Pharmacology for Bipolar Dxo

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    I have a question about psychopharmacology for Bipolar dxo. I understand there are medications for the depression part of Bipolar, and the manic part. The depression part is treated with TCAs, SSRIs, MAOIs, and SNRIs. The mania is treated with Lithium, anticonvulsants and antipsychotics. My question...is the patient on both year around? Or do they take the TCAs during their depression phase and the Lithium during their manic phase? If so, who decides when they take what? I am confused. Please help clear this up for me.
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  5. 3
    I live with a bipolar husband and child and have been through heck pharmacologically with them. Thankfully we have a very supportive Psych NP who respects my input. My NP is fond of anti-seizure drugs like Lamictal and Tegretol coupled with an atypical antipsychotic such as Zyprexa or Abilify. The anticonvulsants didn't work for my family, having only a marignal effect for a few weeks on my son. He is on Abilify and has been for a while, but it starting to not work as well as it used to. We have tried a few other things, but most of them make his cycles worse. I have settled for controlling his depressive moods and marginal control of the manic episodes, Lithium is now being considered.

    I try to explain bipolar (and most psychiatric) pharmacology as throwing a dart repeatly until it finally hits close enough to the bulls eye. It is the most frustrating experience since what works for one person may not work for another, people have very individual responses to psych meds. On top of that, something may work for a while and then stop working. I know other bipolar parents who have kids on 5-6 different meds which scares me.

    With a bipolar person, they may be going through many depressive and manic cycles in the same day, so you are giving medications for both continually in that case. Both my husband and son are rapid cyclers, so very difficult to treat at times.
    VivaLasViejas, JulieL, and epijunky like this.
  6. 0
    Quote from LuckyinKY
    I live with a bipolar husband and child and have been through heck pharmacologically with them. Thankfully we have a very supportive Psych NP who respects my input. My NP is fond of anti-seizure drugs like Lamictal and Tegretol coupled with an atypical antipsychotic such as Zyprexa or Abilify. The anticonvulsants didn't work for my family, having only a marignal effect for a few weeks on my son. He is on Abilify and has been for a while, but it starting to not work as well as it used to. We have tried a few other things, but most of them make his cycles worse. I have settled for controlling his depressive moods and marginal control of the manic episodes, Lithium is now being considered.

    I try to explain bipolar (and most psychiatric) pharmacology as throwing a dart repeatly until it finally hits close enough to the bulls eye. It is the most frustrating experience since what works for one person may not work for another, people have very individual responses to psych meds. On top of that, something may work for a while and then stop working. I know other bipolar parents who have kids on 5-6 different meds which scares me.

    With a bipolar person, they may be going through many depressive and manic cycles in the same day, so you are giving medications for both continually in that case. Both my husband and son are rapid cyclers, so very difficult to treat at times.


    Thank u so much for sharing! I am glad u hear u found an NP that involves u in their care. That makes such a big difference! It too scares me that some chidren are on a large quantity and combo like that. On our adolescent and child psych rotation that was all too common. So for rapid cyclers, they re medicated for both on a daily basis? What about those who do not cycle that fast?
  7. 3
    Medications are constant. If you take a antidepressant because you are depressed, and do not have a mood stabalizer (lithium,anticonvolsant.....the ones that treat mania) you will shoot to manic. Someone with bipolar should NEVER be on antidepressants without mood stabalizers. And most meds take 4-6 weeks to be effective at all.

    Bipolar is about finding a balance. Think of a teeter totter.....to balance it you wouldnt put a weight on high end and then when it goes down, take it off and throw a weight on the other end......you would never balance it that way. To balance a teeter totter you would put a weight on each end, and then maybe add or take away a little weight on one end or the other when it is still off balance till you find a balance. You have to find a consistant balance in mood and keep it that way. Finding the meds and med combinations for bipolar is hard, and if things arent right adjustments are made to try to make it right, but the ideally once you get it right you do not make changes.

    Mood stabalizers and antidepressants are never "as needed" or due to a single mood episode....they take too long to be effective to be used as needed....and many have bad side effects going on or off of them and have to be slowly tapered on and off of. However sometimes some meds are added on on top of them as an "as needed" medication......maybe an antipsychotic, anti anxiety, or sleep aid.(though any of those may be full time as well)
    VivaLasViejas, JulieL, and epijunky like this.
  8. 0
    thanks so much! that clears it up!


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