Furious Seasons

November 13, 2005

Look Out: Atypicals Touted as the New Mood Stabilizers for Bipolar Disorder

Psych researchers--very infleuntial ones, I might add--whom I have interviewed in recent weeks are openly touting atypicals as the new mood stabilizers. That would mean replacing Depakote or Lamictal or Lithium with an atypical as a first-line approach to dealing with bipolar disorder. It would also mean using them as a monotherapy for long-term use. Some of the docs I spoke with were so enthusiastic about atypicals--despite having NO long-term studies to support their view--that they were effectively pimping for these drugs.

I won't get into who these researchers are right now--I'll name them in a forthcoming article--but suffice to say that when these researchers put their views on paper in scientific journals, other researchers listen to them. So do advocates. So does the media. So do psych docs in private practice. So do gps (who, by the way, are writing about half the atypical scripts). So this is clearly the direction the field is moving in.

The atypical the docs keep mentioning as the most likely candidate to become the mood stabilizer of choice is Seroquel (very much the IT drug these days).

What's worrying about that is I know of few bipolars who have had decent long-term results--much less medium-term results--with Seroquel. Or other atypicals. Weight gain, other metabolic side effects, that kicked in the head feeling the next day, etc. You know about this shit. The side-effects alone are proven not only by the anecdotal experiences of bipolars, but by the recent CATIE study. That study established that in long-term use in schziophrenics that atypicals were difficult to tolerate and that the side effects are leading to patients running smack into the metabolic syndrome--a fancy term docs use to describe increased cholesterol levels, increased sugar levels, and so on. In short, the recent evidence for atypicals isn't so good. And, I cannot stress this enough, there are NO studies of the use of these meds long-term in bipolar disorder.

And yet the psych field wants to make these the new mood stabilizers. My view is that such an approach will turn out to be a disaster for patients--hell, I'll predict that--and a boon to pharma companies.

So what do you think of using atypicals as the new mood stabilzer? If anyone thinks atypicals totally rock for long-term use, then get back to me.

Posted by Philip Dawdy at November 13, 2005 08:49 AM

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Comments

I think there's one point you're overlooking:

According to your research, doctors are thinking of using atypicals as mood stabilizes over long term periods for biploars.

But consider this:

Psychiatric medication works differently for every individual. Not everyone responds the same to every med. For some people, one med could do wonders whereas for another, it could be a gift from hell.

Therefore, when anyone gets on medication, there is an inherent understanding that the paticular med may or may not work. That's simply the reality -- sometimes meds have to be switched or changed in order be theraputic to that individual person.

And so, if someone with bipolar is put on medication by their doctor, it is most likely the case that that med may have to be switched or given at a lower or higher dose, or something of that nature.

So, back to what you said, I think that EVEN IF atypicals are deemed as the best mood stabilizer for bipolars, any individual bipolar with their individual doctor is going to work together to find the best med fit. And even if the bipolar is initially put on an atypical...if that doesn't work, then any decent doctor won't have their patient stay on that atypical, they'd move on to something else.

Overall, I believe that even if one kind of med is deemed as miraculous for a certain population, meds are SO individual for each person, that any semi-decent doctor would change that miraculous drug for their patient if the bipolar and doctor thought it appropriate.

Anyway, I may just be niave, but I don't think you have to worry so much. It may be tricky, but I truly think doctors would be somewhat responsive to their patient's needs and wouldn't keep him/her on it if it was really detrimental to his/her mental wellbeing.

Posted by: Gwen Davis at November 13, 2005 12:19 PM

"but I truly think doctors would be somewhat responsive to their patient's needs and wouldn't keep him/her on it if it was really detrimental to his/her mental wellbeing."

with all due respect...

Hahahahahahahahahahahahahahahaha!

(We have differing opinions. That's all that means. I couldn't resist.)

Posted by: Laura Ogle at November 14, 2005 07:01 PM

Laura,

I'm sorry you've had negative expiriences with your doctors. And come to think of it, I have too. But in all honosty: Are those bad expiriences becuase your doctor truly wished to harm you? Truly wished to cause you needless suffering? Or was more a question of he didn't really know what was best for you? Didn't have a clear grasp of the situation? I'm assuming it's more the later. Anyway, I didn't mean to imply that all doctors are 100 percent on top of things...just that most of them, like most workpeople, don't want to be complete failures at their jobs, and therefore would be "somewhat responsive to their patient's needs".

By and by, I don't mind at all you ratting me out -- feel free to do it anytime. And isn't Philip's website great?!

Posted by: Gwen Davis at November 16, 2005 05:25 PM

Hi Gwen,

I had the pharmaceutical companies more in mind when I responded to your comments. I agree with you that doctors don't mean to be ignorant. They just are, lol! I mean, it's to the point to where the world is sorta upside down, and not because of our mental illness.

Yes, this site is pretty cool!

Posted by: Laura Ogle at November 17, 2005 09:08 AM

I have bipolar disorder. I've been given some 2 dozen drugs since I was diagnosed in 95, but I took my first atypical in 1998 or so. Zyprexa. I was on it for over a year, zombie all the time. So I was switched to risperdal.

Same thing. Couldn't even get off the floor some days. Went awhile after I was taken off it without one. Then I was put on seroquel at 600mg. Super zombie.

Gradually worked down to 350-400mgs but still hated it. All the usual shit plus I couldn't pee most of the time, even ended up on a catheter in an ER one night.

Then almost 2 years ago I was cutting myself and everybody wanted me in the Psych ward so I went in and they gave me abilify. I was still on the seroquel and a few other meds, but after a year or so I started to come off the seroquel.

Took a few months to do it sloooowly and now it's been 4 months since I was on it and life is better. And I'm still on the abilify and ya know I think it's the first med I've taken that has and is still working for me. All at the original 10 mg.

I'm Very cautious about saying something is working, having been fried so many times. And I can't give a long-term vote of support - 2 years is nothing as we know, but so far, mostly so good. Only drawback is my legs shake and I have to take cogentin for it.

It's worth it to have my mind coming slowly back to me. Of note is that abilify is said to help depression more than mania and that's more my concern now, tho I used to be hypomanic most of the time.

The only other psych med I take is klonipin, which helps a lot cause I still rapidcycle and do mixed states most of the time.

So there's my .02 for what it's worth. Maybe sometimes long term use is useful....

peace,
Steve Wells

Posted by: Steve Wells at November 21, 2005 10:56 PM