Rapid Cycling & Lithium
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Q:  Rapid Cycling & Lithium

I'd appreciate it if you didn't post my name.. I didin't see any oinfo on this topic on the message boards... Um..I'm 29 have a Mster's degree in Education, and am beginning studies for another Master's(LCSW). THis past year after having fought through some ripping periods of depression followed by hypo-manic agitation and bullet proof-ness..I was Dx'd with BP II last fall. P Doc one gave me Topamax and told me to lay off the ativan my regualar MD had given me to help me get some sleep and keep me from crawling out of my skin.. I GOT REALLY EDGY. And dropped both the Tmax and the Doc. PDoc 2 gave me lithium,450 increased to 900mg which though I took faithfully I began to swing up and down like rollercoaster even worse than before. In March I went to a conference about BP for work and the presenter said  that Lithium can "push" rapid cycling, and that rapid cyclers should try trileptal??  I have an appoitnment with PDoc 3 next week. For the last two months since I quit the lithium and lost faith in medecine almost entirely, I've been taking Omega3's and ativan and ambien  and though I'm able to ride the tidal wave, my ocean is still very stormy.  I just don't want it to get worse again, my experience with Lithuim was horrible-

Dear Ms. E' -- 
I try to follow the bipolar literature pretty closely and I haven't heard this "lithium can push rapid cycling" idea once.  Do you remember the presenter's name? (
write if you can find it)  I'd like to chase that down if I can.  The usual story on lithium and rapid cycling is that it doesn't work as well as anticonvulsants, although there are clearly people whose bipolar disorder is clearly rapid cycling who nevertheless respond very well to lithium.  

However, if this diagnosis is correct, you still haven't had any of the basic steps we routinely take to try to help here.  Anticonvulsants are the routine thing and you haven't had one yet, except Topomax, which is not really on the list of "mood stabilizers" now after experience has increasingly shown it can make bipolar disorder worse, precipitating both manic symptoms (which may have been what happened to you) and depression -- although I've got a few patients where it worked like a dream, just enough to continue to represent a sort of tantalizing possibility.  I heard recently that the manufacturer stopped, if I heard right, the randomized trial of Topomax as a mood stabilizer because it was looking pretty bad in that study.  That's hearsay, yet. 

In any case I'd urge you to consider some routine stuff: Depakote at minimum, but you could start with Trileptal (a good case can be made for that; many of my patients opt to start there after hearing the rap about each of these.  Depakote has the better data, Trileptal has the lack of weight gain and a slightly better side effect profile overall, in most people's view).  Good luck with that. 

Dr. Phelps

Published May, 2002 


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