Expert: Ivan Goldberg, M.D. - 7/30/2010

Question
Dr. Goldberg--

 First, let me thank you for responding to a previous question I asked you regarding the use of neuroleptics in bipolar disorder. I've decided that, depsite the TD risk, I'll take my chances with Abilify.
 I was prescribed Abilify @ 15mgs/day. This was a dosage reduction from the 30mgs/day I had been taking.  The Abilify worked well, but I went off of it for a couple months. I moved and started freaking out a little, so I went back on it. The 15mgs didn't seem to be cutting through the agitation and low-level psychotic symptoms quickly enough, so I bumped it up to 30mgs, thinking I'd taking the 30 for 6-8 weeks and then go down to 15 for maintenance.  My new doctor said to keep it at 30mgs/day, always and forever.  Is this sound advice?  I'm worried about side effects, and I thought the 30mgs/day was for mania or people who'd been treated with older neuroleptics before and might need a higher dose to control psychotic symptoms.
I am trying to prevent TD. I looked up articles on the treatment and prevention of TD with vitamins, so I've put together a program I hope might help. I take: 6 grams no-flush niacin (switching to niacinamide, same dose, soon); 3-6 grams vitamin C, 800 IU vitamin E, 200 micrograms Selenium, and a B-100. The niacin and vitamin C are divided into 2-3 doses. I'm adding in an additional 300mgs B6 and 5-10mgs melatonin once my next shipment of vitamins comes in.  Do you think this will help prevent TD? I already seem to be tolerating this higher dose of Abilify better than I did before I started taking the vitamins; I don't have muscle stiffness, tremor, unsteady gait, or dysphoria anymore.  
My final question is about Tenex. I have some focus issues (I guess you could call it ADD; to me its more like cognitive weirdness). The Abilify helps tremendously with my concentration, motivation, and focus, but there's still some room for improvement. I also have blood pressure spikes.  When I'm calm and medicated, my blood pressure usually is 120/80 or close to it. When I'm stressed or manic, it can go higher--my highest (that I know of) was 168/110 during an intense manic episode. Right now, its reading high; I forget what the diastolic reading was when I went in to see my doctor last, but the systolic was 151.  Do you think I could benefit from old-school (read: generic and cheap) Tenex? If my blood pressure fluctuates with stress and what not, could the Tenex possibly push my blood pressure too low?  

Thank you for your help.

Ian

Answer
I was prescribed Abilify @ 15mgs/day. This was a dosage reduction from the 30mgs/day I had been taking.  The Abilify worked well, but I went off of it for a couple months. I moved and started freaking out a little, so I went back on it. The 15mgs didn't seem to be cutting through the agitation and low-level psychotic symptoms quickly enough, so I bumped it up to 30mgs, thinking I'd taking the 30 for 6-8 weeks and then go down to 15 for maintenance.  My new doctor said to keep it at 30mgs/day, always and forever.  Is this sound advice? I'm worried about side effects, and I thought the 30mgs/day was for mania or people who'd been treated with older neuroleptics before and might need a higher dose to control psychotic symptoms.

While I am not a fan of the use of antipsychotic medications for the treatment of people with bipolar disorder, here is no doubt that they work. 30 mg a day is a typical dose.

I am trying to prevent TD. I looked up articles on the treatment and prevention of TD with vitamins, so I've put together a program I hope might help. I take: 6 grams no-flush niacin (switching to niacinamide, same dose, soon); 3-6 grams vitamin C, 800 IU vitamin E, 200 micrograms Selenium, and a B-100. The niacin and vitamin C are divided into 2-3 doses. I'm adding in an additional 300mgs B6 and 5-10mgs melatonin once my next shipment of vitamins comes in.  Do you think this will help prevent TD? I already seem to be tolerating this higher dose of Abilify better than I did before I started taking the vitamins; I don't have muscle stiffness, tremor, unsteady gait, or dysphoria anymore.

While selenium is potentially toxic and the plasma level of it soul;d be measured every 6-months the rest of what you are taking is pretty harmless. I am not impressed by he evidence that such a cocktail actually prevents the development of TD.

Best regards . . .

Ivan
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