Q: How Long Should We Wait b/4 Trying Another Mood Stabilizer?
How long should we wait before trying another mood stabilizer? My college age
daughter was diagnosed bp disorder a year ago. She is very ultra sensitive to
medication and responds to them quickly. She has been on Trilpetal (225 mg
daily) and 100 mg of Neurontin for a year. She is still unstable. Her doctor
added 1 ml. of Prozac five months ago, but it still didn't help her
anxiety/stress/depression. Her doctor added 1/4 of a .5 mg pill of Klonopin,
but she is still stressed/depressed. Her doctor added 1/4 of a .75 mg of
Wellbutrin. Within six days, my daughter became manic, could not sleep, heard
voices. So we quit the Wellbutrin, but still have the other meds. I believe
it's time to try another mood stabilizer and phase out the Prozac.
I want to try Lamictal or even lithium (because she needs so little medication
to feel its effect, I think she won't have the weight gain or kidney problem.)
Please help us! She is losing hope of ever feeling normal again!
Dear W'Mom --
The medications tried so far look like a rather systematic avoidance of the most
"tried and true" mood stabilizers, perhaps because your daughter is more worried
about weight gain than you are (and so has shied away from Depakote, lithium,
and some of the "atypical antipsychotics" now used as mood stabilizers. As a
result she's on a tiny dose of a possible (but we're not sure; no randomized
trials) mood stabilizer (Trileptal; where common doses are 600 mg at minimum,
1200 average, 1500 commonly, 1800 on occasion, top end for seizures 2400). The
rest are antidepressants (Prozac; and formerly Wellbutrin) and then the
Neurontin, which is not a mood stabilizer (pretty good antidepressant; can at
least occasionally exacerbate bipolar disorder like antidepressants; though hers
is a very low dose).
The medications you've named that you'd like to see
considered are standard approaches (e.g. per the
Guidelines for the Treatment of Bipolar Disorder). Perhaps you could
discuss those Consensus Guidelines with your daughter so that she is
well-informed in her discussions with her doctor (who may have chosen these
particular medications for reasons neither you nor I are aware of).
How long should one wait before trying another mood
stabilizer? Some are faster than others but I think most psychiatrists would
agree that a month on nearly anything (at its routine doses; or perhaps adjusted
to lower levels for your daughter, though then things get tricky -- is she
taking enough, we'd have to wonder) is long enough to have seen
something. Generally if by that time (or considerably sooner, if symptoms
are bad) I've seen nothing, I start moving on, swapping in something else. If
there's a clear response, but insufficient, I'd be adding something else,
perhaps later taking out the first one very slowly after a period of things
going very well. Just common sense there, nothing magic.
I hope she finds better symptom control soon.
Published December, 2005