My Cymbalta Withdrawal - Review of the Trilogy

I've blogged about my ongoing withdrawal from the antidepressant Cymbalta since I started tapering doses on March 20. In that time I've written three posts sharing my experience with the most recent being "My Cymbalta Withdrawal - Return of the Mind."  

This post is a review and summary of the first segment on my journey to 0 mg/day so far. But with a twist. I am inserting characters and adding plot that represents the Star Wars series.  Why not, right?

The Trilogy

1.  Withdrawal Wars. In "Withdrawal Wars" we find our hero, Duke Taperwalker, at the very beginning of the discontinuation process when he went down from 120 mg per day to 100 mg per day. We come to find out through the master obi-one-clinician that he needs to clear himself of the toxic antidepressant before he can begin to clearly access the Life Force.

Duke had high hopes since he has made it off several psych meds without invoking the wrath of the Discontinuation Syndrome. He's thinking Cymbalta withdrawal will go smooth and last less than six weeks or two months max. Our protagonist is not aware of the evil biopsychoneuropharmacology that lurks in the not-so-distant future. 

2.  The Syndrome Strikes Back. In "The Syndrome Strikes Back" post we find Duke eating a little humble pie.  The withdrawal from Cymbalta took a turn for the worse. He has been overpowered by the Dark Side and is experiencing severe symptoms from the evil warlord Darth Depression.   

It started at the beginning of the second week when they dropped Duke's dose to 80 mg per day. The psychmed rebel fighter began experiencing severe depression, which became mild by the end of the week. During the third week the depression became severe again, but this time worse than the prior week! And the fourth week was like the third. 

Even though young Taperwalker stayed at 80 mg per day, he continues to experience attacks from Darth Depression.  

So, we leave our hero devastated and trapped by the intensity of withdrawal symptoms. The Syndrome has regrouped and attacked with ferocity.  What now?  Where will this perilous journey lead him?
    
3. Return of the Mind. In "Return of the Mind" we find Duke pleasantly surprised and thoroughly relieved by the remission of Darth Depression. However, drug recon data and recent Cymbalta withdrawal symptoms indicate this is going to be a long and arduous process.

The episode starts at a point where the withdrawal from Cymbalta took another big turn. This time for the better! It is near the end of fifth week and he remains at 80 mg per day. Duke has actually had as much as six days in a row with only mild depression!!
It looks like the kid might be stabilized with intermittent, mild depression. He has remained in communication with his rebel leader psychiatrist, Dr. G, on a weekly basis throughout this withdrawal process. 

At the end of the fifth week the Executive Council of the Psychmed Rebel Alliance was convened to decide what to do next. Even though it was not clear what direction Duke's withdrawal symptoms were heading, the recommendation was to stay at 80 mg/day for a few more days and see what happens. It turns out that was a good move!

It is now the end of the fifth week of this episodic battle to get off Cymbalta. Duke Taperwalker has defeated the Discontinuation Syndrome once again!  His mind is clearer and his mood is significantly better. The psychmed rebels are enjoying an extended period of peace between the dark and light sides of the disordered universe. There is hope once again in the Pharma Galaxy!

What's Up Cymbalta What's Up?

I have had better moods lately because we paused the campaign to rid my body of Cymbalta. I've been at 80 mg per day for over five weeks now.

My psychiatrist wants me to stay at 80 mg for an unspecified period of time, but I'm wanting to press on, but respect for her recommendation resulted in a compromise. I agreed I would stay at 80 mg per day for four weeks and at that time evaluate my progress to determine whether to lower my Cymbalta dose or not.

My Cymbalta Withdrawal - Return of the Mind

This is my third post regarding the continuing saga of my withdrawal from the SSRI antidepressant Cymbalta.  It may be helpful to read my earlier posts on this topic: (1) Bipolar Treatment Update - Cymbalta Wars and (2) My Cymbalta Withdrawal - The Syndrome Strikes Back. 

Background

I have been on Cymbalta for six years.  It was added to augment Wellbutrin, my primary antidepressant, and improve treatment of lingering depression symptoms.

Although it worked for several years, I have come to believe that Cymbalta is no longer effective for me as an antidepressant.  It's known that antidepressants can be effective for a period of time (months or years) and then stop working.

Poop Out
  
A loss of effectiveness during antidepressant therapy can occur with most antidepressants.  A sustained, effective response from antidepressant treatment is not always achievable.  

Unfortunately, it's not fully understood what causes this so-called "poop-out" effect, or why it occurs in some people and not in others.  This effect could relate to the disease itself, pharmacological effects, or a combination of the two. 

Tapering - The Slow Withdrawal

I began tapering down from 120 mg/day of Cymbalta (a very high dose) on 3/20.  I dropped to 100 mg/day for the first week without significant problems.  

But when I went down to 80 mg/day at the start of my second week all hell broke loose.  It felt like a depression alien life form came and infiltrated my mind.  Since then I have had many days with mostly severe depression.  Not good.

Status

Well, my withdrawal from Cymbalta took another big turn lately. This time for the better! My depression has began to lift again. The intensity of my symptoms really dropped and since last Tuesday I've had mostly mild depression!! I remain in communication with my psychiatrist throughout this withdrawal process. We almost went back up to 100 mg/day at the beginning of last week because things were so bleak. On Monday we decided to stay at 80 mg/day for a few more days and see what happens.  It turns out that was a good move!
By the Way 

Adverse withdrawal effects and the discontinuation syndrome from Cymbalta are real.  They can be devastating to a certain percentage of users.  If I recall correctly this figure is in the 10 to 20 percent range.  Withdrawal effects are mostly overlooked by Pharma.  Because of this patients get taken by surprise when they try to get off the drug and experience a debilitating withdrawal process instead.

There are numerous papers, articles, and web sites that specifically address Cymbalta's under reported withdrawal effects.  Cymbalta Withdrawal Forums is a site I found helpful.  It used by folks dedicated to rooting out and addressing the adverse effects that can arise while getting off of Cymbalta.  Cymbalta Attorney gives you direct access to lawyers specializing in Cymbalta withdrawal and injury cases.  I'm sure they'd take my money, but I think I'll pass.  Cymbaltawithdrawal.net is another site that addresses Cymbalta withdrawal only.  It's not a good site but thought I'd include it for no specific purpose anyway.  

What's Next?

I will discuss my situation via email with my pdoc tomorrow.  Since things have lifted for several days in a row now she may okay lowering my Cymbalta dose some.  

I'm leaning towards remaining at 80 mg/day for another week to be safe.  This stuff is dangerous!  Also, we need to figure out how what the next tapering dose will be.  

Another 20 mg/day reduction in dosage is an overall drop of 25 percent.  Hmmm.  Maybe a bit much?  

How much would you decrease the next dose?

My Cymbalta Withdrawal - The Syndrome Strikes Back

Man, this has been a really difficult post for me to write.  I have been going through severe withdrawal symptoms (a.k.a. discontinuation syndrome by the medical community) from Cymbalta.  

The depression symptoms I experience keep me from writing.  My mind is dull and slowed with significant cognitive impacts.  Concentration, working memory, and attention is really messed up.  

I'm getting the “impending doom” type of anxiety.  It comes and goes.  I struggle to fight the barrage of negative thoughts.  Those suckers make the depression seem permanent, like it will never subside.  Fatigue, hypersomnia, and anhedonia (lack of interest, motivation, pleasure from normally enjoyable activities) are pervasive when my depression symptoms are this strong. 

The Situation

I have mentioned before that I am in the process of getting off Cymbalta.  It is the second of my two antidepressants.  I have been on Cymbalta for around six years.  It was added to Wellbutrin, my primary antidepressant, to help relieve lingering depression symptoms.

Although it helped my bipolar depression for several years, Cymbalta is no longer effective for me as an antidepressant.  It's well known that antidepressants can be effective for a long period of time and then stop working.  Unfortunately, it's not fully understood what causes the so-called "poop-out" effect, or why it occurs in some people and not in others.

Withdrawal

I discussed going off of Cymbalta with my psychiatrist, Dr. G.  She agreed and planned for me to taper off 20 mg/day each week from 120 mg/day (starting point) to 60 mg/day.  We would evaluate things at 60 mg/day and proceed accordingly.   

1st week (3/20-3/26).  Lowered dose from 120 to 100 mg/day.  Not much change except a little nausea.  Depression was similar to the week prior.  Depression was mostly mild during the week with a couple of moderate depression states.  

2nd Week (3/27 – 4/2).  Dose lowered from 100 to 80 mg/day.  Mood started okay but depression became severe by the second day (3/28).  Depression is moderate to severe for about two and half days at the beginning and mostly moderate to mild for the rest of week.

3rd Week (4/2 – 4/8).  Stayed at 80 mg/day.  This week was worse than the prior week.  I was severely depressed for four days in a row.  Depression began lifting on Friday night (4/6).  Certain symptoms are becoming stronger, like sadness and worthlessness.  Yuck. 

Status

I’m near the end of my fourth week.  The dose remains at 80 mg/day.  Like the two weeks prior I continue to experience days of severe depression.  This time it was five straight days for most or all of the day.  Today is Sunday and it seems like it finally lifting again.  I’m going backwards!   

Now What?

I’m sure glad we stayed at 80 mg/day.  It’s very likely the withdrawal effects would be worse if I had continued to lower the dose.   

I will email my doctor Monday with an update.  I’m not sure what she will say.  She may want me to go back up to 100 mg/day.

I’m going to bring up the idea of taking Prozac to control these Cymbalta withdrawal symptoms.  I’ve read this online in forums and articles.

One article I read today reports that Benadryl (dipenhydramine) helps with withdrawal symtoms.  I just started taking that today.

Summing It Up

Well, withdrawal from Cymbalta is not going as I'd expected.  I thought it was going to be without problems since I tolerate antidepressants well overall and I successfully got off Abilify several months ago.

Now I’m not sure what’s going on.  I just keep moving along.  I feel like Frosty the snowman when I tell myself “I’ll be back again someday.”  I will keep you posted as this perilous journey to de-Cymbaltanize myself continues.

Ketamine for Bipolar Depression Treatment

The debate continues over the best way to treat bipolar depression.  To a large extent, most of the antidepressants prescribed for bipolar depression are suspect with respect to their efficacy and tolerability.  

Looming in the background are a handful of emerging psychiatric antidepressants that demonstrate efficacy and rapid response time (hours or days).  I touched on this subject in a December post about seven novel treatment medications for bipolar depression.  In a post from last month I wrote about another potentially awesome drug, scopolamine.  I even tried it!

Meanwhile, the emergent drug ketamine has been studied in the scientific literature for the treatment of mood disorders.  Most studies focused on relief from major depressive order with only a few evaluating bipolar depression treatment.

Ketamine is a very rapid (as fast as 40 minutes) treatment for bipolar depression with acknowledged short term efficacy.  While its overall safety profile and tolerability seem positive, concerns about a few side effects (e.g., hallucinations) seem to persist.

Drug Background

Ketamine is used routinely as an animal tranquilizer and an anesthetic for surgery.  Unfortunately, it's also infamous for being used routinely in the recreational drug scene.  So, it comes with a bad rap to begin with.

The media recently published some curious stories about using ketamine as an add-on antidepressant for "difficult-to-treat" depression.  At the end of January NPR did a story about a severely depressed person's ketamine experience.  

I thought it glossed over the serious adverse effects. Also, this is an account of the experience of only one person who is not bipolar.  Bipolar treatment experiences are highly variable among individuals and unique for each brain.  Check out the story and you be the judge.   

The scientific literature affirms ketamine is a rapid acting and effective antidepressant.  And although the drug is well tolerated overall, some side effects still cause concern.  Potentially serious side effects reported are hallucinations, increased blood pressure, confusion, and respiratory stress. 

This is only some general information about ketamine.  If you want more facts and information check out my ketamine hubpage.

Ketamine Studies
There are dozens of scientific studies of ketamine going back 40 years.  However, most of the early studies were done to assess ketamine for use as an anesthetic during surgery, not as an antidepressant.

Fortunately, within the last decade or so there have been a good number of  studies involving ketamine for treatment of major depression, treatment resistant depression, and bipolar depression.

A recently completed trial showed a rapid and significant improvement in mood when using ketamine for bipolar depression.  It demonstrated rapid and significant improvement in depressive symptoms for the 79% of participants that responded to ketamine infusion.  Improvements remained significant through day 3.  The most common side effect was dissociative symptoms that occurred only at 40 minutes post-dosing. 

A 2010 study of 18 individuals having treatment-resistant bipolar depression found ketamine produced robust (71% responded to treatment) and rapid (response within 40 minutes) antidepressant effects from a single intravenous dose.  The researchers found ketamines effect of improved moods remained significant through day 3.   

Research in 2010 showed that multiple doses (6 infusions over 12 days) of IV administered ketamine (0.5 mg/kg over 40 minutes) administered to 10 treatment resistant, depressed individuals was robust (90% met positive response criteria) and tolerable.  Psychotic symptoms (e.g., hallucinations) were minimal and side effects are reported as generally mild.  However, three participants (30%) experienced "significant but transient dissociative symptoms."  Eight people relapsed between 6 and 45 days after ending ketamine treatment.  One had only minimal depressive symptoms for over three months! 

A 2006 trial used ketamine for treatment-resistant major depression.  The placebo-controlled, randomized, double-blind crossover trial concluded that ketamine is a rapid (less than 2 hours response time) and robust antidepressant when administered as a single intravenous dose.  The 17 trial participants were diagnosed DSM-IV major depression (treatment resistant).  Results show that 71% met response criteria and 29% were in remission (no symptoms) when measured the following day.  Also, following the trial 35% maintained a positive response for at least 1 week. 

Even with over 10 years of research on ketamine for treatment of depression, further studies are still required to better understand proper therapeutic dosages, administration methods, side/withdrawal effects, and other relevant factors.  There needs to be more data with statistical relevance (e.g., larger sample sizes) analyzed for treatment efficacy, tolerability, and safety.

Findings

1. Ketamine has established itself as a novel, rapid, and robust antidepressant with seemingly unresolved tolerability concerns;
2. Further trials are needed to substantiate earlier findings from some of the smaller studies; 
3. Additional trials are needed to investigate the possibility of using ketamine for longer treatment duration.  Specifically, the long term treatment that may be needed for effective acute and chronic bipolar depression treatment in some individuals;  
4. Clinical trials data is needed to develop dosing guidelines and administration techniques; and
5. A couple of side effects are still a concern, but otherwise ketamine is tolerated well.

Conclusion There are no safe and effective antidepressants available that have the rapid and powerful onset like ketamine.  We have scientific studies of the drug's mood changing effects going back over a decade.  It's not like ketamine is new to the block.  I think it's time to accelerate the advancement of promising treatments like ketamine. 

I'm not optomistic about ketamine's future.  Research and clinical trials are taking way too long.  It's reputation as a recreational drug doesn't help matters.  Ketamine could very well end up stuck in limbo between initial lab studies and your medicine cabinet    So, would you consider particpating in a ketamine study?  I know I would!  Take care friends and take your meds.

Bright and Sunny Bipolar Afternoon

Ah, it's feeling like spring here in Southern California today.  It's a sunny afternoon without a cloud in the sky.  This has me in a light and jovial mood.  


My depression mutes much of the good mood.  I know it won't last forever.  But I'm certainly not complaining!




Anyway, I thought I'd find some things to laugh about and have done just that.  Here is some funny bipolar stuff I found from around the web.  Hope you enjoy! 

(1) You know you have bipolar disorder when:

• You can identify medication in the dark merely by shaking the container;
• Your drugs help you achieve reality, not escape from it; and
• You know more about mood disorders than your physician, yet still question your bipolar diagnosis.

(2) You know you have bipolar depression when:

• You have been told to “just snap out of it!” more than 3 times today already;
• Your "not talking" becomes the reason others want your antidepressant dose increased; and
• Instead of looking at the weather in the morning, you stay in bed, read about moon phases, work on your mood chart, count meds remaining until refill, and .

(3) You know you have bipolar mania when: 

• Your pharmacist (who you have on speed dial) stops trying to explain side effects of your meds, and starts asking you for information; 
• You can recite half of Homer’s Iliad and your bank account numbers, but can’t remember where you put your keys, car, or drivers license; and
• It's February and you’ve already spent the entire year’s budget.

After getting settled down for their first appointment the psychiatrist made the innocent mistake of asking the acutely manic patient how he was doing overall.  The excited individual replied, "I am fine.  I have bipolar disorder but I'm not crazy.  Crazy?  I was crazy once.  They put me in a room strapped to a chair in the middle.  That bugged me.  Bugs?  I hate bugs.  They drive me crazy!  Crazy?  I was crazy once.  But now I'm on seven psychiatric medications.  I take medication three times a day.  This constantly puts me in touch with the illness I have.  Do you know how that feels?  It drives me crazy!  Crazy?  I was crazy once. . ." 


A psychopath may think that 2 + 2 = 5 and could care less.  The neurotic knows that 2 + 2 = 4 and worries day and night.



After the acutely manic individual became relaxed and settled on the couch, the psychiatrist began the first therapy session. 

"I'm not aware of your problem." the doctor said.  "So perhaps, you should start at the very beginning."   

"Of course." replied the patient.  "In the beginning, I created the Heavens and the Earth..."

In a deep depression the patient says, "Doctor, doctor, I can't concentrate.  One minute I'm fine, and the next I'm blank!

Doctor asks, "Well, how long have you had this symptom?

Patient replies, "What symptom?"

Two psychologists were silently walking down the hall together.  One turned to the other and said, "Hello, how are you?"  Immediately the other thought, "What does he mean by that?  I hate when he uses psychology on me." 


If you are in a bipolar mania and want to avoid another 5150 (involuntary psychiatric hospitalization), then be careful what you tell emergency officials.  It is best to be selectively obscure, with clarity and sincerity when answering questions from police, emergency personnel, and mental health workers.  This will cloud their ability to recognize that you are delusional.


Two doctors opened offices in a small town and put up a sign reading, "Dr. Smith and Dr. Jones, Psychiatry and Proctology."  Some town members were concerned that the sign was too formal and proposed "Hysteria and Posteriors."  Both doctors quickly disagreed and proposed the catchy phrase "Schizoids and Hemorrhoids."  The town's mental health advocates felt this would be politically incorrect and suggested "Catatonics and High Colonics."  As soon as the controversy hit the papers thoughtful suggestions began rolling in: "Manic Depressives and Anal Retentives", "Minds and Behinds", "Lost Souls and Assholes", "Analysis and Anal Cysts", "Nuts and Butts", and "Loons and Moons."  Finally, after considerable debate they decided it would be "Dr. Smith and Dr. Jones, Odds and Ends." 

THE 10 COMMANDMENTS OF BIPOLAR DISORDER

1. Thou shalt not worship the bipolar condition.
2. Thou shalt not obsess over dangerous things, people, and places when severely manic or depressed.
3. Thou shalt not doubt, feign interest, or blame the holy chemical imbalance theory. 
4. Remember the ritual of taking your psych meds.
5. Thou shalt honor and not manipulate family or friends.
6. Thou shalt not kill or beat up anyone while in a manic fit, no matter how much ye really want to, or how much they deserve it.
7. Thou shalt not commit adultery unless in a manic state.
8. Thou shalt not throw and break stuff that does not belong to thee.
9. Thou shalt allow others to occasionally get a word in edgewise.
10. Thou shalt not covet other people's attention nor send crazy e-mails at odd hours of the night.


Do you have any good bipolar or mental health jokes?  If so, please comment here or you can send it to me at bipolartrail@gmail.com.  


Added 3-17-12.  A son and his father are traveling on the interstate.  There is a bad accident.  Both need medical attention.  The father, a schizophrenic, gets taken to a nearby mental hospital.  The son, believed to have early onset bipolar with schizoaffective tendency, was taken much further to a mental hospital for children.  The physician enters the room to attend to the boy and says, "I can't treat this child, he is my son!"  How is this possible?

Scopolamine for My Bipolar Depression

I wrote a post back in December about seven mostly promising new drugs for antidepressant treatment.  Of the seven I am now looking towards scopolamine as a possible add-on to my current medication treatment.

For the record, each day I take Wellbutrin (450 mg), Cymbalta (120 mg), Lamictal (300 mg), Xanax (0.25 - 1 mg), NAC (2000 mg), multivitamin, fish oil, (300 mg omega-3 fatty acids), and aspirin (81 mg).

Background

Scopolamine has been shown in limited clinical testing to provide rapid, robust antidepressant effects for depression and bipolar depression.  The drug works much faster than SSRI type antidepressants, taking only hours instead of weeks to reach therapeutic levels.

However, it is not approved to treat depression or bipolar depression. Scopolamine is approved for use to control motion sickness and to reduce post operative nausea.  It is most often delivered transdermally (through the skin) using a special patch - a membrane-moderated transdermal drug delivery system.

I read through some online user reviews and ratings of scopolamine.  Not surprisingly, the effects from the patch varies from person to person.

The majority of people commenting say that the patch (scopolamine) works much better than OTC motion sickness medicine they have tried.  Some people wrote of side effects after removing the patch, mostly headache, nausea, dry throat/mouth, and blurred vision.  Most people say the side effects are worth the benefit of not getting motion sickness.

Scopolamine Findings

Based on what I have uncovered I find the following observations to be of interest:

• Intravenous scopolamine can be a rapidly acting, effective antidepressant.  Additional information is needed to asses the efficacy and tolerability of transdermal delivery.
• Scopolamine treats unipolar and bipolar depression.
• Scopolamine can be taken in several forms including orally, intravenously (IV), and transdermally (through the skin).
• Side effects concerns include memory impairment, dry mouth, nasea, drowsiness, blurred vision, and headache.
• Scopolamine works better for women than men.  That seems odd?
• Scopolamine for depression treatment still requires further study to determine therapeutic dosages, delivery mechanisms, side/withdrawal effects, and other relevant factors.  There needs to be more data with statistical relevance (e.g., larger sample sizes) analyzed for treatment efficacy and tolerability.   

The Scopolamine "Test"

So, after digesting several scopolamine studies and other web sources I decided to give it a go!

The scopolamine I received was through the skin (transdermal) by a patch.  This patch has the brand name Transderm Scop and requires a prescription in the U.S.  In Canada they are available from pharmacists without a physician's prescription.  Yay!

According to the package a Transderm Scop patch contains 1.5 mg of scopolamine.  The1.5 mg of scopolamine is programmed to deliver 0.5 mg per day over three days.  This is the approximate equivalent of a 72 hour continuous intravenous infusion at 5 micrograms per hour.  According to fellow blogger Garth Kroeker, a patch dose ". . . would roughly approximate the IV doses [4 micrograms per kilogram) used in several studies . . ."

I didn't have any patches handy but my friend had an extra patch and gave it to me.  It expired in 2001 so I'm hoping it still works.  This clearly is not a scientific study!

I applied the patch at 10 am.  After about 30 minutes I felt a little nausea.  This could be from an empty stomach with psych meds and coffee?

Wow! It's been an hour and I just realized pupil in my right eye is huge!  The left is normal.  I've been rubbing my right eye.  Maybe I got some scopolamine in my eye!  I hope this goes away.  My vision seems fine.

I looked on drugs.com for side effects related to vision.  There was a mention of unilateral dilation being reported suggesting "some ocular events may be due to inadvertent contamination of the eye when there is failure to wash the hands after drug application."

Well that makes sense.  I didn't wash my hands with soap and water after applying the patch.  Note to self: keep scopolamine out of eye and try to follow directions better.

Scopolamine: Final Analysis

Well, results are inconclusive.  The patch had no noticeable therapeutic effect for me.  Also, there was very little trouble (if any) with side effects or withdrawal effects.

I wore it for the directed 3 days.  I wore it an additional 4 days out of concern of withdrawal effects.

The big questions are whether the expired patch I used was effective and if I received a therapeutic dose.  I would guess the patch was ineffective and I didn't receive enough scopolamine.  Need to repeat test.

My next move is to obtain some patches that haven't expired and try this again.

By the way, my dilated pupil returned to normal by the third day.

7 Novel Bipolar Treatment Medications

This post is a brief overview of seven emerging or novel drugs for treating bipolar disorder.  This should not be considered a thorough analysis of the state-of-the-art in psychotropic medications. Most of these products have not finished being tested.

Your psychiatrist has probably not even heard of them.  So don't get too excited about seeing if they will work for you anytime soon.  I am posting this out of curiosity and hope for the future.  I think it is encouraging to know science is making headway towards more effective drugs with less side effects.

Current treatments for bipolar depression have a considerable lag of onset of action.  An alternative product with rapid antidepressant effects (hours or days versus days or weeks) is needed.  Ongoing research is promising with newer, faster acting drugs in the testing or approval stage.

1. Ketamine is a drug that has some clinical testing and appears to work well for treatment resistant bipolar depression.  It is fast acting and generally well tolerated.  An IV is used for administering the drug so you better like getting poked.  

It seems product development on this drug has stalled since it can cause hallucination and significantly interupts normal brain function.  Because of the ability to experience abnormal states ketamine is popular at underground parties and raves.

2. Oxycarbezepine is a derivative of the mood stabilizer carbamazepine (Tegretol).  It is being studied for acute mania, hypomania, mixed episodes, and rapid-cycling.  For now a lack of sufficient quality trials precludes us from knowing its effectiveness and tolerability. 

3. Riluzole is a novel chemical that is being studied for treatment of bipolar depression.  It is already an FDA approved prescription drug used to treat Lou Gehrig's disease.  Studies show it effective in treating acute bipolar depression alone or in combinations with other antidepressants.  The first large controlled trial of Riluzole is being conducted at the Yale Depression Research Program.

4. Tamoxifen has been evaluated for acute mania treatment.  Results from several trials demonstrate that it is both effective and well tolerated.  One researcher said that Tamoxifen isn't perfect but it fits the bill.  Is that an endorsement?  It is a promising antimanic drug but larger studies are needed before it can be sent to the FDA for approval.  Interestingly, the drug has been in use for two decades to treat breast cancer under the brand name Nolvadex.

5. Tiagabine is an anticonvulsant being studied for maintenance treatment of bipolar disorder.  It is already FDA approved for treatment of partial seizures under the brand name Gabitril and it is already being used off label for controlling anxiety.  As with most of these emerging treatments tiagabine needs better studies before a determination can be made as to its therapeutic potential for bipolar disorder.   

6. Saredutant is a promising neuropeptide being studied for treatment of major depression disorder.  Neuropeptides work on different neurotransmitter systems than conventional antidepressants.  Saredutant produced favorable results and is in clinical trials for long-term efficacy and safety.

7. Scopolamine.  Scopolamine showed rapid, robust antidepressant properties in clinical testing.  It is being tested for relief from both depression and bipolar depression.  It is interesting to note that this drug is already in use for motion sickness relief.  If it ends up working then you can go boating without puking or being sad.  

Research for drugs that can effectively treat bipolar disorder continues.  It is exciting to note they are finding chemicals that work much faster than what we are used to, showing effects in hours instead of days or weeks.  It is also promising that some of these medications are already approved and in use for other treatment purposes. 

The understanding of bipolar mood mechanisms is increasing. While promising solutions are being discovered it can be disappointing at how long it takes for them to get studied and approved for use.  However, we should be grateful for what we already have and hopeful that science will make enhanced meds that work even better.


Do you know of other medications being studied for bipolar treatment? 

ALERT - Meds Change

I'm making my first medication adjustment for my bipolar in over a year.  I'm reducing the Abilify I take by 50 percent from 30 mg/day to 15 mg/day in the evening.  We'll see soon how this works out, stay tuned.

Abilify was prescribed for my depression - specifically, it is being used as an add-on treatment for treatment resistant depression when an antidepressant alone is inadequate.  The exact way Abilify (or any other psychiatric medication for that matter) works is unknown. It is thought that it may work by affecting the activity of some key brain neurotransmitters — adjusting dopamine, instead of completely blocking it, and adjusting serotonin.  Okay, whatever.

I reported to my psychiatrist last Friday that some depression symptoms were not acceptable.  I was having too much difficulty getting out of bed and starting my day.  She said Abilify can sometimes make people groggy and get the "stuckness" feeling.

So, we decided reducing the Abilify was worth trying.  I was skeptical at first since Abilify was the last drug I added to my medication regime back in October 2010.  It was added at that time to curb an oncoming depression episode.  I do remember it helping some at the time.

With the current adjustment my new medication cocktail is: Morning - 450 mg Wellbutrin, 60 mg Cymbalta; Evening - 15 mg Abilify, 300 mg Lamictal, and 60 mg Cymbalta.  I also take a multivitamin and 300 mg of omega 3 from a fish oil capsule.  I'm glad the fish oil is in a capsule because it tastes pretty nasty.  Is this stuff the extract of fish guts or what?

Here's a mosaic of my current medication cocktail. ==>  ==>  That's all for now.  Join me next time for a look at bipolar disorder and stress!