Q:  Lupus & Medications for Bipolar

My spouse has been diagnosed with lupus recently and is now taking lithium to treat bipolar disorder. Should we begin looking for other medications to treat the disorder? Or, will lithium still be an acceptable treatment?
 

Dear Ms. B' --
I have no experience with this combination. Looking at PUB MED for references, and entering "bipolar lupus lithium", yielded no results. "Bipolar lupus" had some interesting results (you can try that yourself on Pub Med) including a report of lupus apparently caused by one of the medications we use an alternative to lithium sometimes, carbamazepine.^Schmidt

So I suppose we could say on the basis of that case report alone that perhaps carbamazepine might not be such a good idea for your spouse, if there were alternatives, although that reaction could have been a one-of-a-kind phenomenon with no implications for other patients.

However, almost the opposite has been reported for Depakote (valproate),^{KahnHYPERLINK "http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3394852&dopt=Abstract" D  another common alternative to lithium, where three patients with lupus or MS responded very well to the medication when it was given for bipolar-like symptoms.}

Finally, note the report of lupus showing up as a first episode of mania,^{Khan S} where the "manic" symptoms responded to treatment for the lupus, raising the question as to whether your spouse clearly had bipolar disorder prior to the lupus, or whether those symptoms might be caused by the lupus itself, and therefore perhaps not even require additional treatment beyond the treatment for lupus (although in the case report, you'll see that a "first generation antipsychotic, thorazine, was also used in addition to the lupus treatment).

So, it sounds like the first thing is to decide whether the lupus might explain the bipolar symptoms or if it's a simultaneous problem; then treat, perhaps looking at Depakote a bit earlier than we otherwise might consider.

Dr. Phelps

Published January, 2004