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. 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home MENU: Screening Test “Ask the Doctor” (BPD)Borderline Personality Disorder Annual Updates Biological Unhappiness Disorders & Official Criteria Dr. Heller’s C.V. & Picture How Dr. Heller Got Involved If You Want to See Dr. Heller as a Patient Testimonials Table of Contents for the Book ‘Biological Unhappiness’ How to Order “Life at the Border” Why Read ‘Biological Unhappiness’? Goals AD(H)D and Relationships BPD, Bipolar or ADHD? Suicide What if BuSpar makes me anxious or ill? A Suicide Attempt Per Minute in the US Grandparents raising Grandchildren Information About Children What Signs are there that Someone May ‘SNAP’? TV & Cartoon Characters with Depression & Other Disorders Dr. Heller’s Office Website Dr. Heller’s Lectures Mentally Healthy People Retraining the Brain Today is a Gift Reviews Links Webrings Site Index Home Video DVDs now available! You can watch and listen to Dr. Heller in the comfort and convenience of your own home. Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. “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. Dr. Leland Heller Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E Okeechobee, FL 34972 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved. May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness, BiologicalUnhappiness.com, & Dyslimbia Press are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)