Rapid Cycling Treatments?

What medications or other forms of treatment have helped you with rapid cycling? I was told (and read) that Lamictal has not been approved for rapid cycling. It helps shorten the duration of my depressive episodes, but it does not help with the cycling between hypo/mania or mixed states. I do plan to bring this up to my pdoc, but it helps me to know real experiences from others.

I'm on Seroquel, Gabapentin, and Klonopin, along with Lamictal. I am curious what others have found to be most effective for rapid cycling?

When I was last hospitalized in November, I got to see the best psychiatrist ever. I have bad rapid cycling and I’m prone to mixed episodes (the 3 times I was hospitalized were for mixed episodes). She told me rather than being on the mood stabilizer, antipsychotic, anti-anxiety combo I was typically on (at the time I was on Lamictal, Risperdal, and Klonopin) I needed to be on TWO mood stabilizers rather than the one mood stabilizer and one antipsychotic. I forget her exact words, but the gist is that if my biggest problems were my rapidly changing moods, and mixed states, then taking multiple mood stabilizers needed to be the center focus of my treatment. At least two, though she has occasionally prescribed three. I am still on Lamictal (it was upped to 200 mg twice a day) ended the Risperdal (which helped with nothing anyhow), added Trileptal (300 mg twice a day, which still needs to be upped to 600 mg twice a day) and she spread out my Klonopin so that I was still taking 2 mg, but .5 mg in the morning, .5 mg midday, and 1 mg at night.

I have had a harder time staying on a good sleep and day schedule lately, which has made me more inconsistent with my meds and my mental state isn’t as great. But when I was on a good schedule, the Lamictal and Trileptal together, along with the Klonopin spread out throughout the day, was the best I had felt in years. It has made me really buy into this multiple mood stabilizer idea. Even when I’m not consistent with the meds, I have not been in a mixed state and have not had any rapid cycling within the same day. At worst had a “bad day” and felt better for several more days. This is huge for me because I typically cycle several times in the same day.

As much as I hate to admit it, because Depakote (another mood stabilizer) caused me to gain nearly 40 pounds in 8 months and I will never take it again, the combo of Lamictal and Depakote was the only thing that effectively treated my first major manic/mixed episode I had about 5 years ago and significantly reduced my rapid cycling. I did not have much improvement when I took Lithium and Lamictal together, but I personally seem to respond better to two anti-epileptic mood stabilizers at the same time. I rarely have psychotic features (I’ve occasionally had some visual, shadow-like, hallucinations when severely manic) and have found antipsychotics were only good for helping me sleep, they never added anything positive to my moods, and often made me feel like a zombie.

I have been on Lamictal forever, I think since I was first diagnosed about 10 years ago (I had Bipolar 2 diagnosis at the time because it was before I had any true manic or mixed episodes) and I wonder if somehow it’s not as effective for me as it used to be since I have taken it so long. This is the highest dose I’ve ever been on. But the Lamictal and Trileptal combination has worked so well for my mixed episode and rapid cycling, I’m hoping my new psychiatric provider I see next month won’t change it, just increase the Trileptal dose as the other psychiatrist recommended. I believe Trileptal is chemically almost identical to Tegretol, just without the bad side effects, so it seems to becoming a popular mood stabilizer even though it’s an “off label” treatment for bipolar disorder.

Multiple mood stabilizers, and for me two anti-epileptic mood stabilizers, has been the best for my rapid cycling and mixed states. The way the psychiatrist described it to me, it made so much logical sense why multiple mood stabilizers would be best for these two issues. I hope that helps!

Saphris usually knocks me out of cycles well. But as tsrc said I'm on 2 mood stabilizers too, lamictal and equetro. I also take geodon and gabapentin. So really who the **** knows what works haha. I just know when I get into a cycle I add saphris for a while and it goes away after a while.

Rapid cycle and frequent mixed episodes.
A 2nd mood stabiliser was added last nov/dec when I was in hospital. So, I am now on Lithium, Epilim and Seroquel (both types) with prn diazepam (that rarely gets used).

I feel soo normal. My head is switched on and functioning. I really hope I can maintain it.

It was Epilim that was added.

hi. i was on abilify, full dose trileptal, and low dose lamictal. each person is different, of course. for me, depression is more of a problem, with agitation and such each time, so im tapering off the trileptal and the doctor is increasing the dose of lamictal. i have prn gabapentin (anxiety) and low dose prn risperidone (agitation, night time use, ideally).

addressing psychosocial factors (to the extent that I've been able...) helped considerably, too. "no man is an island"--we all live in a social context.

If I get really bad I take haldol for a week or 2 , it usually helps

I was already on two mood stabilizers lithium and lamictal. My doctor raised my abilify dosage and that along with my prn's xanax stopped it.

15 years ago When I was newly diagnosed I was in a clinical trial for rapid cyclers. They'd proven previously that depakote and lithium together were more beneficial for something (I'm pretty sure rapid cycling but not enough on the depressed side?) so they were using that combo with lamictal to try to help the depression.

I don't know what the results were which makes me think it didn't work. I've tried to find publications of the study and never did and I was hospitalized with someone who did the same trial and she'd never heard anything or found publication either.

For what it is worth it did not work for me but since we couldn't get a therapeutic depakote level it wasn't really fully attempted for me. I did much better with the same combination once depakote ER came out but I don't think I was only on the 3 drugs then; I was onto a 4th mood stabilizer soon after ending the trial.

Thank you everyone. I am having a feeling that my pdoc might want to add another mood stabilizer. That seems to help a lot of people here. She did mention it before, but we deferred it, based on the hopes of not having to put me on something that requires ongoing blood work, but it might come to that.

Latuda! I was rapid cycling for 2+ years and it was not until they put me on the that the rapid cycling stopped. With that said I am on Lamictal. I went off of the tutor though because it was making me stomach sick but I might be climb back on just because I think I might be going into another depressive episode.

Once, my pdoc mentioned Latuda. The only issue we had is the insurance problem, where I am not covered at all, and it is expensive. I hope there is a generic someday, or maybe there's a way Prior Authorization would work to get it covered, but I'm not sure. I would definitely be open to trying it though, if that's resolved.

I’ve never found the study online either. I was shown a hard copy of the study a couple of years ago. Unfortunately I don’t remember any of the deets. All I know is that the combo has been effective for me with rapid cycling with mixed episodes.

maybe a temporary increase in Klonopin, or some short term Ativan for in between Klonopin doses? high potency benzodiazepines can help with agitation, mood instability, (hypo)mania, etc....its just not a permanent fix.

This does sound like it could help. Lately, I am trying to take my Klonopin more. I think an increase can work even better, at least to get me through this hard time, until things improve (hopefully).

I found the study. It failed as miserably as I thought and I was in a minority who made it through even though it didn't work for me.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3640341/

Thanks for this. Did you find one that used an Epilim + Lithium combo in your travels? That’s the one I’ve seen. For me Lithium + Epilim is working so far. (I also take Seroquel.)

I don't know if I found that study but it was done at the same place with the same dr leading it. He has published 400-500 articles so it takes a while to find anything specific.

Thanks no pressure at all.