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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by jay on January 30, 2006, at 19:15:22
Hey folks..
Well..I've been recently diagnosed with high blood pressure. I've been on various cocktails of mood stabalizers, antipsychotics and antidepressants over 12 or so years. I was *VERY* unstable up until they started to treat my blood pressure. I am currently on AdalatXL, but that may possibly change. This is a CCB..calcium channel blocker. I know that other CCB's have been used to treat bipolar depression.
Will have to see...but I pray...I hope I've come to the end of my med chasing game. At 36, it is either now or never...so I hope. Yep..that's what I really do...I hope. Any other experiences like this?Thanx,
Jay
Posted by Squiggles on January 30, 2006, at 19:22:10
In reply to Is this it? Blood Pressure meds and Bi-Polar, posted by jay on January 30, 2006, at 19:15:22
If you're taking lithium, as a salt, it
may raise your blood pressure. But the
real culprit is weight gain. Have you
seen a gradual weight gain over the years?Squiggles
Posted by jay on January 30, 2006, at 21:22:32
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar, posted by Squiggles on January 30, 2006, at 19:22:10
> If you're taking lithium, as a salt, it
> may raise your blood pressure. But the
> real culprit is weight gain. Have you
> seen a gradual weight gain over the years?
>
> SquigglesOh yes..it has been *horrific*..the weight gain. It started with Depakote, through lithium (which sadly didn't help me..but I still don't think I gave it enough of a chance.) and the antipsychotics. It's interesting the the calcium channel blockers act some way in a similar fashion to lithium regarding discharges in cells and their communication. But I have found a fairly clear line vetween drug intake = weight gain = metabolic problems (from thyroid to diabetes..the latter which I now have.) = heart/blood problems. I have the family tree makeup for vulnerability for all of these. My Mom, Dad, and Sister are on blood pressure meds. My Dad has had atleast three heart attacks. My Uncle died last year of an aneurism, and had numerous heart attacks beforehand. My Dad is diabetic. (type 2).
So, it's like, lets look at the link between metabolic, cardivascular, and mental illness symptoms. There is co-relation (with caution, I know) written all over the place. If I can get my blood pressure under control, and that provides me with enough mental stability...well, I am going to have a few questions to ask. So many questions..like how did I get from there to here. (I know..we all have these questions..but..)
The other unfortunate thing is, as good as all these psych meds are, they are very unfriendly to the areas listed above..metabolic..cardiovascular (maybe less so).
Jay
Posted by forgetful mary on January 30, 2006, at 21:23:58
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar » Squiggles, posted by jay on January 30, 2006, at 21:22:32
Good Blood pressure site:
http://www.omronhealthcare.com/enTouchCMS/app/viewPromotion?promotionId=1231or BPNUMBERS.COM
Posted by Squiggles on January 31, 2006, at 7:57:45
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar » Squiggles, posted by jay on January 30, 2006, at 21:22:32
> > If you're taking lithium, as a salt, it
> > may raise your blood pressure. But the
> > real culprit is weight gain. Have you
> > seen a gradual weight gain over the years?
> >
> > Squiggles
>
> Oh yes..it has been *horrific*..the weight gain. It started with Depakote, through lithium ...
the antipsychotics.Someone posted the worst weight gain drugs,
but i think it was on a usenet group; anyway,
lithium, depakote especially, and the antipsychotics are notorious for gaining weight.It's interesting the the calcium channel blockers act some way in a similar fashion to lithium regarding discharges in cells and their communication.
What are these? Are they blood pressure pills?
But I have found a fairly clear line vetween drug intake = weight gain = metabolic problems (from thyroid to diabetes..the latter which I now have.) = heart/blood problems.
Well, it depends on the drug. With lithium at
least the metabolic problem can be controlled
with Synthroid supplmentation. I have skimmed
some articles on PubMed where I recall that ALL
psychoactive drugs have some effect metabolically.I have the family tree makeup for vulnerability for all of these. My Mom, Dad, and Sister are on blood pressure meds. My Dad has had atleast three heart attacks. My Uncle died last year of an aneurism, and had numerous heart attacks beforehand. My Dad is diabetic. (type 2).
>
> So, it's like, lets look at the link between metabolic, cardivascular, and mental illness symptoms. There is co-relation (with caution, I know) written all over the place. If I can get my blood pressure under control, and that provides me with enough mental stability...well, I am going to have a few questions to ask. So many questions..like how did I get from there to here. (I know..we all have these questions..but..)
>
> The other unfortunate thing is, as good as all these psych meds are, they are very unfriendly to the areas listed above..metabolic..cardiovascular (maybe less so).Picking the one (or combos) with the least effects mentioned
above, and exercising and dieting throughout might
be a good plan.Squiggles
>
> Jay
>
Posted by jay on January 31, 2006, at 11:21:51
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar, posted by Squiggles on January 31, 2006, at 7:57:45
>> It's interesting the the calcium channel >>blockers act some way in a similar fashion to >>lithium regarding discharges in cells and >>their communication.
>
> What are these? Are they blood pressure pills?
>Yeah...that's exactly what they are. Here is a blurb from psycheducation.org about these meds and Bipolar:
---
Verapamil, IsradipineVerapamil
Isradipine
--------------------------------------------------------------------------------Verapamil has been around a long time, and as a result there are multiple generics around (thus no trade name above). It's in the class of blood pressure medications called "calcium channel blockers".
A long time ago several randomized trials were done which confirmed that verapamil had "mood stabilizing" properties. This may be related to it's action on calcium channels, the small pores in cells that allow calcium to move in and out. Calcium seems to be part of the story of what causes bipolar disorder (for more on that subject, go to that heading from the Diagnosis Details page). However, there were two "negative" trials later, meaning that the data did not show verapamil had mood stabilizing effects.
As a result of this "mixed" evidence, interest in verapamil has been very limited (in addition, because it is available in multiple generics, there is no manufacturer willing to pump money into research and advertising for this medication, so it "looks" less attractive than it really is). I tried it with several patients and was not particularly impressed myself.
Then I met Dr. Steve Dubovsky, an eminent researcher from University of Colorado, who had done much of the original work on this medication. He said "you have to use the non-slow-release version!" So, I've since tried it again in that form, and sure enough, I'm pretty sure I've seen people respond to it, as with other recognized mood stabilizers. Then, a recent surge in interest has come along from several researchers concerned about the effects of conventional mood stabilizers on women's hormones. They point out that verapamil may also be safe to use in pregnancy, which is not true for any of the "big three" (lithium, Depakote, Tegretol/Trileptal). And they have just published a study showing further support (although in "open trial" design, there were actually quite a few more patients in this study than in Dubovsky's original workDubovsky; not conclusive, but strongly supportive evidence) for verapamil's effectiveness in women with bipolar disorder. Some of these women were pregnant.Wisner et al They used the non-slow-release form, if I am interpreting their methods correctly.
There is some concern about immediate-release versions of verapamil having a negative effect on heart function. American Academy... But this issue is still being studied (e.g. Hilleman) and does not appear to be an issue in terms of the use of this medication as a bipolar disorder treatment. For a patient who has known heart disease, or for a patient who is already on a blood pressure medication, a discussion with her/his doctor prior to starting verapamil in either form would probably be wise.
Where verapamil fits in the list of mood stabilizers is unclear because we have so little information on it, and that which we have is conflicting (e.g. see a review by Janicak, 2000). However, it carries relatively few risks compared to other commonly used mood stabilizers and must be kept in mind for cases in which the better-studied medications have not been effective or tolerable. It is also a consideration for a woman contemplating pregnancy, if it can be established before the pregnancy that this is an effective agent, which can take months or even years depending on the woman's usual course of bipolar symptoms.
Isradipine is another calcium channel blocker. There is one observation that has been published by Bob Post and colleagues at the NIMH which apparently represents the entire literature base for use of this agent:
When verapamil was blindly substituted for nimodipine, two BP patients failed to maintain improvement but responded again to nimodipine and remained well with a blind transition to another dihydropyridine L-type calcium channel blocker (CCB), isradipine.Pazzaglia
There are no other articles found searching "isradipine bipolar" on PUB MED or Google (7/2004).
Both isradipine and verapamil are in the FDA's Pregnancy Category C, which means that the medication is neither clearly safe, nor clearly unsafe.
--------------So, this is interesting. But...you know...in my many years as a social worker, I easily conclude lithium *is* the gold standard. I know that is written everywhere, but I've seen it with my own eyes. Many people on lithium are people you couldn't even really tell had mental health issues, even when they talk a bit about their lives. They are not the type of people who come onto a board like this...and you are the exception because you seem to really want to help people. But, their lives are just going along so fine, a place like this doesn't peak their interest much.
So, I do think lithium is a very special drug in many ways, but the whole bipolar issue, the diagnosis and such, has brought in many different types of people who need some different med combos.
Anyhow...sorry for the length...best..
Jay :)
Posted by Squiggles on January 31, 2006, at 11:41:19
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar » Squiggles, posted by jay on January 31, 2006, at 11:21:51
> What are these? Are they blood pressure pills?
> Yeah...that's exactly what they are. Here is a blurb from psycheducation.org about these meds and Bipolar:
>
> ---
> Verapamil, Isradipine
>
> Verapamil
>
> Isradipine
>
>
> --------------------------------------------------------------------------------
>
> Verapamil has been around a long time, and as a result there are multiple generics around (thus no trade name above). It's in the class of blood pressure medications called "calcium channel blockers".
>Are they similar to Beta blockers? I know those
are a recommended substitute to benzos from the
benzo group.> A long time ago several randomized trials were done which confirmed that verapamil had "mood stabilizing" properties. This may be related to it's action on calcium channels, the small pores in cells that allow calcium to move in and out. Calcium seems to be part of the story of what causes bipolar disorder (for more on that subject, go to that heading from the Diagnosis Details page). However, there were two "negative" trials later, meaning that the data did not show verapamil had mood stabilizing effects.
I think it would be a risky substitute for
such a serious illness. If they have a sedative
power, it would be interesting as in Cade's
dawn days of mania treatment, the illness was
actually referred to as "psychotic excitement" -
which is exactly what it is until you hit
the other side.
>
> As a result of this "mixed" evidence, interest in verapamil has been very limited (in addition, because it is available in multiple generics, there is no manufacturer willing to pump money into research and advertising for this medication, so it "looks" less attractive than it really is). I tried it with several patients and was not particularly impressed myself.Ah yes, well the economic factor will always
play a major role in anything that is marketed
with shareholders, including drugs.
>
> Then I met Dr. Steve Dubovsky, an eminent researcher from University of Colorado, who had done much of the original work on this medication. He said "you have to use the non-slow-release version!" So, I've since tried it again in that form, and sure enough, I'm pretty sure I've seen people respond to it, as with other recognized mood stabilizers. Then, a recent surge in interest has come along from several researchers concerned about the effects of conventional mood stabilizers on women's hormones. They point out that verapamil may also be safe to use in pregnancy, which is not true for any of the "big three" (lithium, Depakote, Tegretol/Trileptal). And they have just published a study showing further support (although in "open trial" design, there were actually quite a few more patients in this study than in Dubovsky's original workDubovsky; not conclusive, but strongly supportive evidence) for verapamil's effectiveness in women with bipolar disorder. Some of these women were pregnant.Wisner et al They used the non-slow-release form, if I am interpreting their methods correctly.It does sound promising, but more research
has to make it competitive with the 80%
efficacy of lithium carbonate or citrate; maybe
a mix?
>
> There is some concern about immediate-release versions of verapamil having a negative effect on heart function. American Academy... But this issue is still being studied (e.g. Hilleman) and does not appear to be an issue in terms of the use of this medication as a bipolar disorder treatment. For a patient who has known heart disease, or for a patient who is already on a blood pressure medication, a discussion with her/his doctor prior to starting verapamil in either form would probably be wise.
>
> Where verapamil fits in the list of mood stabilizers is unclear because we have so little information on it, and that which we have is conflicting (e.g. see a review by Janicak, 2000). However, it carries relatively few risks compared to other commonly used mood stabilizers and must be kept in mind for cases in which the better-studied medications have not been effective or tolerable. It is also a consideration for a woman contemplating pregnancy, if it can be established before the pregnancy that this is an effective agent, which can take months or even years depending on the woman's usual course of bipolar symptoms.
>
> Isradipine is another calcium channel blocker. There is one observation that has been published by Bob Post and colleagues at the NIMH which apparently represents the entire literature base for use of this agent:
>
> When verapamil was blindly substituted for nimodipine, two BP patients failed to maintain improvement but responded again to nimodipine and remained well with a blind transition to another dihydropyridine L-type calcium channel blocker (CCB), isradipine.Pazzaglia
>
> There are no other articles found searching "isradipine bipolar" on PUB MED or Google (7/2004).
>
> Both isradipine and verapamil are in the FDA's Pregnancy Category C, which means that the medication is neither clearly safe, nor clearly unsafe.
> --------------Thank you for all the medical news - interesting,
that by coincidence I was reading Healy's
"The Psychopharmacologists" last night and came
across the invention of hypotensives - and how
they originated form *Rawalfa Serpentina* which
was used for many other psychiatric disorders
as well - wonder if there is a common chemical
basis with these new ones. It was then called
Respertin [sp?];
>
> So, this is interesting. But...you know...in my many years as a social worker [hee :-) sure], I easily conclude lithium *is* the gold standard. I know that is written everywhere, but I've seen it with my own eyes. Many people on lithium are people you couldn't even really tell had mental health issues, even when they talk a bit about their lives.Yup, just like me, lol.
They are not the type of people who come onto a board like this...and you are the exception because you seem to really want to help people. But, their lives are just going along so fine, a place like this doesn't peak their interest much.
Well, I do have side effects after all these years, and I should tell you that concerning high
blood pressure a number of other factors have
played a role, i suspect: menopause, possible
brain injury or change from benzo withdrawal, as
well as concussion, and weight gain over the years, and of course a lowering of the thyroid
hormone supplement as it gave me anxiety; could
be the genes too.
>
> So, I do think lithium is a very special drug in many ways, but the whole bipolar issue, the diagnosis and such, has brought in many different types of people who need some different med combos.
>
> Anyhow...sorry for the length...best..
> Jay :)
>
Thanks for the informative and interesting post -
these blood pressure pills sound like a good
substitute for benzos at least - commonly given
to bipolars, as benzos also make you gain wait
and slow you down.Squiggles
>
Posted by Phillipa on January 31, 2006, at 18:44:56
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar, posted by Squiggles on January 31, 2006, at 11:41:19
Good Luck!!!!Fondly, Phillipa
This is the end of the thread.
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