The Guide to Picking the Right Drugs

Let’s get the important stuff out of the way:
I’m not a doctor. I’m not a pharmacist. I’m not a high school graduate. Nope, no GED or anything like that. So you can bet I’m not in any sort of school right now.All of my knowledge about meds comes from experience and research. I’m putting up the books and websites I use on each page, plus I have general bibliographies of books and websites used.

A site such as this should be your fifth opinion about meds.

First your psychiatrist or neurologist prescribes a drug or drug cocktail.

Then you ask your general practitioner / any other doctor you see regularly about the meds.

Then you ask your pharmacist.

Then you ask people in your support group who have had experience with the meds. If you don’t belong to a support group, join one right away.

Finally you crawl around websites and reading books and stuff like that.

Hah! This is the real world. The first thing anyone does today is go home (or wherever the computer access is) and look stuff up on the web. That’s OK. The sequence isn’t important, it’s the value and weighting to which you give the information you get. Remember that. I’m wa-a-a-a-a-ay down the list when it comes to deciding if a med is right for you. But when it comes to asking your doctor about meds to try, other sites like Crazy Meds (OK, there probably isn’t another site quite like this one) are vastly better than drug company ads.

Despite what many of the fearmongers type, I’m not trying to sell you drugs. I am trying to sell you books, software, whatever shows up on the Google ads and hit you up for spare change, but I’m not trying to sell you any particular meds. In fact, meds aren’t always the answer. For some disorders meds are just a waste of time, money and side effects.

So this section is going to try to help you pick the right meds as quickly as possible. The idea is to get you to work with your doctor to use the diagnostic tools available to determine:

A correct diagnosis – the most important thing of all!

The best meds to try first for a very specific disorder. It’s too easy to just lump people into broad categories like “depressed” or “bipolar” and start them on the med-go-round. There are many more symptoms that determine which are the best meds to use. Presuming that meds are the way to go in the first place.

What meds, if any, you should be avoiding. Or at least saving for last to try.

So now everyone is going to want the medium-sized answer as to which meds to take.
I’m still working on that. Along with everything else.

But I can give you the short answers and long answers.

First the short answers:

Bipolar 1: lithium

Bipolar 2: Lamictal (lamotrigine)

Bipolar with rapid to ultra-rapid cycling features (cycling within a month to within a couple of days) and/or mixed states: Depakote (divalproex sodium) if primarily manic or mixed. Lamictal (lamotrigine) if primarily depressed with or without mixed states. Usually with an atypical antipsychotic.

Bipolar with ultradian rapid cycling (cycling several times a day): Depakote (divalproex sodium), Topamax (topiramate) or a cocktail of Lamictal (lamotrigine) and one of: Trileptal (oxcarbazepine), Tegretol (carbamazepine USP) or Topamax (topiramate). Usually with an atypical antipsychotic.

Bipolar 6 or NOS with periods of totally over-the-top euphoric mania: Keppra (levetiracetam). Sometimes alone, sometimes with something else. Dosages can be adjusted. Especially useful for seasonal manias.

Temporal lobe epilepsy: One or more of: Trileptal (oxcarbazepine), Tegretol (carbamazepine USP) or Topamax (topiramate).

Frontal lobe epilepsy: Lamictal (lamotrigine) or Dilantin (phenytonin)

Hippocampus-based epilepsy or other stuff with weird-ass symptoms they can’t pin down: Keppra (levetiracetam). Sometimes Lamictal (lamotrigine). Sometimes either of those mixed with Topamax (topiramate).

Lennox-Gastaut Syndrome: Lamictal (lamotrigine) and/or Topamax (topiramate).

The long answers you get to look up yourselves, as these are a big part of my online research material:

The University of Texas, a leader of psychiatric research in this country, has published several alogrithms at one handy site, including their ever-popular Bipolar Algorithm Manual UT is probably the leading research center for affective mood disorders in the United States.

Harvard Medical School’s Psychopharmacology Algorithm Project – Covers depression, schizophrenia and anxiety.

 

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