A recent article in the American Journal of Psychiatry sheds light on the vexing challenge of treating depression in individuals who have an underlying bipolar disorder: For many people with bipolar disorder, depression occurs more frequently and damages function more severely than mania, but treating bipolar depression with antidepressants carries the risk of triggering manic symptoms.
Please check out Suelain Moy’s excellent interview of Dr. Fink, “Treating Bipolar Disorder: A Q & A with Dr. Candida Fink, Part 2.” Dr. Fink’s answers cover medication, therapy, self-help, and the benefits of having a strong support network. After reading the interview, please return here and let us know what you think.
About ten years ago, I was diagnosed as having bipolar disorder I. To qualify for a diagnosis of bipolar disorder I, you must have experienced at least one manic episode that was not triggered by medication or substance abuse. Most people with bipolar I experience depression, as well, but depression is not required for a diagnosis of bipolar I.
I have been in a Federal Detention Center (FDC) for the past five months. In accordance with my attorney’s advice, I cannot discuss any details of the case. Recently, I have started corresponding with Joe Kraynak, coauthor of Bipolar Disorder For Dummies. He requested that I share my insights from inside the criminal justice system regarding the way medications are prescribed and administered.
My wife is seeing a psychiatrist who prescribed lithium for her bipolar disorder. Recently, she visited another doctor, who prescribed Mobic (meloxicam), a nonsteroidal anti-inflammatory drug (NSAID), for pain and swelling in her knee. A couple weeks later, we spent the afternoon in the emergency room, where my wife was treated for lithium toxicity and had her lithium blood level checked.
Researchers at the University of Michigan have discovered that antipsychotics may work, at least in part, by restoring normal gene function in people with bipolar disorder. (Chen, H., Wang, N., Zhao, X., Ross, C. A., O’Shea, K. S. and McInnis, M. G. (2013), “Gene expression alterations in bipolar disorder postmortem brains.” Bipolar Disorders, 15: 177–187. doi: 10.1111/bdi.12039)
The research team did post-mortem (after death) examinations on the brains of three groups of people:
According to a recent study published in the journal Nature Communications entitled “A safe lithium mimetic for bipolar disorder,” British researchers are exploring a medication called ebselen as a possible treatment for bipolar disorder in humans. Originally developed to treat stroke, ebselen may be as effective as lithium in treating bipolar mania but carry fewer and less serious side effects than lithium.
As the article points out,
Lithium is the most effective mood stabilizer for the treatment of bipolar disorder, but it is toxic at only twice the therapeutic dosage and has many undesirable side effects.
A few weeks ago, my wife took too much lithium. She had had missed a few days of taking her lithium and decided to correct the problem by doubling her dose for a few days. As you might know or have surmised, that’s a really bad idea. The difference between a therapeutic and toxic level of lithium is quite small.
Symptoms of lithium toxicity include the following:
If you suspect that you may have taken too much lithium, stop taking the lithium and do one of the following:
In a study just published on PLoS One entitled “Lithium Impacts on the Amplitude and Period of the Molecular Circadian Clockwork,” researchers at the University of Manchester (Jian Li, Wei-Qun Lu, Stephen Beesley, Andrew S. I. Loudon, and Qing-Jun Meng) have discovered that lithium works as a pacemaker for the circadian clock, which may help to explain lithium’s mechanism of action – how it works.
Research has long shown an association between low folate levels and depression, particularly depression that’s more severe and less responsive to medical treatment. (Folate is a water-soluble B vitamin in its natural form. Folic acid is the synthetic version found in supplements.)
Folate is critical in the development of the human nervous system, so pregnant women must take folic acid supplements. People who abuse alcohol, people with certain illnesses, and those who take a number of different medications are at risk for folate deficiencies, which can present with a variety of cognitive, emotional, and behavioral symptoms. Doctors may check folate levels as part of an initial workup of depression.
I’ve messed up my meds by going cold turkey due to difficulties with insurance and lack of funds. Now I have to wait for the mail order prescription and I have not had any lithium for a month. This week I started noticing some of my early signs of my hypomania returning. Tonight, I’m not sleeping.
I don’t have a psychiatrist right now since my insurance wouldn’t cover his $300 office visits. I’ve just started with a new primary MD.
What are my options until I get the meds and get them to a therapeutic level? I really want to sleep! I start struggling with anxiety, agitation, and irritability that can escalate to rage. I’m more than a little nervous at this stage. Can you advise?
Your best option at this point may be to contact your primary care physician and explain your situation. Your doctor may be able to provide you with samples or a short-term prescription you can have filled at your local pharmacy to carry you through until your mail-order prescription arrives along with something for the short term to help you sleep.