A novel approach for handling intractable mixed bipolar disorder
Take the example of a patient who is bipolar mixed, depressed or normal with lithium unless exposed to stimulation, such as sunlight, conversation, argument, irritation, or good or bad news, at which time they become agitated or excited, talking rapidly, interrupting, and having flights of ideas.
When they are in their calm or depressive state, extra lithium excretes by clearing through the kidneys. That does not leave enough to control their mania when they are stimulated.
Current practice is to provide lithium, then mood stabilizers such as Depakote, Keppra, or other psychiatric medications such as atypical antipsychotics, and then add adjunctive therapies such as Abilify.
I propose increasing such a patient's serotonin until they are at a stable level of mania with most types of stimulus, and then bring it down to normal levels by increasing their lithium, until their mania is controlled under most normal stimulation as well as when not stimulated, leaving them able to live a more normal and productive life.
The overarching goal is to reduce their depression when not stimulated, while preventing mania when stimulated.
If a patient has a level of hypomania which does not put the patient or others at risk, but does interfere with the patient's quality of life, this could be done in their own home, with supervision via psychiatric visits and phone appointments.
For patients whose mania is more serious, this proposed regime would be done under medical supervision in a hospital setting.
Copyright ©Deborah Barges February 2020 Re-use per open access rules.
