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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 theo on April 17, 2005, at 16:59:40
I'm curious because Lamictal does nothing for mania, I haven't tried Depakote but hear it's only for mania.
I know there's others but really, should one just try Lithium initially and then go with the anticonvulsants if Lithium doesn't work?
Posted by Phillipa on April 17, 2005, at 18:11:52
In reply to Is Lithium the only true Mood Stabilizer?, posted by theo on April 17, 2005, at 16:59:40
It's one of the oldest that I know. But lamictal, tegretol, trileptal, depakote, etc. are all used for mood also. Fondly, Phillipa
Posted by ace on April 17, 2005, at 21:03:33
In reply to Is Lithium the only true Mood Stabilizer?, posted by theo on April 17, 2005, at 16:59:40
> I'm curious because Lamictal does nothing for mania, I haven't tried Depakote but hear it's only for mania.
Try Tegretol.>
> I know there's others but really, should one just try Lithium initially and then go with the anticonvulsants if Lithium doesn't work?Give Lithium a go. But if there is no or minimal relief of symptoms switch ASAP///
ace
Posted by Phillipa on April 17, 2005, at 21:22:38
In reply to Re: Is Lithium the only true Mood Stabilizer? » theo, posted by ace on April 17, 2005, at 21:03:33
Ace! How's the nardil W/D? You're posting! Fondly, Phillipa
Posted by Maxime on April 17, 2005, at 22:31:22
In reply to Is Lithium the only true Mood Stabilizer?, posted by theo on April 17, 2005, at 16:59:40
Lithium & Gene Expression
From Kimberly Bailey Read
The Research ContinuesSince the early 1800s, Lithium has been a first-line medication in the treatment of bipolar disorder (manic depression). Its effectiveness in reducing mania and stabilizing mood is well documented. However, the pharmacology - the characteristics of a drug that make it medically effective – of Lithium is not fully understood ... yet. Researchers continue to seek the mechanism by which lithium reduces emotional instability.
In the quest to gain knowledge about Lithium and, by extension, bipolar disorder, a research team "led by Philip Brandish of Merck & Co., Inc., and Edward Scolnick of the Broad Institute (formerly of Merck and Co., Inc.) have identified genes whose activity appears to be switched on by lithium, suggesting more direct targets for drugs to treat the disorder" (Hardman, 2005).
To understand the research findings of this study, it is important to realize that there's a lot more to genes than we were taught in the simple lectures we probably all remember from high school science. It is true that the genes we inherit from our parents determine almost everything about us – hair color, nose shape, height, intelligence, sex, etc. However, genetics is much more complicated than that. Without attempting to give a crash course in genetic biology, I'll just say that one important aspect of genetics is that many genes in our makeup can "change expression." They can be activated or deactivated. They can begin producing or change production of chemicals in the body.
Inositol monophosphate is a chemical in the brain that works as a switch - turning the activity of certain genes on and off. In some cases the presence of inositol causes a gene to activate, and in other cases it causes a gene to shut down. Specifically, inositol seems to be the switch for genes that produce a hormone called PACAP (which, for the scientists among you, is the neuropeptide hormone pituitary adenylate cyclase activating polypeptide). A shortage of PACAP in mice brains has been linked to hyperactivity and defects in circadian (day-night) behavior, which are both also characteristic of humans with bipolar disorder.
Lithium is known to inhibit production of inositol. Therefore, these researchers “hypothesized that depletion of brain inositol levels is an important chemical alteration for lithium’s therapeutic efficacy in bipolar disorder” (Brandish, et al, 2005).
What does this mean? PACAP is important in regulating certain aspects of our behavior which may be associated with bipolar disorder. The production of PACAP in the brain is turned on by the absence of inositol. Lithium decreases the amount of inositol that is produced in the brain, thus allowing for more PACAP.
In other words:
1. Inositol switches off the gene that leads to production of PACAP. So more inositol = less PACAP, and less PACAP = less stable behavior.
2. Lithium inhibits production of inositol. Less inositol = more PACAP, and more PACAP = more stable behavior.This possible insight into Lithium's mechanism in stabilizing mood holds incredible potential for improved treatment. As previously noted, the effectiveness of Lithium for the majority of those with this disorder is well-established. However, the side effects are quite numerous and for some, intolerable. Additionally, there are those for whom Lithium is an inadequate treatment. Through the findings of this study and others to follow, perhaps it will not be too much longer before specific gene-targeted medications are available.
References
Brandish, P. et al. (2005, March 24). Regulation of Gene Expression by Lithium and Depletion of Inositol in Slices of Adult Rat Cortex. Neuron, 25(6), 861-872.
Hardman, H. (2005, March 23). Beyond Lithium for Bipolar Disorder.
Posted by theo on April 18, 2005, at 7:01:03
In reply to Re: Is Lithium the only true Mood Stabilizer? » theo, posted by ace on April 17, 2005, at 21:03:33
> > I'm curious because Lamictal does nothing for mania, I haven't tried Depakote but hear it's only for mania.
>
>
> Try Tegretol.
>
> >
> > I know there's others but really, should one just try Lithium initially and then go with the anticonvulsants if Lithium doesn't work?
>
> Give Lithium a go. But if there is no or minimal relief of symptoms switch ASAP///
>
> ace
>
>I was actually thinking about a low dose of Depakote just to see if I get in AD effects.
Why Tegretol? Is it suppose to have AD effects and control mania, in my case anxiety.
Here is where it gets dicey. My pdoc who knew me all of one hour thought I might be possibly mild BPII just based off of little input of my family history, alcoholism.
After being off SSRI's, I've noticed they helped with depression but completely stunted my emotional growth, and have noticed my GAD is gone and now just get anxiety in certain situations. So all these years, I was trying to treat anxiety that was mainly a side effect of SSRI's!
Right now I'm giving Concerta a try just to see how my body reacts to stims, which was another suprise because it didn't produce anxiety so maybe I'm a little ADD. Only problem is that I need a stable lift out of my lifeless chronic feelings of doom and gloom. I can't even get enough motivation up to find a career and knowing I need to be makes it all that more frustrating.
Posted by tendency on April 18, 2005, at 10:54:17
In reply to Is Lithium the only true Mood Stabilizer?, posted by theo on April 17, 2005, at 16:59:40
> I'm curious because Lamictal does nothing for mania, I haven't tried Depakote but hear it's only for mania.
>
> I know there's others but really, should one just try Lithium initially and then go with the anticonvulsants if Lithium doesn't work?was on lamictal for 10 months. interestingly, the only thing it did for me was to knock out the mania. made my depression, anxiety and irritability worse. weird.
This is the end of the thread.
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