Q: Asking for Information on Saphris and insight on ECT
You've been very helpful in answering a couple of my questions in
the past and I now have another one - two actually. I'm a depressive bipolar
II, very treatment resistant when it comes to the depression with fairly mild,
brief hypomanic episodes. (along with ADD and a little anxiety thrown in on the
side) I spend the rest of my time at some level of depression. My psychiatrist
and I have tried everything that I can feasibly take - all kinds of
combinations, etc., including the newer atypical antipsychotics Abilify and
Geodon over a span of about 12-13 years.
He just started me on one called Saphris as a last shot before ECT,
and it seems to be working, or at least finally and quickly lifting some of the
extreme depression I've been experiencing for over a year now. What do you know
about Saphris? I realize it is brand new and meant for schizophrenia and
bipolar mania, not depression, but somehow it's working for my bipolar
depression in combination with all of my other meds.
Also, what are your thoughts on ECT? I've tried to put it off as an
absolute last resort because of the possible memory problems it can cause, but
this episode of depression has lasted so much longer and been much, much worse
than any I've had in over 10 years, even to the point of being suicidal for a
short period of time. I would just like to live depression-free, though I
don't know if I'd recognize it if I got there.
Any information on Saphris and insight on ECT you can provide would
be much appreciated. Thanks again!
Dear Laura --
Three ideas, about strategy, ECT, and asenapine (Saphris).
1. Strategy -- there are tools for getting out of depression, and
there are tools for staying out of it. As you know, the latter are called "mood
stabilizers". Lots of things work for getting out of depression, but only a
smaller group are well recognized as having the capacity to help staying well.
Very few patients come to me having had rigorous trials of multiple
mood stabilizers combined with one another, with no antidepressant in the
picture at the time. You might be one. If so, you're right, it's hard to know
where to go next. There are so many combinations of mood stabilizers that can
be tried, I rarely face that challenge.
For example, ziprasidone/Geodon is well recognized to act like an
antidepressant, especially at low doses, so anything that you were on while
you're also on the ziprasidone has to be considered for a do-over. Same story
applies to risperidone; and probably also to aripiprazole/Abilify, which in
bipolar depression has not been shown to be more effective than a placebo, and
I'm still encountering cases where I'm pretty sure (at least at low doses) that
it was possibly making things worse.
So that means trying things like combinations of lamotrigine/lithium/fish
oil/thyroid; or carbamazepine/thyroid/quetiapine (Seroquel); and several other
cocktails that are fairly routine for me.
2. After all that, you might come around to ECT, at lease to get
out of the current episode, but of course that leaves the question of how you're
going to stay well thereafter, which rather leads back to number one above, in
my view. In some people, "maintenance ECT" is used as the preventive approach,
about one session a month. It does work.
3. And then of course you could be the first on the block to try
the new thing, before we have really much of an idea as to whether or not it is
superior to any of our other options, or what exactly one might encounter in
terms of risks, short-term or long-term. On the other hand, it could be that the
new thing, asenapine, for example, would be perfect for you. Trying it is one
way to find out.
Whichever route you choose, I hope you find something very helpful
soon. Have a look at
N-acetylcysteine -- NAC -- while you’re at it (another “new thing”, but one
with which we have much more experience)
Published June, 2010