What Meds Should I be Discussing to Control These Episodes?
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Q:  What Meds Should I be Discussing to Control These Episodes?

I have been dealing with bipolar for a while. I was doing well with Topamax for the manic which for me is more anger related (uncontrollable) with sometimes more pronouonced mania, lot of energy, go nuts cleaning the house etc, but that is not that often, and cymbalta. Recently I attempted suicide and the suicidal thoughts were still persistent, we increased the cymbalta which did not help. we switched to Seroquel which has really snapped me out of the depression. The problem is that I have noticed I am having a lot of uncontrolled rage creeping out. We increased the Topamax dosaage. What I'm curious about is what medicines should I be discussing with my Doctor to control these episodes? I fear if I can't get this under control it is going to cycle me into a depression again.

Thanks for any info you can give me.

Dear Jim

Although I cannot give you a specific recommendation, from many circumstances you describe, you might want to learn about divalproex (formerly tradename Depakote), which has been studied for sudden severe episodes of anger.  The formal name for this condition is "intermittent explosive disorder".  Its relationship with bipolar disorder is not clear.  In my experience, some men with bipolar disorder also would qualify for this explosive disorder description.  I think it is possible that any routine mood stabilizer medication could control these episodes, but divalproex is the best studied in that role.

In that context, I might also note that Topamax is not generally recognized as a "mood stabilizer".  That link takes you to my website page about mood stabilizers.  But if it works for you, that's fine.  If it doesn't, medications on the left side of the page are the usual candidates.

Dr. Phelps


Published June, 2009


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