Aswad -> RE: Problems with new Bi-polar meds.... (4/5/2007 11:56:02 PM)
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Antipsychotics should be a last-line resort, even the atypical ones. The health issues with long-term use are insane, and a professor of psychiatry that I used to see commented that he's taken more schizophrenic patients off them than he's put on them, and those are after all the main patient group for these meds. But, hey, I'm biased after seeing these drugs ruin too many lives. Diazepam, alprazolam, clonazepam and barbiturates can be used to control some types of mania for a while, and dependence isn't really an issue if you don't have drug abuse problems, provided the pdoc knows what he is doing. The risks are lower, and the side-effects far less unpleasant, than the antipsychotics. As for SSRIs, they are generally not the best choice for people with bipolar spectrum disorders, as they have a tendency to induce mania and lower the seizure threshold. There's tons of stuff out there that doesn't have quite the same issues with mania and seizure thresholds. The MAOIs, particularly phenelzine (Nardil), are fairly nice in this regard, having the lowest incidence of mania of any commonly used antidepressants, though phenelzine can cause weight gain. Isocarboxazid (Marplan) or moclobemide (Aurorix) might be a better choice in that regard. Tranylcypromine (Parnate) can probably be too activating. L-deprenyl (Emsam; Eldepryl; Selegilin) might be worth trying at subclinical doses (5mg/day) or as a patch (sustained delivery reduced the likelyhood of mania, and users report less stimulating effects). All of these, except moclobemide, come with dietary restrictions, though. Lamictal is really tricky. When it works, it often works very well. But it's pretty much touch-and-go with regards to the dosage, which is usually started low and titrated slowly. The manufacturer has tried pretty hard to pin down some guidelines for how long it takes to stabilize, but failed to do so. If you need to stabilize this more quickly, you might want to talk to your pdoc about valproic acid (Depakene; Depakote; etc.) instead, or consider a short time as a voluntary inpatient, or both. Also, I've heard good things about the Amen Clinics with regards to treating bipolar. They do a SPECT scan of your brain, and use this in determining the kind of med(s) that will do the trick for you. Hope things work out for you.
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