Q:  Keppra

Do you have any experience with Kepra for very resistant bipolar depression.  I've been through everything traditional, and this is an option that is being presented as my next choice when the next episode occurs.  Each med has improved my situation, and so far Lamictal has kept the depressions controlled but present at least 50% of the time.  However, I'm taking the maximum found to be beneficial and still getting depressed.  My cycles are much slowed but still not gone and I'm currently on 3 mood stabilizers (lithium, depakote er, and lamictal--all at maximum doses).  I've not heard many people discuss kepra and am trying to gather information long before my  traditional October depression occurs.

Thank you.
 

Dear anon -- 
There has been a small beginning on this research question, from the NIMH, but they have not published or presented results yet to my knowledge.  There is one case report, and several reviews now mention it but not based on any systematic trials of the medication.  I haven't tried it yet but it's getting closer to the top of the "what else can we try?" list, somewhere after omega-3 fatty acids and thyroid medication, and getting very close to edging ahead of Neurontin.  Here's my list of mood stabilizers for your review to make sure you haven't missed anything; sounds like you probably haven't.    The "word on the street" is pretty hopeful, but at this point it very commonly is (e.g similarly with Abilify; the word on it is better at this point than it was with Geodon, which has not turned out to be particularly useful, so I think there may be some wisdom in that street word now and then). 

Dr. Phelps

Published September, 2003