Emilija had a great comment on a post below. I gave a link to a table where potential mood stabilizers are given divided into categories of research which show they are effective, neutral, or not effective. She pointed out that some of those in the negative category do work, and some in the positive, FDA approved can trigger cycling for some of us. I started to reply, then decided it was a better post.
Now I lost my original writing. Too bad since of course it was brilliant. :)
Anyway, what I was saying:
I think that this kind of table is a nice guide. It's not definitive. In this case I have used this particular table because I've gotten a lot of very helpful information from the author over the years. (The page is www.psycheducation.org and the author is Jim Phelps. He also is the Ask a Doctor at www.bipolarworld.net).
What I think this is useful for is determining what is the better of 2 choices. If one drug is from the positive results table and the other is the negative I'd rather try the positive one first. We all know people who do well on the drugs in the negative column by their own reports, so clearly the data may not be reflective of what we as bipolar patients feel, but my goal in starting a new drug is always to have the best chance of success with as little fuss. Having said that I've taken drugs from all 3 columns, I think. If not they've been considered and neurontin is up next for anxiety.
I'm a biochemical nightmare, so I like knowing that we're using things that have fairly strong evidence that they will work. On the other hand, I know that there is not research done on me that reflects my biochemical nightmarishness, so nothing is going show to how my mind and body will react to any given approach.
Another example of this is the "antidepressants are contraindicated for bipolar patients" theory. When I was diagnosed I had been through every dose of 11 antidepressants. None helped, most made me worse. I was told that I should avoid antidepressants and that they had nearly certainly been a big force behind my severe rapid cycling. Fast forward 2 or 3 years. I was depressed all the time, nothing was helping it. We decided to try an antidepressant that I'd previously tolerated quite well and use aggressive dosing to maintain stability. I was pretty sleepy for a week and then I felt better. I've been on antidepressants pretty consistently since, although the one used had to change thanks to developing hypertension from the one that worked. The current one (imipramine) works extremely well. We took me off it in the fall and I went back on it quickly.
Wouldn't it be nice if you could just enter symptoms in a computer and get a print-out of what you need to take an how?