Posted by jay on January 31, 2006, at 11:21:51
In reply to Re: Is this it? Blood Pressure meds and Bi-Polar, posted by Squiggles on January 31, 2006, at 7:57:45
>> It's interesting the the calcium channel >>blockers act some way in a similar fashion to >>lithium regarding discharges in cells and >>their communication.
>
> What are these? Are they blood pressure pills?
>Yeah...that's exactly what they are. Here is a blurb from psycheducation.org about these meds and Bipolar:
---
Verapamil, IsradipineVerapamil
Isradipine
--------------------------------------------------------------------------------Verapamil has been around a long time, and as a result there are multiple generics around (thus no trade name above). It's in the class of blood pressure medications called "calcium channel blockers".
A long time ago several randomized trials were done which confirmed that verapamil had "mood stabilizing" properties. This may be related to it's action on calcium channels, the small pores in cells that allow calcium to move in and out. Calcium seems to be part of the story of what causes bipolar disorder (for more on that subject, go to that heading from the Diagnosis Details page). However, there were two "negative" trials later, meaning that the data did not show verapamil had mood stabilizing effects.
As a result of this "mixed" evidence, interest in verapamil has been very limited (in addition, because it is available in multiple generics, there is no manufacturer willing to pump money into research and advertising for this medication, so it "looks" less attractive than it really is). I tried it with several patients and was not particularly impressed myself.
Then I met Dr. Steve Dubovsky, an eminent researcher from University of Colorado, who had done much of the original work on this medication. He said "you have to use the non-slow-release version!" So, I've since tried it again in that form, and sure enough, I'm pretty sure I've seen people respond to it, as with other recognized mood stabilizers. Then, a recent surge in interest has come along from several researchers concerned about the effects of conventional mood stabilizers on women's hormones. They point out that verapamil may also be safe to use in pregnancy, which is not true for any of the "big three" (lithium, Depakote, Tegretol/Trileptal). And they have just published a study showing further support (although in "open trial" design, there were actually quite a few more patients in this study than in Dubovsky's original workDubovsky; not conclusive, but strongly supportive evidence) for verapamil's effectiveness in women with bipolar disorder. Some of these women were pregnant.Wisner et al They used the non-slow-release form, if I am interpreting their methods correctly.
There is some concern about immediate-release versions of verapamil having a negative effect on heart function. American Academy... But this issue is still being studied (e.g. Hilleman) and does not appear to be an issue in terms of the use of this medication as a bipolar disorder treatment. For a patient who has known heart disease, or for a patient who is already on a blood pressure medication, a discussion with her/his doctor prior to starting verapamil in either form would probably be wise.
Where verapamil fits in the list of mood stabilizers is unclear because we have so little information on it, and that which we have is conflicting (e.g. see a review by Janicak, 2000). However, it carries relatively few risks compared to other commonly used mood stabilizers and must be kept in mind for cases in which the better-studied medications have not been effective or tolerable. It is also a consideration for a woman contemplating pregnancy, if it can be established before the pregnancy that this is an effective agent, which can take months or even years depending on the woman's usual course of bipolar symptoms.
Isradipine is another calcium channel blocker. There is one observation that has been published by Bob Post and colleagues at the NIMH which apparently represents the entire literature base for use of this agent:
When verapamil was blindly substituted for nimodipine, two BP patients failed to maintain improvement but responded again to nimodipine and remained well with a blind transition to another dihydropyridine L-type calcium channel blocker (CCB), isradipine.Pazzaglia
There are no other articles found searching "isradipine bipolar" on PUB MED or Google (7/2004).
Both isradipine and verapamil are in the FDA's Pregnancy Category C, which means that the medication is neither clearly safe, nor clearly unsafe.
--------------So, this is interesting. But...you know...in my many years as a social worker, I easily conclude lithium *is* the gold standard. I know that is written everywhere, but I've seen it with my own eyes. Many people on lithium are people you couldn't even really tell had mental health issues, even when they talk a bit about their lives. They are not the type of people who come onto a board like this...and you are the exception because you seem to really want to help people. But, their lives are just going along so fine, a place like this doesn't peak their interest much.
So, I do think lithium is a very special drug in many ways, but the whole bipolar issue, the diagnosis and such, has brought in many different types of people who need some different med combos.
Anyhow...sorry for the length...best..
Jay :)
poster:jay
thread:604595
URL: http://www.dr-bob.org/babble/20060129/msgs/604810.html