Question:
I know you are a very busy man but if
you could indulge me one more question,
my husband is BI Polar mixed I and II. I
have been told that this is the hardest to treat. He
cycles every winter and spring.
Right now he is taking 800 mg Seroquel,
800 mg Tegretol, 300 mg Lithium, 40mg
Prozac. We have not been able to find
anything to stop the cycling that
causes episodes of depression and some
hypomania. We live in a small town and
there are not a lot of doctors accustomed to treating
his disorder.
We have been reading about Abilify
(aripiprazole) and that it can help
with mixed episodes. What do you think?
Dr. Heller's Answer:
Assuming the diagnosis is correct, there
are a number of options. The
medications are reasonable, but if
they're not working well I'll commonly
do the following:
1) Get blood levels for Tegretol
(carbamazepine) and lithium - both
morning and late afternoon (I usually
check around 4PM for most people). The
blood levels need to be in the correct
range in order for the medications to
work.
2) While Seroquel (quetiapine) has
been approved for bipolar, I've been
disappointed in the results. Zyprexa
(olanzapine) is the best and Risperdal
(risperidone) is second best. The
problem with both of these medications
is weight gain, which can be impressive
and result in diabetes. In my
experience, Abilify (aripiprazole) is
better than Seroquel and does not
usually cause weight gain. I commonly
prescribe Zyprexa 10mg nightly
(sometimes with a lower daytime dose)
for 3-7 nights to stop the bipolar
symptoms acutely, followed by Abilify
(aripiprazole).
3) If the BPD is present, a single 3mg
dose of Risperdal at night will usually
stop the dysphoria (anxiety, rage,
depression and despair) 24 hours later.
Abilify (aripiprazole) can then be
added.
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