Posted by Solstice on February 20, 2012, at 18:54:53
In reply to re: Desperate - Part 2 - Please no anti-med posts » Solstice, posted by SLS on February 20, 2012, at 18:32:48
> Well, anyway, Topamax is a drug that I have seen treat successfully bipolar II dysphoric hypomania in a 40 year old woman. She was first treated with 200 mg, but it was subsequently found that 100 mg was just as effective, and reduced the risk of developing kidney stones.
>
> The clinical trials of Topamax to evaluate its efficacy in treating mania have not produced impressive results.I don't know.. but 60% of patients with a wide variety of diagnoses doesn't sound bad to me! Since the study specifically says it appears helpful for mania and hypomania, I'm wondering if the majority of the 60% responders had those two issues.
I would not make Topamax my first choice as a treatment for pediatric bipolar disorder. However, there are anecdotes that report success with its use.
Well.. the first choice was Abilify, which she had all the *bad* side effects. Second choice was Geodon - which was a miracle. The natural third choice was Latuda, which has seemed to fall flat. Lithium and/or Lamictal have reduced the frequency/intensity of the agitation, but not enough improvement to feel like we've found the right thing.
What concerns me is that I don't think we can tell which of these meds provoked the marginal improvement. I think sticking with Lamictal is a strong preference for me because it worked for her sister. However, I should probably note, her sister ironically had the same kind of reaction to Geodon that my younger one had to Abilify. My older one ended up on very low dose Abilify and very high dose Lamictal. It wasn't hard to see that it was the high dose Lamictal that was really hitting the sweet spot for her. She is now off Abilify.
Based on what you know about my daughter so far, what reservations would you have regarding Topamax? Would it be possible for Topamax to stand alone - maybe with Vyvanse - like Geodon did? What about Lamictal.. both Lamictal and Topamax are anti-convulsants. Do they work together, or are they redundant?
> Depakote would be a better choice if one is to explore anticonvulsant mood-stabilizers. My main concerns with Depakote are that the dosage of Lamictal must be reduced and that it might leave your daughter somewhat depressed with continued use.
I would have thought that depakote would be last choice simply because - doesn't it have the weight gain issue?
I wish I understood the varied 'faces' of bipolar depression in adolescents. I know she's got the hypomania - and it might be skating pretty close to mania at times. But that god-awful irritability.. it's so hard to know whether it's a feature of impatient hypomania - or whether it's what bipolar depression looks like in a teenager.
Whatcha think?
>
> In any event, I still feel that Topamax is a viable treatment that can yield improvements in mania in bipolar disorder.
>I've read a lot of the links you provided me.. and Topamax really does seem worth exploring.. especially since it really does look like she does the mixed state thing.
I'm interested in any additional thoughts you have, Scott
Solstice
poster:Solstice
thread:1010739
URL: http://www.dr-bob.org/babble/20120212/msgs/1011029.html