Cecie Asks…

I’ve been told that it has become increasingly the norm to only take the anti-psychotic medications and the heavier hitting mood-stabilizers for a limited period of time to get the moods and scary thoughts under control (when you feel an episode “coming on” or to recover from an episode you were unable to avoid) and then to stop them when you are stabilized.

I guess the idea is…

1. You don’t have to be under the effects of these medications any longer that is absolutely necessary.
2. These medications are actually more effective when used for only a short period of time, during the “acute” phase of the illness.

My questions are:

1. Is this something you recommend to some/all of your patients?
2. How long can I expect to be on an anti-psychotic medication and stronger mood-stabilizer after a manic episode with psychotic features?

Dr. Fink Answers…

During the acute phase of mania or depression, antipsychotics are often added to address psychotic symptoms that may be part of the picture and/or just to provide more rapid relief from the cycle, which they can do. Now something like lithium or Depakote is usually considered the core mood stabilizer (maybe Lamictal, too). The goal, the ideal goal, is that once the acute cycle is over for a while – a few months or more – you could try tapering off the antipsychotic and leaving just the core mood stabilizer.

Most doctors want to work toward having their patient on as few medications as possible for mood maintenance – preventing or reducing frequency/severity of cycles. This is what the practice parameters call for. Ideally, this means one mood stabilizer, preferably not an antipsychotic, because those are the most unpleasant for long-term use, although lithium has plenty of long term problems, as well.

Of course, a single mood stabilizer may be ideal, but it’s often not realistic to assume that this is going to work for everyone in every situation. Many people require layering of mood stabilizers even for maintenance. So while that is always a goal – to get to one med – it is often not do-able. In many instances, the “cocktail” will include long-term use of an antipsychotic.

And this doesn’t even begin to address situations in which antidepressants enter the picture – whether or where they fit in to a long-term treatment plan. Add antidepressants to the mix, and you get another sticky mess of questions.

Photo by e-MagineArt.com, available under a Creative Commons attribution license.

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    Last reviewed: 11 Jan 2011