Calcium Channel Blockers (Verapamil) and Bipolar
For anyone who is wondering, I am currently trying a calcium channel blocker to control my mood. This is a last-line treatment really as there are conflicting reports as to whether it works at all, but when you’re me, last-line treatments are really all you have left. However, some studies say that calcium channel blockers DO work and the upside is that woman can even take them during pregnancy which typically isn’t true of psychotropic medications. I’m copying information on this directly from psycheducation.org which I link to frequently. If you’re bipolar, and you haven’t checked out that site, you need to. It has the most comprehensive treatment information I have ever seen. (There is a book with most of the information as well, which is handy because it’s much better laid out.) So, as Dr. Phelps says:
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.