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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Abby on March 26, 2001, at 0:54:19
Some people are very enthusiastic about the use of atypical antipsychotics for depression.
I just want to raise, one word of caution, mainly because most of those posters are men. I haven't been following drugs as carefully as I should--I'm not sure about ziprasidone---but choosing to take either zyprexa or risperdal can be difficult. Both are associated with weight gain, although this seems to be more of a problem with zyprexa, but for WOMEN the raised prolactrin levels of risperidone can be very troublesome. (Depakote, the anticonvulsant, may not be great for women of child-bearing age either, even though it's considered a first line drug, since it appears to be associated with a markedly increased rate of polycystic ovary disease. I believe that the study was done in Norway or Denmark among epilepsy patients.
Abby
Posted by Cam W. on March 26, 2001, at 6:55:12
In reply to Atypical neuroleptic conundrum, posted by Abby on March 26, 2001, at 0:54:19
Abby - Does, Depakote increase prolactin levels? I know it can cause irregular menses and in rare cases, galactorrhea, but is this directly due to an increase in prolactin levels? Has the increase in ovarian cancer be definitely linked to prolcatin increases? Sorry, I had not heard this and would be interested in reading the study.
Also, with the new atypical agents Risperdal and Zyprexa have been shown to transient raise prolactin levels, but this is usually subclinical. Whether these increases would have any impact over the long term is currently much in debate. The atypicals raise prolactin levels to a far lesser extent than did the older typical agents and I believe that Clozapine, Seorquel and Geodon do not raise prolactin levels at all.
Just what I have read - Cam
Posted by Abby on March 27, 2001, at 16:24:59
In reply to Re: Atypical neuroleptic conundrum » Abby, posted by Cam W. on March 26, 2001, at 6:55:12
> Abby - Does, Depakote increase prolactin levels? I know it can cause irregular menses and in rare cases, galactorrhea, but is this directly due to an increase in prolactin levels? Has the increase in ovarian cancer be definitely linked to prolcatin increases? Sorry, I had not heard this and would be interested in reading the study.
>
> Also, with the new atypical agents Risperdal and Zyprexa have been shown to transient raise prolactin levels, but this is usually subclinical. Whether these increases would have any impact over the long term is currently much in debate. The atypicals raise prolactin levels to a far lesser extent than did the older typical agents and I believe that Clozapine, Seorquel and Geodon do not raise prolactin levels at all.
>
>Cam,
My knowledge is much more limited than yours. I do not believe (recall ever reading) that depakote raises prolactin levels.
The information I'm relating is more of a tip form from my current psychiatrist who specializes in the treatment of bipolar patients. He is also inclined to see everyone as bipolar, but I think that's safer than seeing everyone as suffering from major depression. He seems to like lithium a lot, and if it's tolerated add on from there.
He isn't totally against antipsychotics in the treatment of mood disorders, but he prefers, in general, to go through the mood stabilizers first. In treating women patients the raised prolactin level is an issue to consider. Also he's seen some and reported to the manufacturer some cases of mania that seem to be risperidone induced.
I'm not sure how he treats patients with full blown mania-- I'm on neurontin---but from our meetings he seemed to prefer tegretol for women. For someone like me, he's not really keen on taking the risk, albeit incredibly rare, of getting a fatal blood disease.
I hunted up the cite on depakote in women. It's not prolactin but hyperandrogenism. I'm clearly out of the loop, b/c I hadn't even heard of geodon. Here's the original article abstract.
N Engl J Med 1993 Nov 4;329(19):1383-8 Related Articles, Books, LinkOut
Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy.
Isojarvi JI, Laatikainen TJ, Pakarinen AJ, Juntunen KT, Myllyla VV
Department of Neurology, University of Oulu, Finland.
BACKGROUND. Reproductive endocrine disorders are more common among women with epilepsy than among normal women. These disorders have been attributed to epilepsy itself, but could be related to antiepileptic-drug therapy. METHODS. We studied 238 women with epilepsy who were seen regularly at the Outpatient Department of the University Hospital, Oulu, Finland. Their mean age was 33 years (range, 18 to 45), and the mean duration of therapy was 9 years (range, 0 to 31). Twenty-nine (12 percent) were treated with valproate, 120 (50 percent) with carbamazepine, 12 (5 percent) with valproate and carbamazepine, and 62 (26 percent) with other medications; 15 (6 percent) were untreated. Vaginal ultrasonography was performed to determine ovarian size, and serum sex-hormone concentrations were measured in 41 women with epilepsy and menstrual disturbances, 57 women with epilepsy and regular menstrual cycles, and 51 normal women. RESULTS. Menstrual disturbances were present in 13 of the women receiving valproate alone (45 percent), 3 of the women receiving valproate in combination with carbamazepine (25 percent), 23 of the women receiving carbamazepine (19 percent), and 8 of those receiving other medications (13 percent). Forty-three percent of the women receiving valproate had polycystic ovaries, and 17 percent had elevated serum testosterone concentrations without polycystic ovaries; 50 percent of the women receiving valproate and carbamazepine had polycystic ovaries, and 38 percent had elevated serum testosterone concentrations without polycystic ovaries. Eighty percent of the women treated with valproate before the age of 20 years had polycystic ovaries of hyperandrogenism. CONCLUSIONS. Menstrual disturbances, polycystic ovaries, and hyperandrogenism are often encountered in women taking valproate for epilepsy.
PMID: 8413434------------------------------------------------------------------------
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You probably already know this, but I hope this helps.Abby
Posted by Cam W. on March 27, 2001, at 17:23:12
In reply to Reporting back on risperidone and depakote » Cam W., posted by Abby on March 27, 2001, at 16:24:59
>
This is the end of the thread.
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