Posted by Scott L. Schofield on March 7, 2000, at 17:33:50
In reply to Re: Rapid Cycling Bipolar Disorder, posted by dove on March 7, 2000, at 12:40:26
> Another note, I did horrible on Tegretol, truly horrifying, but Verapamil had a mind blowing effect, and that's in the positive. It has been the *only* med ever, that calmed the cycles. I have gone to four p-docs, and two internal medicine docs, asking for it. Well, it ain't no scheduled med now is it, and no one's trying to buy it on the streets, so what's the problem. Their reasoning always returns to the primary p-doc's opinion that I need to get stabilized on the AD first, then add the mood-stabilizer. I live in a rinky-dink little midwest town, limited insurance, limited choices, keep hoping for the proverbial lightbulb to pop on over the doc's heads.
>
> Keep us updated, I am very interested in how you manage the plethora of symptoms.
>
> doveHi.
There are *many* citations in the literature regarding the use of verapamil in bipolar disorder. Unfortunately, most of them describe studies that have been designed to evaluate its efficacy in treating acute and severe mania. Most of these indicate that it has only modest positive effects for this presentation. However, verapamil is more likely to be effective in hypomania and mixed-states, and may be particularly useful as an adjunct to mood-stabilizers. Anecdotal reports describe verapamil as being effective to treat the depressive phase of bipolar illness as well, and may serve as a prophylactic against relapse into both phases. Verapamil seems to be of little value for treating unipolar depression, however.
There is sufficient rationale to try verapamil when other alternatives fail.
I included just three Medline citations below so that you may have something in black-and-white to show your doctor.
- Scott----------------------------------------------------------------
Am J Psychiatry 1992 Jan;149(1):121-2
Verapamil versus lithium in acute mania.
Garza-Trevino ES, Overall JE, Hollister LE
University of Texas Health Science Center, San Antonio.Twenty acutely manic patients were studied in a double-blind randomized trial comparing verapamil with lithium. The Petterson Mania Scale, the Brief Psychiatric Rating Scale (BPRS), and the Clinical Global Impression (CGI) were administered before treatment and weekly during 4 weeks of treatment to evaluate response to verapamil and lithium. Both treatment groups improved significantly, and there were no significant overall differences between treatments.
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Neuropsychobiology 1993;27(3):184-92
Calcium antagonists in manic-depressive illness.
Dubovsky SL
University of Colorado School of Medicine, Denver, CO 80262.Increased free intracellular calcium ion concentration ([Ca2+]i) has been found in lymphocytes and blood platelets of patients with bipolar affective disorders when they are acutely ill, but not after recovery. Because lithium alters intracellular calcium ion dynamics and lowers platelet [Ca2+]i in affectively ill patients but not controls, drugs whose primary action is to modulate [Ca2+]i in hyperactive cells have been used as antimanic agents. The best studied of these is verapamil, a calcium channel blocking agent (CCB) that appears most effective for lithium-responsive patients. Because they interact with different central CCB receptors, second-generation CCBs may have a different spectrum of action. CCBs are usually well tolerated and may be useful for a number of other psychiatric, neurological and medical conditions.
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Compr Ther 1990 Dec;16(12):18-23
Perspectives on bipolar illness.
Cook BL, Winokur G
Department of Psychiatry, College of Medicine, University of Iowa, Iowa City.Based on evidence available at present, it appears that heterogeneity does exist within bipolar disorder. Persons with mania differ in family history of affective illness, their age at the onset of illness, sex, and organic cause and course of the illness. The question of how these variables influence an individual's response to treatment has never been systematically studied. Multicenter trials of the various antimanic agents need to be conducted to determine whether the various subgroups of manic patients have different pharmacological response profiles. At present, the clinical management of mania is best approached using lithium carbonate in a dosage adequate to achieve a 12-hour serum lithium level to 1.0 to 1.2 mEq/L. The time to response is usually 2 to 3 weeks, and during this period an antipsychotic or benzodiazepine agent may be added to help control symptoms such as agitation or sleeplessness. Prophylactic maintenance with 12-hour serum lithium levels between 0.8 and 1.0 mEq/L should be used for at least 6 to 12 months after resolution of the manic episode. In patients with more than one episode, lithium maintenance therapy may need to be continued indefinitely. In patients who are not responsive to lithium, the most prominent alternative therapies include anticonvulsants and calcium-channel blocking agents. Anticonvulsants (e.g., carbamazepine, valproic acid, clonazepam) are generally first used as alternative therapy (either alone, or in combination with lithium), followed by a calcium-channel blocker (e.g., verapamil). Clinical practice would generally suggest first using the alternative agent alone, then adding lithium if response is inadequate.
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Schizophr Res 1999 Sep 29;39(2):153-8; discussion 163
Comparative pharmacology of bipolar disorder and schizophrenia.
Post RM
Biological Psychiatry Branch, National Institute of Mental Health, Bethesda, MD 20892-1272, USA. [email protected]The treatment of acute mania and schizophrenia overlap considerably in terms of the typical and atypical neuroleptics, but begin to diverge with the recognized mood stabilizers for bipolar affective illness--lithium, carbamazepine, and valproate--which are substantially less effective in schizophrenia than in affective illness. Moreover, the L-type calcium channel blocker verapamil is reported to be effective in mania, but it may exacerbate schizophrenia. A series of new putative mood stabilizing anticonvulsants (such as lamotrigine, gabapentin, and topiramate) and possible second-messenger targeted treatments (tamoxifen and omega-3 fatty acids) deserve further study in both affective and schizophrenic syndromes. Repeated transcranial magnetic stimulation (rTMS) of the brain offers considerable promise in the treatment of a variety of neuropsychiatric syndromes, especially with preliminary evidence of frequency-dependent effects on regional cerebral blood flow. New insights about the potential neurotrophic effects of lithium and the gene transcriptional effects of other psychotropics offer exciting new targets for therapeutics and strategies for future clinical trials and therapeutic applications in both syndromes.
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poster:Scott L. Schofield
thread:25437
URL: http://www.dr-bob.org/babble/20000302/msgs/26277.html