Diagnosis and Treatment of Bipolar Disorder - Treatment of Bipolar Disorder

Written by HealthyPlace.com Staff Writer

Voodoo: I would like to hear your thoughts concerning the use of Topiramate (Topamax) in the treatment of Bipolar Disorder.

Dr. Fieve: Studies are, to date, very few, but promising. This is another antiepilectic drug that we hope will be effective in both phases of bipolar illness and it is rumoured that the weight problem that comes with other drugs maybe less so with Topomax. I am treating a number of patients with it at this point and it looks good, but way off in the distance before trials are completed across the US. Trials are beginning by top investigators throughout the country to fully evaluate the preliminary positive findings in smaller numbers of bipolar patients.

David: Here are some audience responses on the best treatment for bipolar disorder:

valasing: Most effective treatment: Effexor, Depakote, and Wellbutrin.

cassjames4: My parents are both Bipolars. Depakote has done VERY well for my mother, she just started on it last year. Lithium didn't seem to work for her. They are 67 and have been diagnosed for a long time. I am 31years old.

michelle1: Nothing yet.

CLIFF: LITHIUM ! LITHIUM ! AND IN THAT ORDER.!! CHEAP, AND DOESN'T CHANGE TOLERANCE!

carol321: Depakote gave me aggressive behavior and I've heard others complain of the same. The PDR lists hostility as a possible side-effect.

Karen2: Lithium & Celexa & fish oil.

liandrq: Yes, I have bipolar and nothing seems to work.

WildZoe: A mix, Lithobid 900 mg a day, Wellbutrin SR 2 a day, Topomax 1 a day (25 mg since I just began).

vernvier1: I'm bipolar and for the last five years Lithium, Wellbutrin, and Depakote have worked pretty fair.

momof3: Have you noticed particular mood swings with seasonal changes in children. I know that doctors see them in adult bipolar patients. Lots of parents of bipolar kids are saying that their kids seem either manic or depressed right now.

Dr. Fieve: In the literature, mood changes of depression, or breakdowns of depression, or mania, tend to be more frequent in the fall and the spring. Although many people will have swings any time of the year.

Conway: Can you address rages and promiscuity as symptoms.

Dr. Fieve: YES! Both are usually seen in mania, but I refer to manic patients as either happy manics or angry manics. In both cases, medication works but, I still feel Lithium is the first choice in both, the happy and angry manic states ONLY if the doctor knows what he is doing. If the doctor is young or inexperienced, give Depakote or another medication instead.

cassjames4: Both my parents are Bipolar. My mother is finally on medications and in treatment and doing ok, but my father is getting progressively worse and dying from cancer as well. He has even burned down our family house as a result of this mania that he's been in for about 8 years now. He thinks life has never been better. He won't accept help. Is there anything I can do?

Dr. Fieve: Your father has to agree to an evaluation and some treatment since it is more important that he does not burn down another house and harm himself or his family, rather than remain in a happy manic state in his unfortunate terminal illness. If he refuses treatment, you should consider hospitalization, since the next act of violence might be fatal. Was the burning of the house a suicide attempt? This can occur in states of mixed mania as well as depression

liandrq: Thank you, Dr. Fieve. I'm attempting to cure myself. Is there a way to control manic depression? Also, I have a hard time believing that what is happening to me is real. I feel I am just a bad person. What can I do on my own to change this.

Dr. Fieve: Unless you are a very mild case of mood swings, which do not lead to risk-taking, or self-destructive, or angry behaviour to others, you cannot sit out these recurrent mood swings. I would go for an evaluation, and get direction of whether treatment is needed or not. At the end of infrequent consultations, two or three a year, I might say to a patient with very mild moodswings which do not lead to negative consequences in the person and or the family's life, that it is your choice: do you want to ride these out or do you want me to give you a short-term - two to three month trial - of Lithium or alternatives to see which you and your family prefer. Vitamins do not help, and feeling you are a bad person is either a part of your depression, and/or negative self-image, which might be corrected with medication and or lithium, and/or just plain therapy.

David: Dr. Fieve, for those in the audience who are the significant others of Bipolar sufferers, the parents, the spouses, the close friends, how do you survive the unpredictability and mood swings of the person with bipolar over an extended period of time? From comments I am receiving, it has to be very trying and exhausting?

Dr. Fieve: I would like to suggest to the family members to, first have a meeting with the patient and his/her doctor and try to get it all out in the open with respect to your frustrations living with the patient. And ask the doctor treating your relative what to do. Secondly, there are books on the bookstand, that explain the illness, including my own book Moodswing, and there is considerable educational information on the web, community lectures, and manic depressive support groups throughout the country. Finally, if none of these suggestions are helping, assuming the patient is in treatment, I would suggest a second opinion by a psychopharmacologist who has a track record for seeing a large number of bipolar patients and treating them over a long period of time.