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Q: What Treatment Options are Available for Someone w/Rapid Cycling
Bipolar?
Help!!!!!
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. E’
--
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 you’ve got
plenty of company: there are many people going through something very like these
two problems right now.
Okay, so
you’re 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 we’ll 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 (don’t 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 – see the essay on
Light and Darkness – are just a dud, but at least they’re cheap and
presumably harmless).
Pay
particular attention to lamotrigine, which is getting cheaper now that it’s
generic, but is still pretty spendy if you don’t have insurance; and low-dose
lithium, if your kidneys are good (have the clinic doc’s check that before
starting, as well as your thyroid).
Speaking of
thyroid, one last approach that’s not standard but is intriguing and very
relevant for a woman with rapid cycling, is the UCLA approach using thyroid as a
mood stabilizer. Here’s a page on
thyroid basics, and then the page describing that
UCLA approach.
Bottom
line: there’s 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 you’ll need to find a provider – including
maybe that regular MD of yours – to work with you on these things. You can send
her to my website to learn more (I’m not making money there, it’s just a handy
way to grow the number of MD’s who understand this stuff)).
Good luck
with all that!
Dr. Phelps
Published November, 2009
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