Posted by med_empowered on March 17, 2006, at 23:10:47
In reply to Re: Meds for mixed state???, posted by bipolarspectrum on March 16, 2006, at 22:25:25
mixed states are tough, in part b/c for a long time they weren't well-recognized; "clasicc" bipolar I disorder involves discrete episodes of (euphoric) mania and (intense) depression. With the increasing attention towards bipolar II, there's also been interest in the mixed states of various sorts of bipolar.
Keppra might be good--it seems better for the mania end of things (some people report depression on it), but its pretty "clean" in terms of drug-drug interactions. Also, I think benzos can be helpful--if nothing else, they help slow things down a bit so you're less likely to do something stupid.
If you can't tolerate 1 mood-stabilizer @ full dose, perhaps you could mix? Mixing mood stabilizers happens sometimes in BP--for some people, multiple mood stabilizers are a better option than adding in antidepressants or benzos. Some combos: depakote/Lamictal (anti-depressant action from lamictal, plus anti-manic action), lithium+(tegretol, depakote)--strong anti-manic action; might also be a good call in cases of bipolar depression before trying an antidepressant; Anti-convulsant (tegretol, trileptal, keppra, depakote, possibly phenytoin) plus atypical antipsychotic (the AP can be used short-term or longer-term, as-needed)--anti-manic action, possibly some anti-anxiety/anti-depressant action, as well. The only combo I'd avoid w/o even trying is Lithium+antipsychotic, since that can make side effects from both meds more intense (back in the day, some cases of permanent brain damage were reported with haloperidol+lithium combos; no one really knows how safe these combos are long-term or what kind of subtle cognitive deficits they could produce).
Good luck!
poster:med_empowered
thread:621113
URL: http://www.dr-bob.org/babble/20060315/msgs/621531.html