medication question

[Music]

I'm diagnosed with bipolar and I'm currently taking lithium, gabapentin, and seroquel. I can't afford to keep buying gabapentin as it costs so much and there is no generic version available. So I was wondering if anybody knew what affordable medications there were that augments the effect of lithium or is a mood stabilizer I could take at the same time as lithium.

I know I sbould be asking my doctor this but I just want to go into my next appointment with a list of suggestions I could ask her about. Thanks for any replies I get!

Laters

[OMFG!You'reActuallySmart!]

Gabapentin is an interesting medication because it has no documented side-effects, so it's viewed as a win-win. It was initially made and successfully used for anxiety disorders but for bipolar, research has shown it's essentially the same as taking a sip of water, in other words, useless. It is FDA Approved for anxiety disorders but NOT for bipolar disorders. Despite this, I've heard more doctors are pushing gabapentin for bipolar patients probably for the reason it has no side-effects, good history with anxiety disorders and so it may be given to help with manic or hypomanic episodes. If it's doing nothing for you, then there's no point in taking it.

I'm assuming you're inquiring about very potent anti-depressants or mood-stabilizers so here are some of them: amoxapine (SSNRI) and metergoline.

For less potent anti-depressant or mood-stabilizers: amesergide, Vanatrip, busiprone (FDA approved for GAD only but quite often used as an anti-depressant), citalopram, Prozac, Cymbalta, mianserin, Seproxetine, quipazine and atomoxetine (SSNRI).

I'm not sure if your psychiatrist has mentioned this to you but certain anti-convulsant medications also are effective mood-stabilizers, such as Lamictal (FDA approved for treating bipolar type I), Trileptal and valproic acid. Take note of the last one because it can affect your liver and you probably need regular blood tests. An anti-convulsant I didn't mention is carbamazepine because it can cause more harm than good, plus Trileptal is its metabolite that has far fewer side-effects without losing much potency.

For very potent anti-psychotics that are known to or may assist in treating bipolar disorder: chlorprothixene (older anti-psychotic made in 1959), iloperidone (FDA Approved for schizophrenia only in 2009), methiothepin, fluphenazine (older anti-psychotic with nasty long-term side-effects), ziprasidone, bifeprunox, amisulpride**** and sertindole*. There are many many other anti-psychotics not often used for bipolar so I've tried to narrow down the list.

For less potent anti-psychotics that can treat bipolar disorder: Clozapine, Fluspirilene (more for hypomania), risperidone**, trifluperazine, Abilify, roxindole***, cabergoline (meant for prolactin but has been shown in research to assist with rapid-cycling bipolar), perphanazine (older relatively weak anti-psychotic compared to all others mentioned) and trifluoperazine (older weak anti-psychotic).

* = one of the very few anti-psychotics in which no matter the dosage, causes minimal to no sedation side-effects.
** = certain types or brands of risperidone can be extremely potent or relatively weak.
*** = rapid potent anti-depressant, which is unusual because it does not address mania nor hypomania whereas all the other anti-psychotics address mania, hypomania and/or depression.
**** = usually treats mania but at lower doses, functions as anti-depressant.

[inthebelljar]

You should tell this to your doctor. Sometimes my psychiatrist's office gives me coupons or free samples when I'm short on money. They can also switch you to something less costly if anything else.

[Music]

All that information is more than useful, but I was wondering which one would work as similar as gabapentin did. Another person with bipolar suggested Lamictal to me, but I don't know which would be the best replacment.

Which would work best with lithium, for rapid cycling, and for anxiety? And cause the least cognitive side effects because I already have too many of those from the past medications I've been on and am on.

[OMFG!You'reActuallySmart!]

The most similar medication to gabapentin would probably be pregabalin and is more potent than gabapentin as well as newer. To treat an anxiety disorder, there are several options in terms of what types of medications.

One group of medications that can augument SSRIs while treating anxiety and sometimes acting as an anti-psychotic is the azapirone class. In particular, from this class: tandospirone (used to treat cognitive impairments from schizophrenia), Buspar (not very potent and researchers aren't in agreement whether it can improve cognitive impairments), eptapirone (very potent with minimal side-effects) and Lullan (anti-psychotic as well as anti-depressant and anti-anxiety). They could treat the depressive aspects of the rapid-cycling and possibly reduce anxiety during the manic phase but not reduce the manic phase itself. All have a very short half-life and work pretty fast.

Another class of medications to treat anxiety but will produce some sedation (intensity will vary per medication) and muscle relaxation are benzodiazepines*. However, unlike the above list, benzodiazepines have a much longer half-life, so you may not need to take many pills in one day. For example, medazepam has a half-life of up to 200 hours, whereas azapirones have half-lives less than 5 hours. Although 200 hours seems a long time, some other benzodiazepines have up to ~250 hours (did not list those because they usually are powerful sedatives) but the others below have half-lives at a MINIMUM of around 20-40 hours. Ones that have few cognitive side-effects are Ativan**, Xanax, Bromaze (powerful sedation side-effects at high doses but not at low doses), etizolam, Librax (very old, works very fast, very potent but can cause aggressiveness and impulsivity), medazepam, Ox-Pam (not very potent), pinazepam (few to no cognitive side-effects), prazepam (fewer cognitive side-effects but more than pinazepam) and premazepam (significant cognitive side-effects at first but with repeated exposures, they reduce a fair amount).
Remember all of them have some sedation effects as it's part of their way of treating anxiety.

The issue with benzodiazepines is they are addictive so if you're on them, it's not for a long time, usually maximum of 1-2 months. Azapirones on the other hand are less likely to be addictive so they can be used for long-term use. If the symptoms are severe and aren't being well-controlled, then you may be given benzodiazepines and the exact medications may be geared toward heavy sedation (i.e. not the ones I listed as I assume you're relatively stable). Such ones would be temazepam (used in the US Air Force to help pilots sleep when they cannot do so otherwise), Rohypnol and Erimin (knocks you out in around 15 minutes).

* = a few benzodiazepines, such as clonazepam can have cognitive side-effects lasting up to half a year. Most of them will not but this one has a well-documented history of that.
** = certain types can be very potent to sedate aggressive psychiatric patients who won't comply.