Expert: Ivan Goldberg, M.D. - 10/24/2010

Question
QUESTION: hi dr. goldberg:

help! i feel like i'm running out of options. i have been diagnosed with rapid cycling BPII. Antidepressants (SSRI, SNRI, MAOI, TCAs) increase my cycling and make me suicidal. I cannot tolerate the sedation from antipsychotics (or the restlessness from Abilify). I did not respond to Lithium and gained too much weight from Depakote (even though I was only taking 125 mg!). i can tolerate Lamotrigine but continue to have problems with agitation, cycling, concentration, obsessive thoughts, impulsiveness etc. is there anything left?

thanks for your help.
tom    



ANSWER: Hi . . .

It sure sounds as if you are thinking and feeling in a very hopeless way. While you certainly have tried somethings that have not worked, people with history such as yours often stop cycling when treated with innovative treatments such as c carbamazepine or oxcarbazepine plus Topamax + a calcium channel blocker.

Most people who come to me with a history of being unable to Lamictal turn out to have been started on too high in initial dose, and when started on 2 to 5 mg per day usually turn out to be bale to take it.

Best regards . . .

Ivan
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---------- FOLLOW-UP ----------

QUESTION: Thank you Ivan. Which calcium channel blocker do you typically prescribe? Have you had any success with T3/T4 thyroid augmentation and, if so, which ones have you used?  

Answer
Hi Ian . . .

Your mention of thyroid augmentation reminds me that I forgot to mention hypermetabolic doses of thyroid as a way of reducing/stopping rapid cycling.

The calcium channel blocker with the most success in stopping rapid cycling is nimodpine.

See: http://www.ncbi.nlm.nih.gov/pubmed/9333552

and, http://www.ncbi.nlm.nih.gov/pubmed/8177920

Best regards . . .

Ivan
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