Posted by SLS on April 23, 2009, at 8:57:41
In reply to Re: mixed state bipolar I or II, posted by samantha28 on April 22, 2009, at 18:56:50
> What would be the difference in treatment in treating bipolar I with a mixed state and bipolar II with a mixed state where depression as the major mood state superimposed with hypomanic/manic symptoms?
First of all, I don't believe that all agitated depressions are mixed-state bipolar. In addition, there is described in the literature the existence of depression with racing thoughts that is not a form of bipolar illness.
Let us say that you are bipolar II. You pretty much know the fundamentals already. Lithium is not considered a first choice for a number of reasons, but most of all, it doesn't seem to work very often, although a case could be made for it being combined with Lamictal to help prevent relapses. Personally, I wouldn't take that route. Depakote would be a better choice of mood stabilizer or bipolar II. I happen to see Topamax work very well for someone's dysphoric mania. I guess you could call dysphoric mania a mixed-state where mania predominates. However, I would not call a mixed-state where depression predominates an agitated depression, since there are many people with unipolar depression who fit this description.
I think you are absolutely right about the use of antidepressants being a valuable tool to treat bipolar II depression. They probably would not be such a good first choice to treat bipolar I depression because the risk precipitating a switch into mania is so high. For bipolar II, I think it is helpful to have Lamictal 200mg on board while testing other therapeutic agents. I don't feel that this drug is often effective on its own, but it can make a huge difference when used as augmentation.
I have personally witnessed Topamax (topiramate) be successful at treating a woman with bipolar II mixed-state. This drug is often overlooked for lack of investigation in clinical studies. I think it works for bipolar depression as well, but you need to be very slow in titrating the dosage to a therapeutic level. The slower you go, the greater the likelihood that you will not develop the cognitive side-effects that this drug is known to produce. It is a good idea to drink plenty of liquids with Topamax to help prevent kidney stones. When I was taking Topamax, I asked for occasional blood tests to monitor for metabolic acidosis as Topamax is an inhibitor of carbonic anhydrase.
What drugs were you thinking about taking?
Wellbutrin + Lamictal seems to work well in bipolar II deprssion. Parnate is also very good, but one must be careful and monitor their diet and the use of other medications.
I have an uncommon type of bipolar disorder where I remain chronically depressed except for when certain drug treatments induce mania. For what it is worth, I am having success with:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mgI am adding memantine (Namenda) to these four drugs in an effort to break through a plateau that I have reached in my progress towards remission. Memantine is approved for use in Alzheimers Dementia. However, it has already shown itself to be helpful in treating OCD. The NIH is currently conducting a trial of memantine to bipolar depression. They have completed a trial of memantine in unipolar depression (Major Depressive Disorder) and found it to be ineffective. The problem here is, of course, that they were not using memantine as an adjunct, but rather as monotherapy. It may yet demonstrate some utility in depression.
You might want to take a look at this:
http://clinicaltrials.gov/ct2/show/NCT00305578?term=bipolar+AND+memantine&rank=2
I have my hopes.
- Scott
poster:SLS
thread:891436
URL: http://www.dr-bob.org/babble/psycho/20090421/msgs/892295.html