Abilify for bipolar

[Lurkielurk]

Say you have a new patient who you suspect has bipolar II, ultra rapid cycling or perhaps some other mild form of bipolar. Patient appears mildly symptomatic and reports recent hallucination and "confusion" (time/place/general orientation) during mood states a few days ago.

Is insisting on an antipsychotic standard and acceptable? Is attempting monotherapy with abilify a good medicine for this patient? No mood stabilizer is started.

Looking for opinions. To me, starting off with an antipsychotic seems kinda severe but then again I'm not a psychiatrist.

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[Anasazi23]

The treatment for bipolar is a mood-stabilizer. If you're sure that's what they have, then a mood-stabilizer is warranted.

There are many choices, some better than others depending on the "flavor" of the bipolar, comorbid conditions, etc.

Abilify doesn't sound like an unreasonable choice in this case, though much more info would be helpful.

 

[whopper]

One thing I felt was strange was if Abilify & Zyprexa both have an FDA indication for Bipolar maintenance, not just treating acute mania, and several of the mood stabilizers do not, does that make Abilify & Zyprexa superior in the treatment of Bipolar in some cases? If so, then why is the standard, and why do the logarithms say try a mood stabilizer first.

Abilify (& not Zyprexa) is metabolically neutral, I often times do not get complaints from patients concerning its side effects, in fact several seem to like that it wakes them up a bit in the morning. With every other medication--mood stabilizer or not, I usually get some type of sedation/weight gain/cholesterol/fear of their kidneys or liver failing in the future problem.

It has made me wonder if Abilify would be better as a first choice medication for some types of Bipolar vs mood stabilizers.

However take into consideration that from my own experience, and from pretty much everyone I talk to about this, Abilify doesn't seem to work on "heavy duty" cases, and per studies takes longer to stabilize patients vs the other atypicals. If it works, great, but it doesn't seem to work as well vs the other atypicals for mania.

I tend to use it on populations that are higher functioning, more likely to be compliant and not as dangerous for the above reasons. If it could work, why put them on lithium, Depakote, Zyprexa or the other meds with more side effects?

 

[billypilgrim37]

However take into consideration that from my own experience, and from pretty much everyone I talk to about this, Abilify doesn't seem to work on "heavy duty" cases, and per studies takes longer to stabilize patients vs the other atypicals. If it works, great, but it doesn't seem to work as well vs the other atypicals for mania.

I've been encouraged by my attendings in bipolar cases to go straight to 30mg of Abilify, because many bipolar cases seem to actually worsen on 15-20mg. This seems consistent with the FDA approval recommended doses for bipolar as well.

 

[Lurkielurk]

Physician states that she wants to start one drug at a time because of risk of polypharmacy, and also she wants appropriate time to evaluate drug efficacy.
She is against starting lamictal or anything else because of the above reasons, additionally she is against a mood stabilizer because "it is only for maintenance" and also "it is usually for depression".

The initial dose was small (5mgs starter pack). I have noticed my cycling to be worse the first week. Usual for me is 2-3 days of low or high moods and now it is every other day.
I report this to her.
At follow up she says to wait another week.


I'm just curious is this treatment appropriate? She seems to ignore that my moods are getting worse, I had more confusion, I'm sleeping worse, etc. and she is against any mood stabilizer and would ONLY consider an AAP.

 

[pingouin]

SDN is not to be used for medical advice. Please speak with your physician about your concerns.

Closing this thread.