, I think lamotrigine might be the ideal choice. It is widely accepted as having rather robust antidepressant effects. In my experience, low dosages of lithium make lamotrigine work better. The ideal dosage for me is 300 mg/day. If I increase the dosage to 450 mg/day, I relapse.

I hope this helped. Do you think using an antidepressant destabilizes your condition or provokes mania?

- Scott


Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.

 

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