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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by zarathustra on October 4, 2001, at 18:59:39
I have finally gotten some credible help, I went to the emergency department at a Toronto Psychiatric hospital, I have been seeing a shrink who now says I have hypomania and am being medicated completely wrong.
He says my previous 'occaisonal' responses to Paxil (i'm on fifty mgs now and its not working) were not the Paxil working properly, but me being in a state of hypomania. I cant believe him, I felt normal, I felt so good. Anyways if I am hypomanic, then why is he tappering my Paxil to zero, to put me on Seroquel?????
Seroquel is for Schizophrenia (or so the C.P.S. says)is he not being up front about his diagnosis of me?
Posted by SalArmy4me on October 4, 2001, at 19:26:28
In reply to Seroquel for hypo-mania?, posted by zarathustra on October 4, 2001, at 18:59:39
DUNAYEVICH, EDUARDO M.D. Quetiapine for Treatment-Resistant Mania. American Journal of Psychiatry. 157(8):1341, Aug 2000:
"Antipsychotic medication is safe and effective in the treatment of mania... Some of these agents appear efficacious in the treatment of mania. Quetiapine is an atypical antipsychotic that is effective for the treatment of schizophrenia. We report the use of quetiapine as an adjunctive therapy in combating treatment-resistant bipolar disorder.
Ms. A was a 39-year-old married woman who was hospitalized for worsening mania after reduction of her trifluoperazine dose from 15 to 12 mg/day. Her symptoms included insomnia, racing thoughts, sexual preoccupation, impulsivity, irritability, increased energy, pressured speech, flights of ideas, paranoid ideation, auditory hallucinations, and suicidal ideation. She was also taking valproic acid, 2000 mg/day, and lithium carbonate, 1200 mg/day. Her blood levels of these drugs were 116 µg/ml and 1.2 meq/ml, respectively. Ms. A's bipolar disorder had begun during her 20s, and she had initially responded to treatment with lithium carbonate. After several relapses, she started experiencing breakthrough symptoms while taking therapeutic doses of lithium, which required augmentation with both valproic acid and antipsychotic agents. These medications were poorly tolerated, causing weight gain, alopecia, hirsutism, mild oral tardive dyskinesia, and parkinsonism, both with standard antipsychotics and with olanzapine and risperidone. ECT had been minimally effective.
At admission Ms. A began treatment with quetiapine, which was titrated to 75 mg t.i.d., while she continued maintenance treatment with valproic acid, lithium carbonate, and 6 mg/day of trifluoperazine. Her manic symptoms decreased rapidly with minimal sedation. After discharge she was unable to immediately follow up with outpatient treatment and was readmitted 10 days later with an exacerbation of mania. Her quetiapine dose was increased to 150 mg b.i.d. and 200 mg at bedtime over 4 days. The trifluoperazine and valproate doses were decreased to 4 mg and 1500 mg at bedtime, respectively, to minimize sedation and sialorrhea. Ms. A was discharged after 8 days of hospitalization with full remission of her manic and psychotic symptoms. Over the next 6 months her doses of trifluoperazine and valproic acid were tapered off and discontinued. Her quetiapine dose was adjusted to 200 mg in the morning and 400 mg at bedtime, resulting in weight loss and a decrease in sedation. She has remained clinically stable with combined lithium and quetiapine therapy.
This case suggests that quetiapine can be safe and effective in the treatment of the manic and psychotic symptoms of bipolar disorder..."
Posted by Cam W. on October 4, 2001, at 22:59:08
In reply to Seroquel for hypo-mania?, posted by zarathustra on October 4, 2001, at 18:59:39
Zara - Antipsychotics are often given to control hypomania. They are, or should be, given short term (eg. 2-4 weeks), or until the mania clears. A recent metanalysis of studies using antipsychotics in bipolar disorder has shown that long term use of antipsychotics (atypical and typical) is usually unwarranted, but many docs continue to use APs after the mood incongruent emotions, flighty thought patterns, and delusions (symptoms that the APs control).
Another study also showed that mood stabilizers should be used before antidepressants in the bipolar disorders. Antidepressants should only be added if an adequate trial of a mood stabilizer (esp. lithium; or Depakote™ - divalproex; or other MS + Lamictal™ - lamotrigine; or other MS + Neurontin™ - gabapentin). In bipolar disorder, to avoid bouts of hypomania (and the kindling effect that is associated with it), antidepressants should never be given without a mood stabilizer.
From the prescription your doctor has written, I'd say that he is trying to rid you of your hypomania, not schizophrenia. After the mania is under control, he will probably recommend a mood stabilizer. Then, if absolutely necessary, he will add an antidepressant.
Of course you feel good being hypomanic! Too good. It would be nice to operate on that level all of the time...except for the "crash and burns". Remember, each hypomanic or episode you get, the next one comes sooner, lasts longer, and is more severe (kindling effect). You have to break the kindling effect, and decrease the their number and length. In pre-medication times, kindling often lead to a lifetime in an asylum from about age 30. It was the only way to keep these people from hurting themselves when they were either extremely manic or dreadfully depressed.
I believe that your doc first few moves have been the correct ones. - Cam
Posted by Gracie2 on October 5, 2001, at 2:27:24
In reply to Seroquel for hypo-mania?, posted by zarathustra on October 4, 2001, at 18:59:39
I am the cheerleader and the poster-girl on this board for Seroquel. I've been cursed with sleeping problems since I was a teenager and it's effected my whole life...falling asleep in class, being groggy and confused at work, wandering around the house at 3am like a sad ghost. I could sleep for only 2 or 3 hours at a time until, after a week or so, I was so exhausted that I would fall in bed and sleep for 20 hours. Then it would start all over again.
With seroquel, I can go to sleep when I'm supposed to, sleep like a rock for 8 hours, and get up in the morning without drowsiness. It was truely a godsend for me. And I'm not schizophrenic.
-Gracie
Posted by Erin59 on October 6, 2001, at 1:49:13
In reply to Re: Seroquel for hypo-mania?, posted by Gracie2 on October 5, 2001, at 2:27:24
>
> I am the cheerleader and the poster-girl on this board for Seroquel. I've been cursed with sleeping problems since I was a teenager and it's effected my whole life...falling asleep in class, being groggy and confused at work, wandering around the house at 3am like a sad ghost. I could sleep for only 2 or 3 hours at a time until, after a week or so, I was so exhausted that I would fall in bed and sleep for 20 hours. Then it would start all over again.
> With seroquel, I can go to sleep when I'm supposed to, sleep like a rock for 8 hours, and get up in the morning without drowsiness. It was truely a godsend for me. And I'm not schizophrenic.
> -GracieI agree with Gracie that Seroquel can be a very good drug, but for a different reason. I am hypersomniac but I was given Seroquel to quell suicidal tendencies, morbid and distorted thinking that is symptomatic of my depression ad PTSD. I too was a bit freaked out when I was given an antipsychotic primarily used for schizophrenia (my Dad was severly schizophrenic). Although it makes me a bit groggy in the AM, I notice I will go a full day without a dark thought, flashback or suicidal idealization. In this respect, it has worked well for me.
Erin
Posted by jay on October 6, 2001, at 7:43:28
In reply to Re: Seroquel for hypo-mania? » zarathustra, posted by Cam W. on October 4, 2001, at 22:59:08
Cam:
You mention mood stabalizer over antipsychotic for hypomania. Is there any research that warrents long-term use of atypical antipsychotics *with* an antidepressant for BP2 (rapid-cycling)?
I get *very* depressed without an antidepressant, especially when using either an antipsychotic or a mood stabalizer.My doc said this is a real sign of BP2, in that I switch far too easily without *any* meds (a.d. or a.p.) It's a balancing act with the meds, but I know I *need* both. I do have a tendancy more towards depression,but my mania is of the *very* dysphoric type. I can't afford to be depressed or manic, but 'tis the case for all of us, I guess!
Any comments?Thanx...
Jay
> Zara - Antipsychotics are often given to control hypomania. They are, or should be, given short term (eg. 2-4 weeks), or until the mania clears. A recent metanalysis of studies using antipsychotics in bipolar disorder has shown that long term use of antipsychotics (atypical and typical) is usually unwarranted, but many docs continue to use APs after the mood incongruent emotions, flighty thought patterns, and delusions (symptoms that the APs control).
>
> Another study also showed that mood stabilizers should be used before antidepressants in the bipolar disorders. Antidepressants should only be added if an adequate trial of a mood stabilizer (esp. lithium; or Depakote™ - divalproex; or other MS + Lamictal™ - lamotrigine; or other MS + Neurontin™ - gabapentin). In bipolar disorder, to avoid bouts of hypomania (and the kindling effect that is associated with it), antidepressants should never be given without a mood stabilizer.
>
> From the prescription your doctor has written, I'd say that he is trying to rid you of your hypomania, not schizophrenia. After the mania is under control, he will probably recommend a mood stabilizer. Then, if absolutely necessary, he will add an antidepressant.
>
> Of course you feel good being hypomanic! Too good. It would be nice to operate on that level all of the time...except for the "crash and burns". Remember, each hypomanic or episode you get, the next one comes sooner, lasts longer, and is more severe (kindling effect). You have to break the kindling effect, and decrease the their number and length. In pre-medication times, kindling often lead to a lifetime in an asylum from about age 30. It was the only way to keep these people from hurting themselves when they were either extremely manic or dreadfully depressed.
>
> I believe that your doc first few moves have been the correct ones. - Cam
Posted by Cam W. on October 6, 2001, at 17:07:01
In reply to Re: Seroquel for hypo-mania? » Cam W., posted by jay on October 6, 2001, at 7:43:28
Jay - Most of the scientific information of late has tended to say that, after the hypomanic episode is over, there is usually no need to continue an antipsychotic. The antipsychotic can be reinstituted if the hypomanic episode returns, but otherwise, it is not usually needed continuously.
There has been concerns raised about using antidepressants in BPII. While, often it is unavoidable, perhaps increasing divalproex or lithium doses (if possible) should be the first step. Next, try to add on to existing therapy, on of the new mood stabilizers, like Lamictal™ (lamotrigine), Topamax™ (topiramate), or perhaps even Neuronton™ (gabapentin), to try to ease the depression, with triggering mania.
The above is an idealized (ie. Pleasantville, early in the movie) treatment plan. We shouldn't use antipsychotics once the hypomanic episode passes. but we do. We shouldn't use antidepressants in any bipolar disorders, but we do.
Actually, some recent evidence points to one's stability on the mood stabilizer, as to whether an antidepressant can be added. If one is within the therapeutic window of divalproex, adding an antidepressant seems to come with a lower risk of manic switch.
Antipsychotics do have their place in the first line of bipolar treatment, especially in emergency situations. After the risk of harm has past, mood stabilizers should be initiated, and any left over mood incongruent activity should be control with an antipsychotic, until the mood stabilizer is up and running. If there are still left over symptom, they should be dealt with by trying to fit in other mood stabilizers, and perhaps some anxiolytics, into the equation.
I dunno what the right answer is; everyone is individual, so every tratment should be individual. - Cam
This is the end of the thread.
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