Q:  Zyprexa & Son's Medical History

i have been diagnosed with bipolar disorder(mixed states) over ten yrs ago and remember feeling it since i was nine. i have been stable and able to maintain a job for over 12 yrs now. i take tegretol(mood stab) and lorazepam for occasional sleep problems. 

i'm having problems feeling really depressed lately,especially coping with the fact that both of my, now adult, children have bipolar disorder and now my 13 yr old grandson was recently diagnosed and on trileptal.

my main concern is my 31 yr old son, who has a significant medical history. 3 back surgeries, his colon removed, he has hep c, he also went into cardiac arrest during one of his surgeries,and a recovering heroin addict.  he recently started going to mhmr,cause the mania got so bad.they prescribed him zyprexa. he goes into such extreme manic states(he does not know what he is doing)then he of course gets depressed, nonfunctioning. is this an ok med for folks with any liver difficulties and/or hep c. guess i should be thinking about my self, huh?

thanks for any information you may provide. sorry this is so long
linda
 

Dear Linda -- 
Not long; understandable; and just like a mother to be asking help for her child first.  So, is Zyprexa a good mood stabilizer?  looks like the answer to that is a big yes, based on two recent studies which compared Zyprexa and Depakote.  One study was sponsored by the Zyprexa manufacturer and designed in a way that slightly favors Zyprexa looking good; but one was sponsored by the Depakote manufacturer.  In both cases Zyprexa outperforms Depakote significantly (we shouldn't forget about lithium, of course; there's a Depakote/lithium head-to-head comparison underway in Britain currently).  So, based on these data and other studies which also show Zyprexa to be better than placebo, we can pretty safely say at this point that Zyprexa is an effective mood stabilizer.  

And, as you may have learned, it can bother people's liver.  So can Tegretol, of course; and Depakote.  Lithium doesn't.  But, in your son's case, the way we would usually approach this is to give the medication we really want to use for the bipolar disorder, then watch his liver tests (simple blood tests) to see if his particular liver is being bothered by that medication.  If it was, we'd then be forced to switch.  Note that given your response to Tegretol, he might end up having to look at the close Tegretol cousin called Trileptal, which is similar in most respects except bothers livers much less.  

Be cautious about letting anybody give you an antidepressant now.  Your worries might respond better to good psychotherapy, if you can access that; that's a safer approach to take for depression in someone with bipolar disorder.  

And as you've probably told yourself many times, you didn't pick your genes nor pick the ones which would get handed on.  

Dr. Phelps

Published January, 2003