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 Marcia Purse

Treatment-Resistant Bipolar Disorder

By July 27, 2009

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This evening I was reading an article published in the Psychiatric Times by James C-Y Chou discussing treatment-resistant bipolar disorder. Dr. Chou notes treatment-resistant bipolar disorder is “clinically familiar.” Translation? At some point in time, most of you will have an episode that is particularly difficult to stabilize. This point isn’t really argued. We all know this is true and so do our doctors. The academic discussion about treatment-resistance is more about the factors that define this.

What I found particularly interesting in this article was an analysis of the first-line drugs – those medications considered the starting point – for treating bipolar disorder. Nine medications were reviewed for how well research demonstrated the drug’s ability to control depression, mania and to maintain stability preventing a recurrence of depression or mania:

All of these medications except for Lamictal have a marked strength in treating mania; Lamictal has demonstrated its strong ability to treat depression. Only Seroquel received top marks in all areas of treatment. One other important note from Dr. Chou is that “in acute mania antidepressants should be discontinued immediately.”

What does this mean for you? It means that medication changes in response to episodes should be expected. It means that good communication between you and your prescribing doctor is important. It means you probably don’t want to order that year-supply of a medication even to leverage bulk savings. ~Kimberly

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Comments
July 31, 2009 at 10:12 am
(1) Anita S says:

I appreciate this outline of the different meds comparing and contrasting them! It’s too bad Seroquel is the best with both mania & depression; I was on it for several years but the side effects (severe drowsiness, cognitive slowing, tremor) were finally too much for me.
~lunarmoth131

July 31, 2009 at 1:18 pm
(2) Karen says:

My son is taking Olanzapineand Depakote, but he has put on so much weight it is geting him down, he also sleeps a lot – is this normal?

July 31, 2009 at 5:19 pm
(3) Denise Williams says:

I’ve been mania free for seven years now. It took about a year of taking seroquel for them to go away completely. I still struggle with mild depression. The mania was disabling me. I had full blown manic episodes every 6 months that lasted 8 weeks or so and then I would go into a deep depression for months after. I suffer from side effects but it’s worth it. I am actually living life now and loving it.

August 15, 2009 at 3:21 am
(4) justehh says:

When I was first diagnosed at age 14 I was put on multiple combinations of medications. Finally they settled on lithium and tegretol. Reasons being the anti-depressants were either making me violent or suicidal. I never was suicidal or violent before. From 17 till 26(current) I’ve been off meds but since age 24 I can’t seem to stablize myself or get through anything that comes my way. So now I’m on depokote. I went almost 10 years doing just fine without everyone knowing I was bipolar. Oh well. I tried and did darn good. :/

August 25, 2009 at 1:43 am
(5) robbi says:

I also take seroquel, it helps me sleep.I have been taking it for several years. I like the medication. It’s one of my best meds.

March 12, 2010 at 11:51 am
(6) Jamie says:

Well, all I can say is this… having lived 12 years with Treatment Resistant Depression, I am at the last couple of meds to try before undergoing ECT. I am scrambling to find anything that will help me, no matter how nontraditional it may be as I am certain that in my case, ECT will be more detrimental to me in the long run. I spend my day on the Internet researching and researching, but have come up with nil. It is truly fritghten because I want to live more than anything, however, my level of depression is so severe and long-lasting that it is not living. It is simply a human body that is breathing but shows no other signs of life.

July 29, 2010 at 3:45 pm
(7) karen says:

what has helped you for treatment resistant depression?

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