Neurontin & Risperdal vs. Alternative Treatments
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Q:  Neurontin & Risperdal vs. Alternative Treatments


Dr. Phelps,

My 57 year old father suffers from bipolar disorder. Currently, he has been committed to a mental hospital for evaluation. He is in a severe manic state and has been for almost 1 month. His case worker phoned me and they want to put him on neurontin and risperdal. He is refusing to take the medication until I tell him to. After doing some research on the web I am very worried and do not want him taking these drugs. To make matters worse, he is just getting over an ulcer that was caused by cirrhosis. He also has an enlarged spleen and dangerously low platellets from the cirrhosis. Because of this, his liver may not be able to take these drugs. I really would like to try him on an alternative treatment using 5HTP, vitamins and amino acids. what is your advice? Because he is in such a manic state does he need a toxic drug first and then follow up with alternative treatments?  Would lithium be a better choice? Are there any safe drugs for this? He was in a  severe stage of depression for about 9 years and then was normal for about 6 months before going manic. I wish I knew what put him in the manic state. Just prior to that he was doing so well. He totally changed his diet for the better and was drinking only water and green tea and was taking supplements to help his cirrhosis and ulcer.


Dear Ms. J' -- 
Sorry to be very slow in responding to your question.   Perhaps some of these answers may still have some value.  Circumstances force me to be brief. 


1. Teamwork in general
It's great that your father relies on you, or trusts you even when he's this ill.  I hope the hospital team figured out that they needed to have you on board as part of the team to get things going right.  They would need to satisfy you about the medication options by addressing these questions you put here.  It's not "standard of care" now to approach it like this, but we're getting there. 

2. Neurontin and Risperdal
Meanwhile, it is getting closer to standard of care to insist that the medication options selected have some evidence that they are effective.  This evidence does not exist for Neurontin, although sometimes it's still a rational choice for other reasons (on few occasions, in my opinion, but there is some evidence for it's antidepressant effects; it's anti-pain effects; and anti-anxiety effects), so maybe there were some good ones in your father's case.  In fact, his cirrhosis may well be the reason: it does not require liver metabolism, and many of the more standard ones do, e.g. Depakote and Zyprexa -- though that's true of Risperdal too...

Risperdal has much better evidence of effectiveness in this circumstance, getting close but not, in my opinion, equivalent to the evidence for the medications commonly accepted as mood stabilizers, which are listed on my site on the updated Mood Stabilizers list.

3. Alternative treatments
I think we should hold you to the same standard, i.e. that the options you propose have some evidence of their effectiveness.   I'm not aware of any evidence for the examples you listed:  amino acids and vitamins;  and 5HTP is a serotonin precursor, as you know, and probably acts like an antidepressant, which is exactly what he doesn't need in this circumstance. 

However, on this note you should have a look at the emerging evidence for omega-3 fatty acids in fish oil, summarized on my site on the Omega-3 page.  In this case there is good and improving evidence for effectiveness, though it's still nowhere near the amount of evidence we have for lithium (or, to a lesser extent, Depakote/Tegretol/Zyprexa).  

4. Lithium
Still the gold standard for acute mania, and treats/prevents the depression that was his more obvious problem (besides alcohol?) for so long. 

I hope things are better already. 

Dr. Phelps 


Published June, 2003
 

 

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