Archives for Side Effects
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: People with bipolar disorder who never took antipsychotics People with bipolar disorder who had taken antipsychotics People without bipolar disorder (the control group)
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: Diarrhea Dizziness Nausea Stomach pains Vomiting Weakness/fatigue/sleepiness Hand tremors Slurred speech Seizures Coma If you suspect that you may have taken too much lithium, stop taking the lithium and do one of the following:
When's the last time you saw your doctor for a med check? A month ago? Six months ago? A year or more? Getting regular med checks, which can vary from weekly to quarterly depending on the level of acuteness of your symptoms, is important for a number of reasons: If you were placed on medications to treat acute mania or depression and you're feeling better now, your doctor may want to remove certain medications and/or decrease dosages to maintenance levels. You don't want to be taking more medication than necessary. During a major manic episode, for example, doctors often prescribe a mood stabilizer, such as lithium, along with an atypical antipsychotic, such as Zyprexa, and then gradually withdraw the atypical antipsychotic as the patient improves.
At a recent meeting of the American Psychiatric Association, researchers presented a study suggesting that ziprasidone (Geodon) was less effective in treating acute mania in people with obesity or hyperglycemia (very high blood sugar level). The study was funded by Pfizer, which makes Geodon, and was done by looking at pooled data from previous studies performed by Pfizer looking at this medication's effectiveness. The lead author of the study, Roger S. McIntyre, Associate Professor of Psychiatry and Pharmacology at the University of Toronto, indicated that while the findings could be related to a need for higher doses in people with higher body mass indexes, it could also be that these differences in body mass and blood sugar could reduce the effectiveness of the drug at any dose. While this type of study is apparently uncommon in psychiatric research, it is actually quite important in helping us understand patterns of effectiveness in various medications used to treat bipolar disorder.
Abilify (aripiprazole) is an atypical antipsychotic medication commonly used to treat schizophrenia and acute mania. In 2005, the Food and Drug Administration (FDA) approved its use in the maintenance treatment of bipolar disorder – to prevent the recurrence of mood episodes. Unfortunately, evidence proving the effectiveness of Abilify as a maintenance medication for bipolar disorder is scarce and questionable.
Exposing the TruthAn article published this week in the open access journal PLoS Medicine (Tsai et al) looks critically at the scientific evidence that supports such widespread use of this medicine for maintenance treatment of bipolar disorder.
A recent study published in the Journal of Clinical Psychiatry entitled "Are Mood Disorders and Obesity Related? A Review for the Mental Health Professional" (McElroy, Susan L.; Kotwal, Renu; Malhotra, Shishuka; Nelson, Erik B.; Keck, Paul E., Jr.; Nemeroff, Charles B.) reveals a possible connection between obesity and mood disorders including major depressive disorder and bipolar disorder. The study found that: Children and adolescents with major depressive disorder may be at increased risk for developing obesity. Patients with bipolar disorder may have elevated rates of overweight, obesity, and abdominal obesity. (Abdominal obesity is specifically related to higher risk of cardiovascular disease.) Persons living with obesity who seek weight-loss treatment may have elevated rates of depressive and bipolar disorders. Obesity is associated with major depressive disorder in females. Abdominal obesity may be associated with depressive symptoms in females and males. Most overweight and obese persons do not have mood disorders.