WHAT CAN BE DONE FOR RAPIDLY CYCLING BIPOLAR? Ask The Doctor Dr. Leland Heller Biological Unhappiness
WHAT CAN BE DONE FOR RAPIDLY CYCLING BIPOLAR?
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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“Biological Unhappiness” “Open this book and it will open your mind. By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery. “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World.
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