These side effects made me think I should go off of Depakote (1000mg/day) and try Lithium:

  • itchy face
  • extremely sensitive scalp
  • more hair in the hairbrush than usual
  • my latest period lasted less than 2 days
  • weight gain (not that I expect it to be better with Lithium!)

The psychiatrist agreed (in his typical terse one-sentence-fragment-email), and I’ve been dialing off the Depakote and will be entirely unmedicated by the start of my work week.

I was initially excited about the manic boost I’ve been getting by going off the med….   I was able to start a blog, write over a dozen queued blog posts, clean the kitchen, and make pizza.  Then it escalated, and my thoughts were racing and I was panicking, and I couldn’t get to sleep last night. I had to take a third of a Seroquel today in order to function.

A long talk with my partner made me reassess everything, including starting Lithium.  My serious manic & depressive episodes are in the fairly distant past now, and I’ve only had hypomania and minor depression this year.

The serious stuff has been the anxiety and the mixed states (rages, dysphoria, etc), and I really want to primarily treat that.  If I can do so without going on a hardcore bipolar drug, that would be awesome.

Stay tuned for manic fun or manic horror!

Who knows what medications lurk in the pockets of co-workers?

Meds 4 Life

October 11, 2009

Can I stop taking drugs if I feel better?

Here’s an abrupt answer from WebMD:

Anyone who has experienced two to three episodes of bipolar disorder is considered a long-term — if not lifetime — bipolar patient. That person should have maintenance therapy. Once your doctor has helped stabilize the moods of the acute phase of the disorder (either a manic or depressive episode), drug therapy is continued indefinitely — often at lower doses.

People with bipolar disorder may take lifelong lithium as maintenance therapy to prevent relapses. When lithium treatment stops, relapses can occur within six months in 90% of patients. Moreover, subsequent lithium treatment and other treatments are less likely to be effective.

WebMD doesn’t cite their sources, so take this with a grain of sodium.

What about if a woman with bipolar wants to get pregnant?  Or don’t I even want to know?

What is bipolar disorder?

October 11, 2009

Cheesy old ad with a young woman saying - so simple

If experts don't understand bipolar, how can patients?

“Bipolar disorder” is a spectrum of disorders whose symptoms include periods of mania and depression; it is thought to be largely genetic, but research is not yet conclusive about the causes, neurology, or treatment. There is a 15% fatality rate, due to suicide.

Here’s a more eloquent definition, exerpted from my favorite resource, “Break the Bipolar Cycle” by doctors Elizabeth Brondolo & Xavier Amador:

Bipolar spectrum disorders (BSDs) are a group of disorders all of which involve cycling moods.  But BSDs are also accompanied by a wide range of other symptoms that affect not just your mood but also your energy, your memory and thinking, and your connection with other people. Because the symptoms change or cycle, it may feel like you are always losing ground, never gaining control over your life.

Then there’s the more clinical DSM-IV diagnostic criteria for each of the 4 types of bipolar it defines:

  • Bipolar I Disorder – at least one Manic or Mixed episode, but there may be episodes of Hypomania or Major Depression (this is what people typically think of when they think of Bipolar or Manic-Depression)
  • Bipolar II Disorder (here I’m quoting Wikipedia, which is quoting the DSM)
    1. Presence (or history) of one or more Major Depressive Episodes.
    2. Presence (or history) of at least one Hypomanic Episode.
    3. There has never been a Manic Episode or a Mixed Episode.
    4. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, delusional disorder, or Psychotic Disorder Not Otherwise Specified.
    5. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • Cyclothymic Disorder – Highs and lows that impair functioning as with Bipolar II, but without meeting the criteria for a Major Depressive episode or a Manic episode
  • Bipolar Disorder NOS – “This designation abbreviated NOS can be used when the mental disorder appears to fall within the larger category but does not meet the criteria of any specific disorder within that category.”

The DSM-IV definitions immediately lead one to ask “what’s mania?  what’s depression?” — there are plenty of links here to lead you to the answers, but I think this is all more than enough for one post.

Hello, I hate you -- that's bipolar

 

Depakote vs Lithium

October 10, 2009

Lithium has been used for over half a century to treat mood disorders -- yet it's still imperfect, and its mechanism isn't entirely certain.

Lithium has been used for over half a century to treat mood disorders -- yet its mechanism isn't entirely known to neurologists.

Fierce online debates about Batman vs Wolverine contain a lot more reliable detail than those about Lithium vs Depakote.  These are the two “biggies” that psychiatrists prescribe for Bipolar, yet they’re really hard to compare,  even for professionals.

Both Depakote and Lithium…

  • Treat mania
  • Treat depression, to a lesser extent
  • Often cause weight gain
  • Are semi-mysteries
  • Are maintenance drugs
  • Require blood level tests to prevent poisoning

Their differences sort of balance out too:

  • Lithium has a stigma, but a solid 50-yr history; Depakote has no stigma, but less extensive time in use
  • Depakote is thought to be effective when Lithium isn’t (eg, for rapid-cycling); but Depakote more often needs to be taken with additional medication

…And perhaps it’s telling that I can’t think of any other certain differences that one could weigh when trying to decide between the two drugs.

Trustworthy details are scarce….  I searched on PubMed for recent studies that mention both Lithium and Depakote — please follow the links to the briefs and draw your own conclusions!

  • Nov 2008, NIMH, Bethesda — Trouble with affective processing and attention is linked with medication (Lithium & Depakote) rather than the disorder itself; yet the attention problem is exacerbated in medicated people diagnosed with type II rather than type I
  • Sep 2008, University of Texas, San Antonio — A finding that Depakote compares well to Lithium in acute mania remission rates
  • Jan 2008, McMaster University — Lithium can affect the hippocampus by increasing its volume, which sounds scary; if I understood the brief correctly, Depakote doesn’t do this. (I also found a cryptic brief that may imply that this very thing is a benefit of Lithium!)
  • Nov 2007, UCLA — An inconclusive study that shows similar effectiveness of Lithium, Depakote, and Carbemazapine (Carbatrol, Epitol, Equetro, Tegretol) on sucidal behavior
  • Jun 2007, Ankara University — Verbal memory impairment found in people with Bipolar is the same whether they’re being treated with Lithium or Depakote; either the impairment is a symptom of the disorder, or an equal side effect of both drugs
  • Jun 2006, Harvard — Depakote may cause a small but significant percentage of women to exhibit symptoms of hyperandrogenism (stuff like hair loss and cessation of periods – basically, becoming a bit more man-like)
  • Nov 2005, Case Western Reserve — Depakote is not necessarily more effective than Lithium for rapid cycling

On Janus & Jana

October 9, 2009

I wanted a WordPress username and corresponding gmail address that weren’t taken and that represented a sun/moon dichotomy. One of the pieces of the bipolar puzzle is the key role light and sleep seems to play in bipolar as well as depression. As such, lightness and darkness seem to be a better metaphor than just the obvious.  So this led me to this Roman deity duo that I wasn’t quite aware of….

    Janus, as liminal two-faced god, looking into two rooms at once, both the future and the past.

Janus, as liminal two-faced god, looking into two rooms at once, both the future and the past.

Jana is the same as Diana, the well-known Roman goddess of the moon and hunt (and of chastity — so she certainly wouldn’t represent mania very well). Janus, however, was new to me: he is the Roman god of doorways, the sun (counterpart to Jana’s moon), and of beginnings and endings. Oh, and to confuse matters, Janus is also the name of one of the moons of Saturn.

My main goal in life is to know everything.   I was recently diagnosed with Bipolar type II (incorrectly — I’m now certain I’m type I), so now I’m trying to know everything about Bipolar.

Sadly, all my efforts have barely amassed any knowledge of the basics — the truth of it is that psychologists, neurologists, and other researchers have way more questions than answers about Bipolar.

My more reasonable goal is write about some of the questions and answers I find. I heartily welcome any knowledge that others want to share!