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new to bipolar- lithium or something else?

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Posted

hi guys i'm new to this board, and somewhat new to bipolar.

i am currently being treated with 5 mg abilify for OCD and xanax for severe anxiety. i tried klonopin but it was a horse tranquilizer at .5 mg for me.

i go back to the pdoc tomorrow, and i'm wondering if i need to mention a mood stabilizer. i have heard not so great things about abilify being a drug that kindles bipolar instead of handling mood swings. she thinks i have cyclothymia. i don't have a problem with depression as much as i do impulsive behavior and sleep, so i guess i'm more hypomanic than depressed- more melancoly than anything.

anyone else out there who has bipolar NOS or cyclothymia? i know everyone's bodies are different, but i jsut want to know what my options are for a mood stabilizer, as i dont know that abilify is neccessarily doing the trick.

thanks!

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Posted

With bipolar NOS your options for mood stabilizers are pretty much the same as anyone else's.

As someone who can't handle abilify, I'd say ask for something else, but exactly what you take is going to depend on your sx.

There is some limited evidence out there that mood stabilizers are better at reapairing the underlying brain dysfunction, so even though I take an AAP for sx (and for all I know, it's doing brain repair as well) I am all for mood stabilizers in bipolar.

If you are more on the activated side, things like tegretol, depakote, and possibly lithium might be your best bets.

More depressive, lamictal and lithium.

Then there's trileptal and topamax and some of the odder stuff, which I would say don't start with although some people have great responses to them, the reserach on their effectiveness is somewhat more limited, and topamax in particular can give some annoying side effects. I don't think I'd ever take the 'max, ever, though it is the only mood stabilizer I haven't tried (and I even tried zonegran, for christ's sakes) just because I don't want to lose my higher order thinking and whatnot.

Cyclothymia CAN and does respond to mood stabiliers has been my clinical experience.

You may need a mood stabilizer and an AAP I don't know, it's a not uncommon situation. Cocktails in BP are fiarly much the norm, i know of pretty few people on just one drug, although it CAN happen and maybe you will be one of teh lucky ones....

However, I am for the most part not a fan of AAP monotherapy for TRUE bp, which it seems like you are fairly convinced you have. And if you say abilify is not working, I'd say switch to a mood stabilizer first.

Be aware that mood stabilizers don't work as quickly as AAPs so it may take a few months to see a full effect. Why this is, I have no clue.

Anna

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Posted

With bipolar NOS your options for mood stabilizers are pretty much the same as anyone else's.

As someone who can't handle abilify, I'd say ask for something else, but exactly what you take is going to depend on your sx.

There is some limited evidence out there that mood stabilizers are better at reapairing the underlying brain dysfunction, so even though I take an AAP for sx (and for all I know, it's doing brain repair as well) I am all for mood stabilizers in bipolar.

If you are more on the activated side, things like tegretol, depakote, and possibly lithium might be your best bets.

More depressive, lamictal and lithium.

Then there's trileptal and topamax and some of the odder stuff, which I would say don't start with although some people have great responses to them, the reserach on their effectiveness is somewhat more limited, and topamax in particular can give some annoying side effects. I don't think I'd ever take the 'max, ever, though it is the only mood stabilizer I haven't tried (and I even tried zonegran, for christ's sakes) just because I don't want to lose my higher order thinking and whatnot.

Cyclothymia CAN and does respond to mood stabiliers has been my clinical experience.

You may need a mood stabilizer and an AAP I don't know, it's a not uncommon situation. Cocktails in BP are fiarly much the norm, i know of pretty few people on just one drug, although it CAN happen and maybe you will be one of teh lucky ones....

However, I am for the most part not a fan of AAP monotherapy for TRUE bp, which it seems like you are fairly convinced you have. And if you say abilify is not working, I'd say switch to a mood stabilizer first.

Be aware that mood stabilizers don't work as quickly as AAPs so it may take a few months to see a full effect. Why this is, I have no clue.

Anna

what is depakote like? i'm not as familiar with that one.

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Posted

I love it, it's the only thing that works for me, but it's great for mania/mixed. I do find it helps stabilize the depressive side of things, but only after about 4 months or so....

It does have a lot of annoying side effects, including a tendency to weight gain (take the ER version if you can get it) and hunger, particularly at higher doses. It can be prone to making your hair thinner, and if you are female it does have that annoying PCOS risk. My periods stop after about 3 months on, every time.

I have gone on/off several times due to thsi, but i finally capitulated to the d., and I just went to obgyn yesterday and found out how to slough off my uterine lining with progesterone, so I'll be doing that for now.

If you're male, it tends to be easier.

It can just be a rough one, on the old body systems (it's hard on the liver as well) but my brain adores it.

Anna

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Posted

More recent studies have indeed suggested AAP's have neuroprotective qualities as well. As far as what med will be most effective for you, it's pretty much impossible to predict. Personally, I'm a big fan of AAP's generally, and seroquel specifically. But that's me.

Depending on how you're doing now, if you're needing something to help stabilize you more quickly, one option might be to start an AAP now, for the speediness, and also start titrating up on lithium, or depakote, or whatever. Then, when you've reached a therapeutic level/dosage of it, taper off the AAP.

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Posted

I love Lithium and Abilify. I have to take Cogentin for some restlessness with Abilify but they've both been good to me. I had more depressive symptoms. Some random off the wall feeling drunk but wasn't, or extreme agitation, or unbelievable anger, at times. I also loved Geodon. No antidepressant could help my depression until I was on Lithium and they aggravated my manic type symptoms.

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Posted

As someone who tends more towards being mixed, I haven't found much luck with lithium. I'm just starting Depakote now, so we'll see how that does. The others that have commented here have given you great advice already. I'd definitely consider talking to your pdoc about adding a mood stabilizer.

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Posted

If your doctor believes that you have cyclothymia, you may be able to manage your symptoms without antipsychotics or stabilizers. Some believe cyclothymia has a different etiology than bipolar and that meds are not the right way to go. Others argue it is on the same spectrum.

Before trying the heavy meds, I would give therapy a serious try. It is part of treating bipolar, so it's not like you'd be going astray. Have you done that yet?

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Posted

You're on a low dose of Abilify. Your doc may just end up raising it to see what happens. Abilify is an activating med. It doesn't play well with some of the BP crowd. For those people who find that it works, it probably doesn't cause kindling as it is stabilizing the mood.

If you tend to swing towards the hypomanic and she's insistent on an AAP, she might end up doing something sedating. Seroquel isn't too bad, if you can deal with the sleepiness. It would probably help with the OCD, and you could might be able to nix the benzo.

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Posted

Bipolar NOS also; I've been on lithium and Abilify for about 3 years I think. In that time, I've had only the beginning of a mixed episode that didn't turn into anything (when I had to reduce my Li dose temporarily), and one manic/hypomanic episode (when I was on much less lithium). Depression has been more of a problem, as it always was, but we're working on that too. It was interesting to me that when I had to reduce my Li dose, I actually felt much more depressed initially, even though I know it works more on the high end stuff for me, but it was kind of a neat demonstration of how it does both. Well actually, from here it's a neat demonstration; it wasn't so much fun at the time.

I've been on a variety of Abilify doses, from 1mg to 12.5mg, and it does different things in different ranges. In my experience the 1-5mg range tends to be more activating, while 5-10mg is a bit more calming. I felt irritable at 12.5mg, so we stayed at 10 and didn't go any higher, though many people do. Fighting a bad depression, I've needed more of a boost the past year or so, so I'm back at 5 (went as low as 2.5 but 5 is better). I've been told I'm not very nice on Abilify alone - we tried that very briefly with outstanding antidepressant effects but way too much irritability. The combination of Li and Abilify keeps the irritability in check nicely.

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