Dear bela24, Hopefully you will find support and useful input from other people who post on this website. The cognitive problems associated with bipolar disorder can be relatively subtle, particularly in bipolar II (rather than bipolar I) disorder, and mainly involve problems with attentional processing, verbal memory and planning/organization. Cognitive problems from a separate conditions may involve separate types of deficits. A thorough neuropsychological test battery should help to define the types of cognitive problems present, and also provide a benchmark for tracking them over time. Some medicines for bipolar disorder or anxiety can interfere with cognitive function -- notably, lithium, benzodiazepines, and some atypical antipsychotics -- while others tend to be more cognitively benign (e.g., SSRIs and other antidepressants, lamotrogine, non-antihistaminergic antipsychotics). Your niece's doctor would want to take all these factors into consideration when thinking about medicines that may best help her mood and anxiety symptoms.
Usually the standard of care in treating hypomania is to eliminate antidepressants (ie, Wellbutrin and Cymbalta) and optimize mood stabilizers. Seroquel 800 mg/day alone may be inadequate for this purpose, or may work better if the antidepressants were eliminated. Trileptal is considered experimental as far as mood stabilization goes -- there aren't really any large-scale positive studies showing it treats mania, but there are negative studies showing it to be the same as placebo in mania. Topamax also has no known antimanic value (its use is mainly for migraine or weight loss) and there are published reports that it may cause depression or otherwise worsen mood.
Research trials with treatments that are not otherwise available provide access to otherwise unavailable options for people who may otherwise have exhausted existing treatments. This is as true in psychiatry as it is in cancer or AIDS research. Other advantages for participating in research, apart from usually free care, are a higher level of monitoring and expertise than is often the case in standard treatments.
Research studies are unrelated to health insurance. They vary in their risks and benefits and provisions for possible damages. Typically, research studies offer short-term stabilization treatment in the event someone's condition worsens, but generally, in the informed consent process, it is usually stated that the subject understands the risks of being in a study and is aware there is usually no compensation or extended free care if a problem were to arise. Participation is always voluntary and people can revoke their consent typically at any point along the way.
Issues of liability and malpractice are the same in research as in routine treatment, and bears on whether a doctor fails to meet the standard of care, and this directly leads to unforeseen injuries.
While stimulants in themselves are not known to possess specific antidepressant properties (with the exceptions of Provigil and Nuvigil), they are often very effective add-ons to antimanic drugs for targeting the lethargy and attentional problems associated with bipolar depression. They are wisely avoided in people with addiction problems or current manic or psychotic symptoms. Unfortunately they are highly understudied, and most studies that exist are small retrospective record reviews that provide rather skimpy scientifically objective findings.
anything is possible...but in the controlled studies that were done with Nuvigil, there was no evidence that it was associated with a higher risk for developing mania than was the case with placebo. Lamictal also is not known to cause mania, or dysphoric mania. Neither Lamictal nor Nugivil treats dysphoric mania, so it is also possible that the manic episode occurred despite (not because of) those medicines, since neither is an anti-manic treatment.
It may be more useful to think of personality structure along the lines of "clusters" -- A, B or C, as the DSM calls them. A corresponds to odd, paranoid, patterns with strange or idiosyncratic ways of thinking (rather like a mini version of schizophrenia); B corresponds to highly dramatic, impulsive or emotionally volatile styles (a mini version of bipolar, if you will) and C corresponds to withdrawn, insecure, avoiding contact with people, and self-doubting (kind of depressed and anxious). "Personality disorder not otherwise specified" has always meant that someone's personality structure does not neatly conform to one of the pre-existing categories, but has elements of A and/or B and/or C. So more important than which slot someone falls into would be understanding what cluster(s) best describe their style and structure in relationships and world view. Medicines also don't do a lot to change personality...it's more fundamentally a descriptor of who someone "is." Maladaptive aspects of personality (like, blowing up when faced with frustration, or tendencies to blame other people for how one feels, or feeling empty or dead inside) can be tempered through psychotherapy, but fundamentally, we are who we are.
You can let your doctor know about the placebo-controlled study of Provigil for bipolar depression published in 2007 in the American Journal of Psychiatry by Dr. Mark Frye, and ask his opinion if it would be appropriate for you.
It should be the doctor's job, not the patient's, to recommend what treatments are most appropriate, so I wouldn't think of this as trying to make points in its favor. It is simply one of several options that has been shown to treat bipolar depression without a clear risk of inducing or worsening mania symptoms.
I would imagine your local library would have a copy, or could perhaps order one if you asked.
The book is a medical textbook written for professionals rather than patients, but because of the interest raised here on the exchange, i thought it worth mentioning as a reference for those who might be looking for information on the topic. Unfortunately I don't know that anyone has written anything specifically on this topic directed to a patient audience.
Given the many areas of overlap between bipolar disorder and borderline personality disorder, there is often a temptation to ignore the unique features of borderline personality disorder and pretend it is identical to bipolar disorder. Unfortunately, borderline personality disorder has different treatments than bipolar disorder, and medications often are not very useful. There is an excellent and informative website maintained by Dr. Robert Friedel called BPDdemystified which has a wealth of information on this condition, which is easily confusable with bipolar disorder.