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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by aazospiro on November 6, 2004, at 20:32:03
Can psychostimulants acutely calm a manic person??? Does this happen? Or prevent cycling???
Posted by Chairman_MAO on November 7, 2004, at 3:06:45
In reply to Bipolar Illness And Psychostimulants :- o !!!!!!!!, posted by aazospiro on November 6, 2004, at 20:32:03
1: Bipolar Disord. 2000 Mar;2(1):56-9.
An open study of methylphenidate in bipolar depression.
El-Mallakh RS.
Department of Psychiatry and Behavioral Sciences, University of Louisville
School of Medicine, KY 40292, USA. rselma01@athena.louisville.eduBACKGROUND: The treatment of bipolar depression is problematic. Mood stabilizing
agents are often inadequate, while antidepressants may induce mania or mood
destabilization. Methylphenidate has been advocated as an effective
antidepressant agent in unipolar depression, and depression secondary to medical
illness. Amphetamine administration has been shown to reduce manic behavior.
These independent observations suggest that methylphenidate may be a safe and
effective agent in bipolar depression. METHODS: Fourteen depressed subjects with
DSM-IV bipolar illness and a Hamilton-depression (HAM-D) scale score of at least
15 had methylphenidate added to a stable mood stabilizer regiment. Patients were
followed weekly for 4 weeks and then biweekly for an additional 8 weeks.
RESULTS: HAM-D scores dropped from 16.9 +/- 1.79 SD at baseline to 9.4 +/- 9.73
on week 12 (p = 0.12, t = 1.84, df= 6) and 9.8 +/- 7.56 on last observation
carried forward (LOCF) (p = 0.019, t = 2.8, df = 10). Psychiatric symptom
assessment scale (PSAS) scores dropped from 17.9 +/- 5.63 at baseline to 4.8 +/-
7.47 at week 12 (p = 0.016, t = 4.02, df= 4) and 6.3 +/- 6.75 on LOCF (p =
0.007, t = 3.74, df = 7). Three individuals stopped secondary to anxiety,
agitation, and hypomania, respectively. CONCLUSION: In this brief, open study,
methylphenidate was effective and relatively safe in depressed bipolar subjects.
1: J Am Acad Child Adolesc Psychiatry. 1995 Apr;34(4):472-6.Case study: antimanic effectiveness of dextroamphetamine in a brain-injured
adolescent.Max JE, Richards L, Hamdan-Allen G.
University of Iowa, Department of Psychiatry, Iowa City 52242-1009, USA.
A relatively enduring and counterintuitive antimanic response to
dextroamphetamine in a brain-injured adolescent who had failed trials involving
divalproex, lithium, haloperidol, and carbamazepine is described. This finding
combined with data from previous reports of antimanic effects of test doses of
stimulants imply that such a pharmacological probe may prove relevant for the
prediction of treatment response of mania to dextroamphetamine and perhaps for
subclassification of bipolar disorder.Publication Types:
Case Reports1: J Clin Psychiatry. 1987 Oct;48(10):412-3.
Dextroamphetamine treatment of mania.
Garvey MJ, Hwang S, Teubner-Rhodes D, Zander J, Rhem C.
Department of Psychiatry, Veterans Administration Medical Center, Iowa City, IA
52242.Five of six acutely manic patients treated with dextroamphetamine experienced a
50% or greater reduction in their mania severity scores. Side effects were noted
in only one patient. The treatment results suggest that dextroamphetamine might
be useful in the treatment of mania.Publication Types:
Clinical Trial1: Arzneimittelforschung. 1976;26(6):1185-6.
[Proceedings: D-Amphetamine in manic syndrome (author's transl)]
[Article in German]
Beckmann H, Heinemann H.
Six manic patients were acutely treated with 30 or 50 mg d-amphetamine,
respectively. There was no intensification in any of these patients of gross
manic behavior or single manic symptoms. Conversely, there was sedation and
considerable reduction of manic symptomatology in all of them. This effect
lasted for 1 to 3 h only. The clinical subgroup "elated-grandiose" was
significantly, the subgroup "paranoid-destructive" was not significantly
influenced. "Drive" and "mood" were similarly reduced. There was, however, no
complete recovery from mania.Publication Types:
Clinical Trial
Posted by linkadge on November 7, 2004, at 11:10:18
In reply to Re: Bipolar Illness And Psychostimulants :- o !!!!, posted by Chairman_MAO on November 7, 2004, at 3:06:45
In other words yes it can.
Mania is proposed to be associated with hypocholinergic function. This is why TCA
are often the worst for initiating a
manic episode.However stimulants strongly activate the prefrontal cortex, and often strongly potentiate the cholinergic systems. This can lead to mood depression and/or stabalization via prefronal cortex activation.
Linkadge
Posted by Ritch on November 7, 2004, at 11:12:15
In reply to Bipolar Illness And Psychostimulants :- o !!!!!!!!, posted by aazospiro on November 6, 2004, at 20:32:03
> Can psychostimulants acutely calm a manic person??? Does this happen? Or prevent cycling???
>
>They have in my personal experience. My rapid cycling tended to flatten out. My mind didn't race at all. I slept more soundly. But stims made me very cold, aloof, and very quiet, yet oddly anxious. My head was quiet-but I just felt very tense. People would question me a lot about why I was so quiet.
Posted by lostforwards on November 7, 2004, at 11:22:55
In reply to Re: Bipolar Illness And Psychostimulants :- o !!!!, posted by linkadge on November 7, 2004, at 11:10:18
> In other words yes it can.
>
> Mania is proposed to be associated with hypocholinergic function. This is why TCA
> are often the worst for initiating a
> manic episode.
>
> However stimulants strongly activate the prefrontal cortex, and often strongly potentiate the cholinergic systems. This can lead to mood depression and/or stabalization via prefronal cortex activation.
>
>
> Linkadge
>Mania being associated with hypocholinergic function explains things I've heard about lecithin being good for bipolar.
Posted by linkadge on November 7, 2004, at 11:28:48
In reply to Re: Bipolar Illness And Psychostimulants :- o !!!!, posted by lostforwards on November 7, 2004, at 11:22:55
Thats right, orally administered choline bitrate or lecethin, can have antimantic/depressogenic effects. Lecethin has also been used with some sucess in treating seizures.
Coffee, for me is a wonderdrug.
it calms me down, it slows my mind down, it helps my anxiety, and my concentration.Linkadge
Posted by aazospiro on November 9, 2004, at 19:35:00
In reply to Re: Bipolar Illness And Psychostimulants :- o !!!!, posted by linkadge on November 7, 2004, at 11:28:48
ok well that would explain why coffee calms me down and even sends me to sleep.
Bromocriptine, piribedil, and almost anything dopaminergic does too. however methylphenidate does the best job without all the nasty side effects. Bupropion was the only exception, this made me very irritable.weirrd!!! Antiparkinson med sinemet 100/10 would put me to sleep in 1/2 hour...well rested too.
Strangely enough I CANNOT tolerate anything remotely serotinergic: Zoloft drives me through the roof, paxil worst, celexa, but not so much Fluoxetine......hmmm strange!! Venlafaxine is even worst. Buspirone is an absolute terror. These meds improves mood somewhat but makes me acutely disinhibited, VERY restless, discontented, anorgasmic, kills morning erections, apathetic, extremely fatigues, kills concentration.
Valproate at low dose seems to potentiate the effects of methylphenidate but if i go above 125 mg twice a day, its trouble......i actually get very hyperactive and even nervous. The benzodiazepines in general make me dumb and dysphoric and irritable with the sole exception of clonazepam. Alprazolam is by far the most irritation potentiating. Yukkkkk!
See the problems is that constant dosing of methylphenidate of 30 mg /d eventually makes me depressed in like 2 months.
i am focused, mellow, very mild tempered, but i feel low. How can I fix this without having to use a nasty serotinergic drug????
would i benfit from a very low dose of an atypical antipsychotic even though I am not schizophrenic?? To stop hypersensitivity of DA receptors?? Like 12.5 mg or lower of seroquel, or low fluanxol, Risperidone, Zyprexa ???
Can you help me
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