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The manufacturer's studies with Seroquel for bipolar depression compared 300 and 600 mg/day and found no greater antidepressant effect with 600 than 300 mg/day. If I had a patient of my own who had been well on Seroquel 300 mg/day but had a depression relapse, in addition to proposing a psychotherapy to address the stresses in the picture, I would probably add a 2nd medicine with known antidepressant properties that was not redundant with Seroquel's mechanism (eg, lamotrigine, Nuvigil, Provigil, possibly lithium, or possibly an antidepressant depending on the individual circumstances of the patient in terms of their candidacy for an antidepressant). See my video under "Resources" re. treatments for bipolar depression; and above all, pose this question to your own doctor for his or her own treatment recommendations.
Dr. G.View Thread

No medicines have specifically been studied to treat GAD in people with bipolar disorder. There is some evidence that Seroquel can lower overall anxiety symptoms when using it to treat bipolar depression.
Dr.G.View Thread

Pharmacogenetic testing at present can tell us information about whether someone may metabolize certain medicines too quickly (meaning they'd need a higher dose) or too slowly (meaning they'd need a lower dose) to compensate for side effects. That's about as relevant as genetic testing is at present. I know of no science to show that these commercially available products can provide information about the efficacy of any psychiatric drug.
Lithium is a salt and is not metabolized, it is just excreted by the kidneys, so, there would be no rationale for claiming to study genes that metabolize it. Lamictal is metabolized by the liver, but not by the enzymes that AssureRX or Genomind (another company that does this) tests (ie, cytochrome P450 enzymes) -- it's by a metabolic process called glucuronidation, and I'm not aware of any known genetic variations in the enzymes that perform this function. These genetic tests say nothing about any diagnosis, bipolar or otherwise -- they just give information about how fast or slow the medicine is broken down by the body. I'm not sure that adds a whole lot of useful information, and it's pricey too.
Abilify has not been shown to treat bipolar depression (was the same as a placebo in the manufacturer's studies). Lamictal by itself also is more potent to prevent depression rather than treat it when it's present. The combination of lithium plus Lamictal has some research to support its value for acute bipolar depression. There are many other treatments though that are better established for bipolar depression, which are discussed in the videos I have links for under "Resources."
Interpersonal/social rhythm therapy (IPSRT) is useful when there is a lot of emotional overinvolvement in families (eg, critical communication styles, overinvolvement), developed largely by David Miklowitz PhD. I have no idea though how to find out if a given therapist is familiar with it, but my guess is it's a very small minority. There are ways of finding therapists trained in cognitive therapy, another form of psychotherapy specific to depression through the Association for Behavioral and Cognitive Therapists (http://www.abct.org/Members/?m=FindTherapist&fa=FT_Form&nolm=1 ).
Buspar is a mild medicine for generalized anxiety disorder. It wouldn't be expected to do much for mood symptoms, and hasn't specifically been studied for anxiety in people with bipolar disorder.
Dr. G.View Thread

Long-term use of clonazepam 2 mg/day creates a physical dependence that could lead to withdrawal symptoms if it were abruptly stopped rather than tapered off. If by "horrible side effects" you may mean physical withdrawal symptoms, then it would be important to make sure that you are tapering off clonazepam under close medical supervision.
In terms of non-benzodiazepine medicines that treat anxiety, just about all have side effects to consider, and vary in how well they work, depending on the kind of "anxiety" being treated. Buspar is used to treat generalized anxiety disorder and has few side effects but isn't always so effective. Atarax, or Vistaril, is an antihistamine (like Benadryl) that also can treat anxiety but can be fairly sedating for some people. Some anticonvulsants have known anti-anxiety properties, notably, Neurontin or Lyrica. SSRIs and other antidepressants also often have anti-anxiety properties, but haven't been well-studied to treat anxiety specifically in people with bipolar disorder.
Dr. G.View Thread

The studies done with Abilify for acute mania by the manufacturer found no greater antimanic efficacy at 30 mg than 15 mg (those were the two doses they compared), but more side effects, including sedation. For delusions or hallucinations, higher doses are sometimes used. For mania, usually a mood stabilizer such as Depakote or lithium is paired with an antpsychotic such as Abilify rather than just using an antipsychotic alone.
Dr. G.View Thread

About a third of people with bipolar disorder can experience problems with memory, attention, and information processing due to bipolar disorder itself, but many other factors can impact memory, including current depression, the effects of some medications, drugs or alcohol, neurologic or medical disorders, aging, anxiety, and other causes. Your doctor would be in the best position to evaluate the nature of your memory complaints and offer an explanation on their likely cause.
Dr. G.View Thread

Mood stabilizers, at least in theory, should treat and prevent both highs and lows, however in actuality, most tend to work better on the highs than the lows. Seroquel (dosed at 300 mg/day) and olanapine-fluoxetine combination are the only 2 FDA-approved drugs for bipolar depression. Seroquel can be very sedating for about 1 out of 2 people, and, like all antihistamines, can have cognitive dulling effects. The studies with Seroquel for bipolar depression dosed it as 50,100,200,then 300 mg/day over 4 days, so if one were following the "recipe" of the manufacturer, the target dose can usually be reached in less than a wek.
Dr. G.View Thread

The controlled studies that have been done in the last 10-15 years with Trileptal have shown that in mania, it is no better than a placebo, but also no worse. I wouldn't assume that it has been causing mood symptoms, although it can cause side effects (e.g., sedation, cognitive dulling) that may no longer be present if you are not taking the medicine. Seroquel dosed at 800 mg/day would be considered more than an adequate antimanic and antidepressant as well as antipsychotic dose, and as such, would "count" as a mood stabilizer.
Generally speaking, I would not make assumptions about whether or not a diagnosis is present based on medication response. Drug effects are not diagnosis-specific. Also, if a medication was helping control particular symptoms, those symptoms would not necessarily resurface immediately after stopping the medicine; even on no medicines, people with bipolar disorder may sometimes have lengthy periods before manic or depressive symptoms come back, which is not always so easy to predict.
Dr. G.View Thread

If someone is in the midst of a manic episode -- not sleeping, doing many projects at once, talking very fast, overenergized -- then their judgment can be impaired and they could do things that are excessively confrontational or provocative, which usually they would then look back on after the episode has resolved and see as quite different from their usual behavior.
When someone is not manic or depressed, personality traits (such as being interpersonally controlling and provocative when there are no other current mood symptoms) can manifest themselves; this would be a key distinction between things that are attributable to bipolar disorder versus traits that are more defining of someone's personality than an illness.
Dr. G.View Thread

Hard to make treatment recommendations in this forum. But generally speaking, psychiatrists try to avoid the hospital if not entirely necessary (eg, suicidal intentions). Short of that, it seems reasonable to me to call your doctor to describe the problem and ask if any changes to current medicines might be advisable in advance of your upcoming meeting (at which time she can capitalize on the opportunity to assess the effects of a possible change made now).
Dr. G.View Thread
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