What Treatment Options are Available for Someone w/Rapid Cycling Bipolar?
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Q:  What Treatment Options are Available for Someone w/Rapid Cycling Bipolar?

I have bipolar and I believe it is either II or rapid recycle. I am depressed most of the time and the manic seems like I'm in a better mood, but I can tell that I'm out of control. I crash when this happens.

I was on seroquel and now I have diabetes. I was taken off of the serequel, but now I'm a reck.

I have a hard time sleeping, I don't want to gain weight, I want my life back. I'm not motivated and I get overwhelmed easily. I start things and never finish them. I feel like I'm being buried alive.

Please help me. I can't seem to find someone here in Florida. The one place I went to where I had meds through an advocate program, would not give me my medication unless I gave them money and the advocate program is free medication. Needless to say, the company who gave me the medication said that this place was NOT supposed to charge me and they allowed me to change where the medication can be sent to; which was my regular MD. However, I need help; please!!!


Dear Ms. Eí --
Sorry to hear about this situation: a maybe-shady help operation (although many free clincs ask for a small donation to help run the place; the one I work with is $5 a visit, but no one is turned away for inability to pay); and getting diabetes in the middle of trying to get symptoms under control.  Not that it helps you directly, but you might not be surprised to learn that youíve got plenty of company: there are many people going through something very like these two problems right now.

Okay, so youíre asking, I think, what treatment options are available for someone with rapid cycling bipolar II, or at least rapid cycling bipolar disorder in which as far as you know, the manic side symptoms are not causing a lot of trouble (sometimes friends or loved ones might have a different opinion about that part, but for now weíll assume that your sense is correct).

Well, I think there are three simple principles here:

1. Maximize non-medication approaches

2. Use mood stabilizers to stop the cycling (donít target the depression, target the cycling, that opens up lots of possibilities in terms of medications)

3. Avoid antidepressants: they can cause or perpetuate the rapid cycling.

You can read more details based on these principles on the Treatment page of my website, with lots of links to additional information. In particular, among the non-medication approaches, see the one about Dark Therapy and take some of the links from there. I think this is an underutilized tool, although it definitely does not work for everyone (for some the amber lenses which can augment this approach Ė see the essay on Light and Darkness Ė are just a dud, but at least theyíre cheap and presumably harmless).

Pay particular attention to lamotrigine, which is getting cheaper now that itís generic, but is still pretty spendy if you donít have insurance; and low-dose lithium, if your kidneys are good (have the clinic docís check that before starting, as well as your thyroid).

Speaking of thyroid, one last approach thatís not standard but is intriguing and very relevant for a woman with rapid cycling, is the UCLA approach using thyroid as a mood stabilizer. Hereís a page on thyroid basics, and then the page describing that UCLA approach.

Bottom line: thereís lots to learn about management of rapid cycling, but the good news is that there are some solid options for you to try as well, and several of them are cheap (though not simple, so youíll need to find a provider Ė including maybe that regular MD of yours Ė to work with you on these things. You can send her to my website to learn more (Iím not making money there, itís just a handy way to grow the number of MDís who understand this stuff)).

Good luck with all that!

Dr. Phelps


Published November, 2009


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