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Fuck Mania.

talkingdrugs

talkingdrugs

Bluelighter
Joined
Nov 30, 2007
Messages
40
To put it simple, which neuroleptic, in your guys opinion, would be the one with the least side effects to it. I've tried risperidone and olanzapine, but the next day unmotivation and emotional bluntness simply make me feel like a zombie. I've also tried a variety of benzos for my mania, but most of them turn out to make me depressed and angry. Any help would be extremely appreciated... I'm starting to feel hopeless.
 
Low-dose Ketamine has helped me with bipolar, but my problem was with depression, not mania.

I believe last-resort drugs for mania are anti-psychotics, and these aren't exactly nice. If you must, I personally think seroquel is the least vicious one.

Although I am anti-lithium, have you given it a try?

I have never heard of people having trouble with controlling mania before, to be honest. It is usually the depression that is the problem.

Are you properly diagnosed with bipolar? There is no such thing is unipolar mania, to my knowledge.

ps. Psychomantis rocks! :)
 
Bipolar I here. Lamotrigine is doing a fine job in kicking my depression in the ass, but the mania is becoming exhausting. Tried lithium. Didn't do much and the shakey hands and nausea were hell.
Ketamine? Interesting... I'll give it a look. Thanks, bro.
 
talkingdrugs said:
Ketamine? Interesting... I'll give it a look. Thanks, bro.
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Not quite ready yet!! hehe. A lot of people have asked me to post an outline of my medicinal use of Ketamine, which I've been doing successfully for more than 4 years without any problems with addiction. I'm working on it, and I'll hopefully post a first draft later today. When I do, please do take a look, but as I said, all the peope it worked for were either depressives or Bipolar II (such as myself). Bipolar I may react differently, and it is, I think, a much more serious disorder.

I was going to recommend you Gabapentin too, but I find that its action seems to be closest out of all the pharms I tried to Ketamine's when it comes to this issue, and therefore I can only recommend it for problems with depression.... however, if you have medical insurance (as it is fucking expensive), give it a try. Its one of my favourite medications when it comes to therapeutic value.

I agree with FnB about avoiding antipsychotics if you can.

His suggestions are what seems to be the standard for bipolar, although be aware: I read these drugs can have seriously nasty side effects (greying hair? :S).
 
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fastandbulbous said:
Carbamazepine would by my first suggestion as well, then say something like valproic acid. Antipsychotics aren't the right tool for dealing with it long term
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What about oxcarbazepine? Supposedly it works the same way as carbamazepine, but without inducing as much side effects. I've actually tried sodium valproate and that didn't help either. Would valproic acid really differ from it?
 
Although I am anti-lithium, have you given it a try?
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a few people i've seen react ungodly to lithium one of which's skin got jauntus, Tinted yellow. Please elaborate as to What reasoning renders you anti-lithium good sir.
 
Jamshyd, any recommendations are valid. Although I've partially managed to control some of my depression, it still is the icing on the cake of my daily, hellish mixed states.
 
FrostyMcFailure said:
a few people i've seen react ungodly to lithium one of which's skin got jauntus, Tinted yellow. Please elaborate as to What reasoning renders you anti-lithium good sir.
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Simply because it has a very small therapeutic window. If the dosing regimen isn't followed strictly and with frequent blood tests, it becomes extremely toxic and (to my knowledge) deadly.
 
Yes, the therapeutic window with Lithium is narrow, yet it could still prove effective (with careful monitoring there should be little chance of incident). If you didnt respond to sodium valproate it is likely you will not respond to VPA (i think VPA/valproate is more effective in type II, and you are probably type I). Very rarely, a doctor may precribe the RLS medication mirapex (pramepexole?) as an off-label treatment for bipolar disorder, however i would assume that this would only help during the depressive periods (also beware of the compulsive gambling side-effect!).

Also, i am making the assumption that your manic episodes must be moderate-severe to warrant olanzapine/risperidone, in which case typical mood stabilizers and anti-convulsants may not be effective, however these may prevent such an episode from occuring. Oxcarbazepine may be a good alternative to carbamazepine, although i not sure if it is any more effective (or less). Also as mentioned, quetiapine (Seroquel) could be effective in controlling manic episodes, and is milder than both zyprexa and risperidone (though probably not as effective)...
 
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A recent paper showed that Modafinil benefitted 50% of bipolar patients it was prescribed to.

that's not bad at all.

But a neuroleptic? You'd probably do fine with just a typical anti-manic.

If you're unwilling to try lithium, and Depakote didn't work, think about oxcarbazepine, lamotrigine, and maybe topiramate, preferably in that order.
 
Isn't modafinil a stimulant? Dude, I can't even handle caffeine. Thanks for the tip, though.
 
Cool. Excuse my ignorance then. I'm just heavily biased against stimulants since most of them usually agravate my irritability and anxiety a lot.
 
talkingdrugs said:
Cool. Excuse my ignorance then. I'm just heavily biased against stimulants since most of them usually agravate my irritability and anxiety a lot.
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Yeah, it's definitely one that's worth trying. It doesn't seem to have any of the negative effects of the other two.
 
I see limited use of modafinil as a treatment for severe and/or type I BP disorder (or mainly during depressive episodes); but i could certainly be wrong...
 
Modafinil under study for bipolar disorder
Medical Studies/Trials
Published: Sunday, 5-Aug-2007
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A preliminary study of 85 patients with bipolar disorder shows that a drug used to treat patients with sleep disorders might also control the depressive symptoms associated with bipolar disorder.

At least 44 percent of the participants in the study reported improved symptoms, a noteworthy improvement for a disorder in which new treatments are needed, according to the study's author, Mark Frye, M.D., director of the Mayo Clinic Mood Disorders Clinic and Research Program.

The study appears in the August issue of the American Journal of Psychiatry.

"There are very few treatments for the depressive phase of bipolar disorder and as a result there is an urgent need to evaluate potential new therapeutics," says Dr. Frye. "Mood stabilizers in general are better at treating mania than depression, but the depressive phase of the illness is far more common. We really need continued research in this area."

This study was completed in 2005 when Dr. Frye was with the University of California, Los Angeles (UCLA).

Bipolar disorder is characterized by an alternating pattern of emotional highs (mania) and lows (depression). It can range from a mild to severe condition, and there may be periods of normal behavior. (For more information about bipolar disorder, visit www.mayoclinic.com) According to the National Institute of Mental Health, 5.7 million adults in the United States are living with bipolar disorder.

Modafinil, the drug featured in this study, is often referred to in the news media as the "wake-up pill" because it is approved by the Food and Drug Administration (FDA) to treat patients who suffer from excessive sleepiness associated with narcolepsy, obstructive sleep apnea and shift work sleep disorder. During the depressive phase of bipolar disorder the symptoms include excessive sleepiness and fatigue, so researchers wondered if modafinil could address these symptoms in patients with bipolar disorder.

"This is a placebo-controlled study with real world community impact," Dr. Frye says. Half of the patients in the study were given modafinil, 100-200 milligrams daily, and the other half were given a placebo over a six-week period. The randomized, double-blind, placebo-controlled trial was conducted at five sites (the University of California, Los Angeles; University of Texas Southwestern; University of Cincinnati; and University of Munich and the University of Freiburg in Germany).

While the trial was small, the 44 percent response rate was greater than that of the placebo group. Forty-four percent said they felt better, while 39 percent said their symptoms were in remission after six weeks. This compares to 23 percent and 18 percent in the control group. Modafinil was not associated with any greater risk of the manic and depressive mood swings associated with bipolar disorder.

How exactly modafinil works to promote wakefulness or improve mood in bipolar disorder is not completely understood. It appears to have an entirely different mechanism of action as compared to other psychostimulants, Dr. Frye says.

Dr. Frye plans to continue his research at Mayo Clinic.

This study was funded by the Stanley Medical Research Institute, which is the supporting organization for the Treatment Advocacy Center -- a nonprofit group dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. Modafinil, the matching placebo, and a supplemental grant for recruitment and advertisement were provided by Cephalon Inc., the drug's manufacturer.

The study's co-authors include Lori Altshuler, M.D.; Shoshanna Nakelsky, M.P.H.; Sun Hwang, M.S.; and Jim Mintz, Ph.D., all of UCLA; Heinz Grunze, M.D., LMU Munich in Germany; Trisha Suppes, M.D., Ph.D., University of Texas Southwestern Medical Center in Dallas; Susan McElroy, M.D., and Paul E. Keck Jr., M.D., both of the University of Cincinnati; Jorge Walden, M.D., Freiburg University in Germany; and Gabriele Leverich and Robert Post, M.D., both of the National Institute of Mental Health.

http://www.mayoclinic.com/
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I think this is the study I was talking about earlier.
 
I'm bipolar II. I currently take lamotrigine as well. Lithium was good when i was non-compliant with meds but lack of emotion and weight gain sucked.
Anyway have you looked into ziprasidone (geodon). It's an anti-psychotic but has lots less side effects then others (weight gain much more rare). No generic brand is available yet.
There is a mood stabilizer Topiramate (Topamax) which is supposed to help reduce the mania. I think i read it works well and helps reduce the mania sometimes associated with lamotrigine. Also has the nice side effect of weight loss. However, it is still under patent so no generic brand available.
I'm think carbamazepine speeds up metabolism of other meds including itself decreasing the blood levels of the meds.

A quick question: Have any of you done psychedelics such as lsd, mdma, mushrooms etc. with the lamictal without giving yourself a 1-2 day cushion? Does it decrease in potency or any other effects?
 
Topiramate isn't all that effective unfortunately. No studies have found it to be effective. It does cause weight loss, though- if only because it makes soda taste so fucking horrible.

Lamotrigine should have no effect on psychedelics.
 
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