Posted by cache-monkey on May 27, 2005, at 13:31:52
In reply to which mood stabilizers do what?, posted by tendency on May 25, 2005, at 18:40:12
I'm looking at the list of meds you've provided:
[topamax]
[lamictal]
> depakote?
> tegretol?
> trileptal?
> lithium?
> others?I'm wondering about your definition of "mood stablilizer"... I suppose it depends on what you're trying to accomplish.
If the goal is treating acute mania, Depakote, Lithium, Tegretol, and possibly Trileptal would all be good agents, depending on your symptoms/chemistry. Tegretol and Depakote are generally believed to be better for mixed states and rapid cycling, while Lithium is better for traditional BP I mania. (But I think the evidence to back up this distinction is conflicting...)
If the goal is treating acute bipolar depression, Lithium and Lamictal are the only ones that are reconized to do this. Lamictal can, however, be too activating for someone with anxiety+depression. (It was for me.)
If the goal is maintenance, again it's Lithium and Lamictal that have been shown to prevent relapse to both poles. Lithium is stronger on the relapse into mania, and I'm not sure about Lamictal's relative strength.
So, in terms of clinical evidence Tegretol and Depakote are really acute anti-manics, while Lithium is a mood stabilizer at all ends and Lamictal is a mood stabilizer from below. (I spend most of my time in depression -- I'm not even sure I have BP; if I do it's very soft. So putting me on Depakote just made me more depressed.) However, many psychiatrists believe that since Tegretol and Depakote "probably" prevent relapse into mania, this "probably" reduces the fall out of mania into depression.
I notice that you've left the atypical APs off your list. These all (Abilify, Geodon, Risperdal, Seroquel, Zyprexa) are approved for acute mania.
Risperdal, Seroquel, and Zyprexa have been shown in clincal studies to benefit acute bipolar depression, with Seroquel by far the most potent. There are also case studies on the other atypical APs that indicate that they might also be good for the depressive side of things.
Zyprexa has also been shown to prevent relapse (more strongly against mania), making it a true all-around mood-stabilizer like Lithium. I would not be surprized if similar results obtained with Seroquel, given its similar profile and chemical structure to Zyprexa. (And some of the other atypical APs may also very well end up being shown to prevent relapse.)
These atypical APs have differing profiles of effects/side-effects. E.g. Zyprexa and Seroquel can be very sedating, while Abilify is quite activating. There's also the weight gain issue, which Zyprexa is most notorious for. Most worrisome is the increased risk of Type II diabetes that runs across the class, although this might be less of an issue for Abilify and Geodon. (And, although the evidence is discordant, Zyprexa is believed to be the worst offender.)
Hope this helps a little.
Best,
cache-monkey
poster:cache-monkey
thread:502877
URL: http://www.dr-bob.org/babble/20050527/msgs/503692.html