Dr. Bob's Psychopharmacology Tips

Rapidly-cycling bipolar patients

Date: Tue, 9 May 1995 21:14:46 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Rapidly-cycling bipolar patients

My approach to hard to treat rapidly-cycling bipolar patients can be summarized as follows:

(no antidepressants) + (Li + carbamazepine + valproate) + (hypermetabolic doses of thyroid)

All antidepressants have the ability to throw gasoline on the rapid-cycling fire (although bupropion is probably the best of the bunch) and if the three mood stabilizers do not work when coadministered, adding the high dose thyroid (300 mcg or so of T4) often slows down or stops the cycling. Bauer and Whybrow have published on this approach.

Date: Thu, 29 Jun 1995 18:38:13 -0400
From: Stephen Sokolov <sokolovs@fhs.csu.mcmaster.ca>
Subject: T4 for rapidly-cycling bipolar patients

Hypermetabolic thyroid hormone in rapid cycling bipolar illness has primarily been performed using thyroxine in doses of 200 to 500 mcg/day. Although clinical lore suggests that this is an effective strategy, it should be borne in mind that the actual number of cases reported in the literature is about 17. I am not aware of T3 being used for this purpose but it should be kept in mind that T3 is at least several times more active than T4, metabolically. If it works it may be reportable.

I suppose that a guiding principle with respect to dose is whether the patient becomes clinically hyperthyroid. You may wish to consult with an internist or endocrinologist.

From: "George Nasra" <nasdoc@penn.com>
Date: Fri, 30 Jun 1995 07:42:23 -0400
Subject: T4 for rapidly-cycling bipolar patients

The initial report on hypermetabolic doses of thyroid hormone by Bauer and Whybrow recommend doses of Synthroid (T4) to lower the TSH to a level slightly below the low normal range. I think it is safe to assume the same for Cytomel.

Bauer & Whybrow 1989. Arch Gen Psych 47: 435-440.

Date: Sun, 26 Nov 1995 14:18:26 -0800 (PST)
From: Ivan Goldberg <psydoc@PsyCom.Net>
Subject: Rapidly-cycling bipolar patients

The treatment of people with rapidly cycling bipolar disorder is a challenge.

Calcium channel blockers have no role to play except in those few patients who are lithium responders, but who are unable to tolerate the side effects of the lithium.

Among the common reasons for rapid cycling not being controlled are:

• the use of alcohol or other street drugs
• the use of antidepressants
• the use of anxiolytics.

Date: Mon, 5 Feb 1996 09:36:32 -0500 (EST)
From: Donald Franklin Klein <dfk2@columbia.edu>
Subject: Rapidly-cycling bipolar patients

On Sun, 4 Feb 1996 snagymd@mem.po.com wrote:

I have a woman in her 30s with a rapid-cycling bipolar disorder who cannot tolerate lithium, valproate, or carbamazepine.

From: CharanL@aol.com (Michael Levin, MD)
Date: Sun, 4 Feb 1996 22:43:14 -0500
Subject: Clonazepam for rapidly-cycling bipolar patients

One of my child psychopharmacologists suggested clonazepam (Klonopin) as an alternative mood stabilizer. It makes sense, as it is an anticonvulsant.

From: MKomrad@aol.com
Date: Tue, 13 Feb 1996 21:58:04 -0800
Subject: T4 for rapidly-cycling bipolar patients

I have often used T4 for rapid cyclers. Though it hasn't by itself helped, I often find it improving responses to anticycling agents.

Subject: T4 for rapidly-cycling bipolar patients
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Fri, 16 Feb 1996 06:54:00 -0500

On 02-15-96, Jane Garland said:

I should have noted this -- I have not seen response alone, but only with lithium, valproate etc.

This topic is indexed under the following subjects:

URL: http://www.dr-bob.org/tips/split/Rapidly-cycling-bipolar-pa.html
Original tips copyright 1994-97 original authors.
Web page copyright 1995-97 Robert Hsiung.