Bipolar Disorder type 2 Meds

[johngalt50]

Our 34 year old son was just diagnosed with Bipolar type 2.  During hospitalization he was put on Praxil (sp) and Zyprexa, with additional anxiety medication as needed.  Although he never experienced the severe manic episodes typical of Bipolar, he did get extremely depressed and became very paranoid. His thinking patterns lacked logic and were a bit removed from reality. For example he developed a fear of driving and of things being wrong with the house that might harm his daughter and spouse, though nothing was wrong.
Here is my concern.  His mother was diagnosed Bipolar 25 years ago.  She started on Lithium then and is very stable on the medication.  At one point a new psychiatrist tried Depakote with her and the results were disasterous.  She had a full blown episode that was very alarming.  It included a severe paraoid thought pattern that we had not seen before.  My concern is over the meds our son is getting.  Are they as effective as the lithium?  I realize that I am asking for a generalization.

[alikat1205]

I know with my daughter, her dr. said Lithium is a last resort drug.  It can cause serious weight gain, and liver damage, it has to be constantly monitored.  If he can't get a good response from other drugs, then they will move on to Lithium.  There are many, many drugs for BP, so if the current combination doesn't work for him, there are many others to try -- unfortunately it is a trial and error type of thing and may take many different combinations to hit on the right one, and that may take awhile.  Good luck.

[therese83]

Zyprexa is very good help  for the paranoia and for helping people who are believing things that are not true.

How many mg is he on?

[therese83]

I had similar symptoms to your son and was diagnosed with psychotic depression, here in Austria, Europe.  

I have a very good doctor, she is considered the best in this country where medical care is the best in the world.  

I was put on zyprexa 5mg and effexor 225 mg, which is a similar regime.

I was able to give up the zyprexa after the year but remain on an anti depressant.  It is just that my depression got so bad i went down very low + she classified this as psychotic as i never had any high or elevated mood.

Hope this helps.

[johngalt50]

He is on 15 mg of zyprexa.  The doctor told him he could take an additional 5 mg if he needed it during the day to help control the paranoia and uncontrollable thoughts

[johngalt50]

Talked to his psychiatrist today.  He said that is was useful to know that a family member had done well on the lithium.  He said that lithium could be added to the current regimen. It is going to be up to the dr. and my son, though.

[therese83]

Give it time, you need to be patient with these things and it is very much a 'trial' of a new medication.

I did notice good improvement with the Zyprexa after 4 - 6 days.

I wish him and you well.

[LeftCoastChick]

I'm on Lithium, and it's a very safe drug - extremely high doses have to be monitored careful, like many other drugs. I get my blood sugars checked for Seroqual, which I don't mind, it's a fantastic drug along with Lithium.  I was on Lamactil alone but I became suicidal again, my pdoc put me on 300mgs of Lithium and it was only 2 days and wow what a difference. Since then, I've only had minimal depression. . Unfortunately most BP's have to take a drug cocktail, 2 or more meds.Seroqual at high doses can help with the psychotic features as well. They've also found and higher doses it can act as an AD, very interesting. I was told Zyprexa can be an "activating drug" to some, and cause anxiety. Paxil can really numb you out, I asked my pdoc yesterday, but I still feel flat, and she said that would not be a choice for BP, but if your son is really paranoid it might settle him down, an odd choice though.

I would sit down with his pdoc if you have power of attorney, which I suggest when he's well to set up with you or a family member, so when he isn't well, his choices of treament are clear. The hospital which the clinic I go to is located, requires it. There are certain drugs I refuse to be on as well as it would be worse if I was put in isolation.

You have so many things to deal with, I hope every thing smoothes out and he's feeling better.

[johngalt50]

Thanks for the feedback.  I will give the current meds a little more time.  Then I am going to suggest that he add the lithium.  Like you, my wife has done very well on Lithium.  When her doctor moved her back to lithium after the failed attempt with Depakote, the change came very quickly.  

[ILADVOCATE]

Well let me explain having tried all of these medications again the phrase from the site (everyone really should check it out) "Depression Central" "any medication can cause any side effect". That comes from a well known mood disorders specialist (not one I have seen).That of course depends. Antipsychotics will all cause tardive dyskinesia and put a person at risk for diabetes and Zyprexa is the prime offender for diabetes. But when Zyprexa worsened my paranoia years ago and it happenned to a friend of mine I knew what was going on. But that's not a "common" side effect. As for "safe" we should be factual. On the one hand, Lamictal can cause Stephen's Johnson's syndrome in one in a thousand people which is the rash that people worry about and I know someone who almost died of it but yet I'd say Lamictal is safe. Lithium can cause weight gain and has a potential for long term kidney damage so that's why people have blood tests to monitor for that. Some psychiatrists will not use Lithium over ten years for this reason and transition consumers off it and onto other medications but some psychiatrists such as my psychopharmocologist disagree. There are no exact guidelines except with dosaging and the monitoring of blood tests. Even with the Zofran I am I must get a liver function test once a year.
   Let's look at the two categories of medications. As per the antipsychotics the risk of diabetes is common and can be monitored for and the risk of tardive dyskinesia is to quote my psychopharmocologist "5% per person per year for typical antipsychotics and 2.5% per person per year for atypical antipsychotics". Clozaril is the only antipsychotic that is currently a medication that won't cause this long term side effect, which I have in advanced form. As for diabetes Zyprexa is the most likely to cause it but if a person isn't gaining weight on it then they are okay but if they are then its a good idea to ask their psychiatrist to change them to Abilify which is the least likely to cause it although it still happens. As for antipsychotics that will not cause tardive dyskinesia or diabetes and promote a full recovery, the glutamate antagonists, a new class of antipsychotic in development have not caused either of these side effects are promote a fuller recovery. I am on glycine, a glutamate antagonist in Phase II FDA and have made a full recovery from schizoaffective disorder. My psychopharmocologist will be publishing the results in a psychiatric journal. In the meantime for the official study google "Dr. Javitt, glycine".
  As for mood stabilizers there is much out there that is currently available that are approved medications available and used off label experimentally for bipolar. If someone's mood stabilizer is working and they can tolerate the side effects there is no reason to make an immediate change. But if they can't and have tried what's out there then they could consider seeing a mood disorders specialist. Not all medications are as effective on both ends except perhaps Lithium. Depakoate is better on depresion than mania and Lamictal in higher doses can sometimes even create mania. That's why I was taken off Lamictal and changed to another medication. That doesn't mean it will happen but it is a risk but Lamictal, in me at least and other people had less of the cognitive blunting side effects of Lithium and Depakote but each person's biochemistry is different. If you want to find out more about more mood stabilizers that a mood disorders specialist could and would be able to prescribe here's an up to date list:
http://www.psycheducation.org/depression/meds/moodstabilizers.htm

[LeftCoastChick]

Just a FYI, Lamactil may cause mania at really really high doses. Moderate doses don't. I'm on 200 mgs, and doing just fine!

All meds have some side effects, but if prescribed and introduced slowly, many including Lamactil won't have the serious side effects, so don't be scared off by the long lists of possible side effects.

[monkeyc]

Lithium is the most effective MS for both mania and depression, your son is somewhat like my normal presentation actually though I do get hypomanic very easily.. Lithium works well for me and its a very safe drug PROVIDED you follow the rules, understand the side effects and get the right tests done.  Its also very cheap.

As for people who say Lithium isnt good long term there are many patients who have been on it for 20 or 30 years.

The major reason lithium is not prescribed as much in the US is its generic and unprofitable and no one pushes it - preferring the newer AP drugs which are also much more expensive and have serious side effects (Lamactil isnt the worst by any stretch)  Lithium requires an actual patient doctor relationship as it needs to be managed and a lot of pdocs dont want that, the sad fact is they want $$ in the door but not to have to manage a patients care.  

Cognitive blunting is also very rare on lithium, it is a non psychoactive but it can cause it in some people, pretty much all MS and AP drugs have cognitive effects as do all Anti Depressants regardless of the lies the doctors will tell you.  Anything that messes with brain chemistry can blunt you.

[PinkTZ]

i havent read the comments of others, but im on 3 x 100 mg capsules per day. In abou 25 years some body organs do deteriorate, its hard on the system. Its a salt so you have to watch your salt intake or you'll be running for water evey two minutes...besides that i guess its pretty safe...every med has side effects.

I was told that new meds will come out to replace lithium....im skeptical though...

oh it also makes you gain weight...but really that shouldnt be a concern :D

Cheers!

[monkeyc]

Weight gain is a side effect of the majority of mental health drugs if you look at the side effects.  Its not a "you will either" it is a side effect like others.

Most common lithium side effect is in fact fine motor tremors.

oh and on salt.. yes it is but as you will be drinking at least 2 litres of water a day on lithium if you are doing the right thing your salt intake isnt a major problem - proper hydration is no just a good idea for lithium its vital.

[LeftCoastChick]

I agree with Monkey

Since starting Lithium, I drink 8+ cups of water( 2 Litres)  on top of juice or iced tea. It good for flushing the system out and a good work out for the ol' kidneys. I was told if I did that, I wouldn't have any long term issues. Being proactive is the better then patching something up later no? good luck!

[johngalt50]

What you two have described is what my wife's experience has been.  She has been on lithium for 25 years.  She does have the fine motor tremors and is nearly constantly thirsty. The weight gain has been on and off. She has a few other health issues, but those tend to run in her family, i.e. diabetes and high blood pressure.  All that said, the lithium has kept her very stable.  The few times she has gotten off have been disastrous, most especially when her doctor tried Depakote.  
Thanks for sharing your experiences.

[LeftCoastChick]

What dose is your wife on? The higher the dose, there are more possiblities of side effects, yet constant supervision can keep someone from having such side effects. My weird side effect is craving dairy, I'm not sure which drug is doing it, but at least it's not a bad thing, I was calcium deficient before :)

My Dad is diabetic, and is always drinking, he watches his blood sugars very carefully, and he gets tested consistently for his BP and Cholesterols. The tremors can come from all sorts of reason, and your spouse should get checked out that it isn't something else. As well there are other meds that can augment the Lithium and bring that's meds dosage down if it's the culprit. Does she take Lithium more for the depression or for the mania? Depakote, I'm told is not the drug of choice for BP2's, check with her pdoc if she has one. I'm on a combination of Lithium/Lamactil/Seroqual, the first two for depression, the last for the manic/anxiety episodes.   I've had some serious sweet cravings, but I've been like that off the meds as well. Being super vigilant is so important in BP.
Sorry if I'm rambling.