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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by phidippus on October 31, 2014, at 19:00:07
Atypical antipsychotics antagonize dopamine, seratonin and agonize some seratonin receptors.
Yes, they treat mania and can sometimes treat depression, but not in a way that provides true mood stabilization.Eric
Posted by burial on November 1, 2014, at 9:20:20
In reply to AAPs are not mood stabilizers, posted by phidippus on October 31, 2014, at 19:00:07
i don't think it's that simple. I've been on zyprexa 20mg for some time now, and haven't been manic since. Also i'm on valproate, which definitely doesn't do anything for depression but which is officialy a mood stabilizer? I don't think there is a med which tackles both mania and depression equally, but i haven't tried lithium yet
Posted by herpills on November 1, 2014, at 9:55:47
In reply to AAPs are not mood stabilizers, posted by phidippus on October 31, 2014, at 19:00:07
> Atypical antipsychotics antagonize dopamine, seratonin and agonize some seratonin receptors.
> Yes, they treat mania and can sometimes treat depression, but not in a way that provides true mood stabilization.
>
> Eric
>Anything can be a mood stabilizer. If someone takes only an antidepressant, and it stabilizes their mood, then it's a mood stabilizer.
Lamictal is an anticonvulsant that a government agency in the US decided could also be prescribed as a mood stabilizer.
There's really no point in defining what is or is not a mood stabilizer.
Many people on the atypicals feel that they stabilize their mood. There are far more atypicals which are indicated for bipolar disorder than there are anticonvulsants.
Posted by Christ_empowered on November 1, 2014, at 18:04:13
In reply to AAPs are not mood stabilizers, posted by phidippus on October 31, 2014, at 19:00:07
I dunno...back in the day, various doses of the older antipsychotics were used for...everything, lol. TD lawsuits put an end to a lot of that.
The newer drugs can get a lot of issues under control with fewer problems, although acquisition cost is an issue. Long term seroquel, for instance, compares favorably to lithium for bipolar I.
Posted by phidippus on November 3, 2014, at 10:27:55
In reply to Re: AAPs are not mood stabilizers, posted by burial on November 1, 2014, at 9:20:20
>valproate, which definitely doesn't do anything for depression
There are some studies that show Depakote has some antidepressant qualities, but the bulk of the data on it shows it has no efficacy in treating bipolar depression and that it can actually cause depression. I know I was depressed on it.
>I don't think there is a med which tackles both mania and depression equally
When I think of mood stabilizers, I think of the AEDs used and lithium. These medications have a very different mechanism of action from AAPs and have a more global effect on neurotransmission than AAPs do.
Eric
Posted by phidippus on November 3, 2014, at 11:16:59
In reply to Re: AAPs are not mood stabilizers, posted by herpills on November 1, 2014, at 9:55:47
> Anything can be a mood stabilizer. If someone takes only an antidepressant, and it stabilizes their mood, then it's a mood stabilizer.
In the classic sense I believe a mood stabilizer is a drug that treats depression and mania at the same time. The person taking an antidepressant is already stable-maybe depressed, but stable. Mood stabilizers work in such a way that flip-flopping of one's mood is minimized.
> Lamictal is an anticonvulsant that a government agency in the US decided could also be prescribed as a mood stabilizer.
Lamictal is an anticonvulsant which showed mood stabilizing properties which were then exploited by it's maker-eventually they gained FDA approval.
> There's really no point in defining what is or is not a mood stabilizer.It certainly helps. That way, doctors aren't prescribing Yohimbe for bipolar patients. If a medication is defined a mood stabilizer then we know it helps treat manic depression.
> Many people on the atypicals feel that they stabilize their mood.
I've never met a bipolar person whose mood was stabilized taking an AAP alone. They can augment a traditional mood stabilizer, no doubt, but they can't work alone as a mood stabilizer.
>There are far more atypicals which are indicated for bipolar disorder than there are anticonvulsants.
So?
Eric
Posted by phidippus on November 3, 2014, at 11:22:38
In reply to Re: AAPs are not mood stabilizers, posted by Christ_empowered on November 1, 2014, at 18:04:13
>Long term seroquel, for instance, compares favorably to lithium for bipolar I.
I've never seen a bipolar person do well on Seroquel alone. Those who do well on Seroquel also take a mood stabilizer.
Eric
Posted by Christ_empowered on November 4, 2014, at 6:25:57
In reply to Re: AAPs are not mood stabilizers » Christ_empowered, posted by phidippus on November 3, 2014, at 11:22:38
That's true. I think back in the day they used a lot of low dose Thorazine and Mellaril w/ lithium, so...not a whole lot has changed, although the APs are much more expensive.
Posted by herpills on November 7, 2014, at 8:02:42
In reply to Re: AAPs are not mood stabilizers » Christ_empowered, posted by phidippus on November 3, 2014, at 11:22:38
> >Long term seroquel, for instance, compares favorably to lithium for bipolar I.
>
> I've never seen a bipolar person do well on Seroquel alone. Those who do well on Seroquel also take a mood stabilizer.
>
> EricI've noticed a lot of the atypicals have maintenance indications but only if combined with Depakote or Lithium. But why not Lamictal?
Posted by phidippus on November 8, 2014, at 5:33:43
In reply to Re: AAPs are not mood stabilizers » phidippus, posted by herpills on November 7, 2014, at 8:02:42
Maybe they just left it out.
Eric
Posted by SLS on November 8, 2014, at 7:01:53
In reply to Re: AAPs are not mood stabilizers » phidippus, posted by herpills on November 7, 2014, at 8:02:42
> > >Long term seroquel, for instance, compares favorably to lithium for bipolar I.
> >
> > I've never seen a bipolar person do well on Seroquel alone. Those who do well on Seroquel also take a mood stabilizer.
> >
> > Eric
>
> I've noticed a lot of the atypicals have maintenance indications but only if combined with Depakote or Lithium. But why not Lamictal?In my experience, Lamictal demonstrates little, if any antimanic or prophylactic (mood stabilizer) effects. It may, however, help to suppress ultra rapid cycling when combined with lirhium valproate, or an atypical neuroleptic. It can take as long as six months for treatment to penetrate the cycle. The addition of lamotrigine works better when mania is not evident when first administered.
- Scott-----------------------------------------
"Anticonvulsants are not a class when treating mania. While valproate and carbamazepine are significantly more effective than placebo, gabapentin, topiramate, and lamotrigine are not."
http://www.ncbi.nlm.nih.gov/pubmed/20015083
-----------------------------------------
"Lamotrigine added to valproate successfully treated a case of ultra-rapid cycling bipolar disorder"
http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1819.2007.01624.x/pdf
-----------------------------------------
Posted by burial on November 9, 2014, at 15:48:32
In reply to Re: AAPs are not mood stabilizers » herpills, posted by SLS on November 8, 2014, at 7:01:53
as much as my experience tells me from being bipolar, it's that benzodiazepines kinda work like mood stabilizers too, although it may not be for others too
Posted by Christ_empowered on November 10, 2014, at 9:24:36
In reply to Re: AAPs are not mood stabilizers, posted by burial on November 9, 2014, at 15:48:32
you're right, burial. In acute mania and psychosis, high potency benzos are used so they can use lower doses of antipsychotics. In long term management with antipsychotics, some docs will use benzos so they AP dose can be kept a bit lower, at least for some people.
This is the end of the thread.
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