Gabapentin for bipolar do

[sweetlenovo88]

Getting tired of providers giving gabapentin for "mood" or bipolar d/o. My understanding is evidence shows poor efficacy and there is no FDA approval for this purpose. While we are on the subject, trileptal has also shown poor efficacy in mania?

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[Shikima]

I've had poor results on mania with Gabapentin, but it does work in some to help control anxiety. I've had good results using Trileptal as a mood stabilizer and can pair it with other mood stabilizers.

Just stay away from Tegretol.

 

[J ROD]

Lamictal is good for depressed type.

 

[deleted736562]

The only mood stabilizers that have good evidence for them for the treatment of mania are Depakote and Tegretol. Lamictal is good for prevention of depressive relapse but is useless in acute treatment. Interestingly, both Depakote and Tegretol don't have that good evidence for chronic treatment for prevention of relapses. Lithium does better than both.

 

[J ROD]

Acute mania - Lithium, Depakote, all else fails.....shock'em! lol

 

[romanticscience]

Ghaemi, a bipolar guru, recommends gabapentin for other specified bipolar disorders (e.g., bipolar spectrum disorder). His rational is that the med is well tolerated, safe, and has little med interaction. Balancing a non-specific disorder with its tolerability, he says it's worth a try. Furthermore, he says mixed-symptoms should be approached as etiologically closer to bipolar (Mood stabilizers) in nature rather than depressive (SSRI/SNRI).

Ghaemi, S. N. (2007). Mood disorders: a practical guide. Lippincott Williams & Wilkins.

 

[Blitz2006]

I've had poor results on mania with Gabapentin, but it does work in some to help control anxiety. I've had good results using Trileptal as a mood stabilizer and can pair it with other mood stabilizers.

Just stay away from Tegretol.

Really?

We are told here Lithium first, Tegretol 2nd. Depakote try to avoid because of the side effects (but it is good for acute mania and chronic maintenance), and Lamictal for Bipolar II. Trileptal is "banned" because we are told its garbage. And I'm pretty sure I'd be kicked out of residency if I was caught treating Bipolar with Topamax!

 

[Armadillos]

Maybe I just like giving people diabetes, but unless I can have someone on lithium I would probably choose an SGA over almost anything else. Seems to help the depressive aspect of bipolar way more than mood stabilizers do and bipolar is primarily a depressive illness. Granted I'm still early in training, so I'm sure my mind will change.

 

[PistolPete]

I've found gabapentin to help anxiety in a minority of patients. Otherwise it's fairly useless in psychiatry. It's great for neuropathic pain though.

For acute mania I was taught lithium/depakote with a SGA. Add a benzo for tough cases. Add Liquid Benadryl if they're still not sleeping (since it contains like 15% alcohol or something). For maintenance, lithium or lamotrigine. Consider monotherapy with SGA.

 

[HarryMTieboutMD]

https://www.ncbi.nlm.nih.gov/pubmed/26580001

I use this as my go to- written by big names in the field without huge COI issues

 

[northernpsy]

I like trying gabapentin in anxious alcoholics, but definitely would not consider it to be worth anything as a mood stabilizer for legit bipolar disorder.

 

[smalltownpsych]

I like trying gabapentin in anxious alcoholics, but definitely would not consider it to be worth anything as a mood stabilizer for legit bipolar disorder.

Pretty much any alcoholic, especially the younger ones, in first six months of recovery is going to be emotionally reactive, anxious, and having a tough time with sleep and I am glad you are seeing that it is usually not Bipolar Disorder. The older severe alcoholics will be slowed and blunted for about a year.

 

[Shikima]

Really?

We are told here Lithium first, Tegretol 2nd. Depakote try to avoid because of the side effects (but it is good for acute mania and chronic maintenance), and Lamictal for Bipolar II. Trileptal is "banned" because we are told its garbage. And I'm pretty sure I'd be kicked out of residency if I was caught treating Bipolar with Topamax!

Tegretol has far too many drug-drug interactions potentially. Remember, they're not *ONLY* on psych medications....

 

[MLT2MT2DO]

Ghaemi, a bipolar guru, recommends gabapentin for other specified bipolar disorders (e.g., bipolar spectrum disorder). His rational is that the med is well tolerated, safe, and has little med interaction. Balancing a non-specific disorder with its tolerability, he says it's worth a try. Furthermore, he says mixed-symptoms should be approached as etiologically closer to bipolar (Mood stabilizers) in nature rather than depressive (SSRI/SNRI).

Ghaemi, S. N. (2007). Mood disorders: a practical guide. Lippincott Williams & Wilkins.

Aka Borderline personality disorder?

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[Dharma]

Acute mania - Lithium, Depakote, all else fails.....shock'em! lol

Had a textbook manic patient recently who made a very quick turn around on Invega. Was refusing Lithium, Depakote, Trileptal, etc. That said probably would've been even quicker if he didn't refuse.

 

[Merovinge]

Had a textbook manic patient recently who made a very quick turn around on Invega. Was refusing Lithium, Depakote, Trileptal, etc. That said probably would've been even quicker if he didn't refuse.

There is a mountain of evidence for SGA's being effective for mania. I would never hesitate for an inpatient manic patient to be started on an appropriate SGA.

 

[st2205]

There is a mountain of evidence for SGA's being effective for mania. I would never hesitate for an inpatient manic patient to be started on an appropriate SGA.

I think a better question is if there are many people out there who aren't using SGA first line for mania.

 

[Shikima]

Had a textbook manic patient recently who made a very quick turn around on Invega. Was refusing Lithium, Depakote, Trileptal, etc. That said probably would've been even quicker if he didn't refuse.

Excellent opportunity to convert to LAI.

 

[romanticscience]

Aka Borderline personality disorder?

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There's debate whether BPD represents a variation of a mood disorder (Akiskal). However, what I was getting at were situations where the patient has both manic and depressive symptoms, but which do not meet strict criteria for bipolar I or II. Here are examples:


▾ Cyclothymia (DSM-5)
▾ "Mixed-depression" (Koukopoulos)
• A. MDE
• B. 3 of 8: Psychic agitation, racing thoughts, irritability/unprovoked rage, absence of ******ation, talkativeness, dramatic description of suffering ore frequent spells of weeping, mood lability or marked reactivity, early insomnia

▾ "Bipolar spectrum" (Ghaemi)
• A. At least one MDE
• B. No spontaneous hypomanic or manic episodes
▾ C. Either of the following, plus at least two items from D, or both of the following plus one item from criterion D:
• 1. Family history
• 2. Antidepressant-induced mania or hypomania
▾ D. If not items from criterion C are present, six of the following nine criteria are needed:
▾ 1. Hyperthymic temperament
• Habitual short sleeper (<6hr per day, including weekends)
• Excessive use of denial
▾ Schneiderian hypomanic traits
• Irritable, cheerful, overoptomistic, or exuberant
• Naive, overconfident, self-assured, boastful, bombastic, or grandiose
• Vigorous, full of plans, improvident, and rushing off with restless impulse
• Overtalkative
• Warm, people seeking, or extroverted
• Overinvolved and meddlesome
• Uninhibited, stimulus-seeking, or promiscuous
• 2. Recurrent major depressive episodes (>3)
• 3. Brief MDE (average, <3mo)
• 4. Atypical depressive symptoms
• 5. Psychotic MDEs
• 6. Early age of onset of MDE (younger than 25)
• 7. Postpartum depression
• 8. Antidepressant wearoff (acute but not prophylactic response)
• 9. Lack of response to >3 antidepressant treatment trials.