Bipolar Disorder - Why One Medication May Not Work

Video Statistics and Information

Video
Captions Word Cloud
Reddit Comments

Love her videos. She has some other great ones on various bipolar topics.

πŸ‘οΈŽ︎ 6 πŸ‘€οΈŽ︎ u/mbarvar πŸ“…οΈŽ︎ Aug 05 2020 πŸ—«︎ replies
Captions
Hi, I'm Dr. Tracey Marks, a psychiatrist, and I make mental health education videos. Today, I'm answering a viewer question about how you can still have mania or depression in bipolar disorder when you're on medication. It's like, if you're on medication, you should be stable, right? Here are excerpts from the question from Jay, and I've edited just to make it a little shorter. "I'm 23 years old. I have bipolar II disorder and ADHD. I'm on Lamictal 300, Rexulti three milligrams, and Adderall 20 milligrams. I have been hospitalized four times in the last eight months, including attempt of hanging six months ago. My most recent hospitalization was in May, shortly after I experienced a hypomanic episode that felt great, then felt leveled out. Now I'm experiencing a depressive episode, and it hit hard. I do every June. My question is how much cycling is normal while on medication? Should I be getting this depressed still? It's pretty intense and came on suddenly. Tried to add in an antidepressant in the past, made things 10 times worse, and I went off the deep end. Is it possible that I'm still not on the right meds for me? Med changes terrify me after what happened with the antidepressants." Thank you, Jay, for this question. What you're describing sounds like rapid cycling bipolar disorder. I talk more about rapid cycling bipolar disorder in this video. Rapid cycling happens when you have more than four episodes of either depression or mania in a year. And this can happen when you recover from an episode, and then have like two months where you're feeling fine, and then have a recurrence of the same mood state, or you can switch directly from one mood state to the next, without any break in between. So you can go from being hypomanic to depressed, to hypomanic again, without any period of feeling normal. There are things that can contribute to switching or cycling, like your thyroid state, antidepressants, drugs, or even stimulant use. So Jay is on Adderall for his ADHD, but the use of Adderall can increase your risk of cycling or switching. It doesn't have to, some people with bipolar disorder can successfully take stimulants without a problem, but it is something to keep in mind if you're having this problem and you also take stimulants. And it's also something to keep in mind if you're having this problem to check your thyroid levels with blood work. Your doctor can write a request for you to get blood work to check this, but here's another big factor, and that's the choice of medication that you're on. Most times, people with bipolar disorder require a combination of medications that you take at the same time. Why, because the medications treat different aspects of the disorder. The main four phases that we target in treating bipolar disorder are acute depression, acute mania, mixed states, and the maintenance phase. Acute means that it's the active state that you're in, and it's relatively recent. Maintenance phase is the period between episodes, when things have stabilized. Not all of the medications work for every phase, so you could be put on a medication because you're manic, and then once that mania goes away, you could have a depressive episode pop up because that original mania drug isn't doing a good enough job keeping your depression away. Let me show you how this works with the actual drugs. The medications we use to treat bipolar disorder fall into two categories, the anticonvulsant medications and the antipsychotic medications. We use antipsychotic medications even if you're not psychotic. That's just the original classification that the drugs fell under when they were first developed and later became used as mood stabilizers for bipolar disorder. The anticonvulsant medications are called anticonvulsants because they treat seizures, so neurologists will use them for seizure management, they can also use them for migraines, some doctors will use them for pain management as well, like nerve pain. Psychiatrists will use them for bipolar disorder predominantly. There are some off label uses like anxiety, and that's a different video. Off label means that it's not the original purpose that the drug was approved for. So here's how this breaks down. I'm gonna use the brand names because they're easier to say, but I do have a handout for you that you can download from my website that will have the brand name and the generic name for you. You can use this handout as your own reference, and as a top talking point with your doctor about the medications that you might be interested in. So these are the medications that have been approved by the Food and Drug Administration for acute mania. The antipsychotic medications are Abilify, Saphris, Vraylar, Zyprexa, Seroquel, Risperidol, and Geodon. The anticonvulsant medications that have been approved for mania are Tegretol, lithium and Depakote, and technically lithium is not an anticonvulsant. It's really in its own category. All three of these medications require blood level testing though, so if you do take them, you're signing up for a commitment of having your blood level regularly checked, fairly frequently at first, maybe like every couple of weeks or monthly, until you get a level that's in the correct range, and then about once or twice a year. For bipolar depression, the only medications approved to treat this phase are Vraylar, Latuda, Seroquel and Symbyax, which is a combination pill that includes Zyprexa and Prozac. Notice there are no anticonvulsants on this list. For mixed episodes, the approved medications are Abilify, Saphris, Vraylar, Zyprexa, Seroquel, Risperidol, and Geodon. Again, there are no anticonvulsants on this list. The maintenance phase is when you're pretty much out of your depression or mania, you can have some residual symptoms, meaning there's still a little bit of something going on, but you're over the hump of the intense symptoms that were causing you a lot of dysfunction. Most people don't have 100% resolution of everything, but they are improved enough to where whatever they have is manageable. So maintenance medications work best to extend the length of time between episodes or prevent them from occurring altogether or decrease the intensity of the episode that does come back. Think of these medicines as having armed guards protecting your perimeter to keep the enemy from coming in. The antipsychotic medications approved for the maintenance phase are Abilify, Saphris, Seroquel, Geodon, and Zyprexa. The anticonvulsants are lithium, and then there's Lamictal. Now I keep saying approved, FDA approved means that when these drugs were tested, they were shown to work for a specific phase, and that's what they got their approval for. Your doctor can still prescribe medications that are for a non-approved purpose, like using Abilify to help with your bipolar depression, but it may not work as well because it doesn't have a track record for that, but it's still possible that it could work well enough for you. So let's go back to Jay's medication regimen. For bipolar disorder, he's taking Lamictal and Rexulti. Rexulti is an anti-psychotic that's only approved to treat schizophrenia and depression. It's not approved for bipolar disorder. Lamictal works best when you're in the maintenance phase and it really does its best job of preventing depressive episodes or lessening the intensity of them. So Jay, you're really not on something that has a track record of treating mania or even treating acute bipolar depression. Lamictal is not great for a current depressive episode. So if you're taking Lamictal, it's like having a lot of armed troops protecting your perimeter, but if the enemy is able to break through that barrier, Lamictal's done, and another medication has to swoop in and take control. So we tend to use Lamictal along with another medication, which is most commonly an antipsychotic medication. Why, because the antipsychotic medications are the main ones that do the heavy lifting in treating mania, depression, and mixed symptoms. From the list that I went through, there's only one medication that treats all four phases, and that's Seroquel. So if Seroquel is such magic, why wouldn't everyone take it and never get sick again? Because everyone can't take Seroquel. Seroquel has a lot of side effects. It causes a lot of weight gain and it may make you very tired. Some people can't wake up until they've had at least 12 hours of sleep, and with this medication, you can't just get up and shake it off. You can spend hours feeling like your head just doesn't clear up until mid-day. So if you have an early morning job, that's not gonna work well. The next drug that's the most versatile in treating three out of four of the phases is Vraylar. The only thing Vraylar has not been shown to do that well with is the maintenance phase. So because of that, if you take Vraylar, you will probably need to take another medication like Lamictal or lithium to protect your perimeter and keep the enemy from coming back. So the moral of this story is that combination therapy is very common in bipolar disorder because different medications have different purposes. The medication that gets you better may not be the same medication that keeps you better. So often treatment with bipolar disorder requires changing medications because of things like side effects or insurance coverage. The newer medications, the newer antipsychotic medications that are still brand name only can cost on an average of a 1,000 to $1,500, if you have no insurance, and even if you do have insurance, your insurance may eliminate more of the more expensive medications from the list of drugs that they'll cover. When they do this, they'll request that your doctor use an equivalent, but there may not be an equivalent that will do the job that we want it to do, and that you can tolerate. Gaining 50 pounds is not a minor side effect, and it's very appropriate to eliminate that medication from your available list because of that. Fortunately, many of these medications are generic and therefore more affordable. In the handout, I'll show you which ones are generic. So we do the best we can with what we have to work with, and if that means taking a medication off label, so be it, if it works, but at least now, you know the reasoning behind combining certain medications together and why only taking one may not be enough to keep you from cycling. Watch this video for more information on mixed symptoms and bipolar disorder. I also have a bipolar playlist where you can learn more on some of the things that I talked about in this video. Thanks for watching. See you next time.
Info
Channel: Dr. Tracey Marks
Views: 67,074
Rating: 4.9397283 out of 5
Keywords: mental health channel, mental health education, dr tracey marks, bipolar disorder, mental health, bipolar disorder treatment, rapid cycling, bipolar disorder (disease or medical condition), bipolar disorder medication, bipolar medication
Id: KDMbRW_fEwM
Channel Id: undefined
Length: 11min 58sec (718 seconds)
Published: Wed Aug 05 2020
Related Videos
Note
Please note that this website is currently a work in progress! Lots of interesting data and statistics to come.