I’m always going on and on about how there are only two medications approved to treat bipolar depression (quetiapine and a fluoxetine/olanzapine combination) and about how we need new, novel ways of treating depression in bipolar disorder.
Well, this might not be novel, but it is new.
Lurasidone (Latuda) has now been approved both as monotherapy and as adjunct therapy (with lithium or valproate) in the treatment of bipolar depression by the Food and Drug Administration (FDA). Lurasidone was tested and approved for people with bipolar I.
What is Lurasidone (Latuda)?
Lurasidone is an atypical antipsychotic by Sunovion Pharmaceuticals that previously was approved for the treatment of schizophrenia.
In a six week randomized, double-blind, controlled study using lurasidone as monotherapy for the treatment of bipolar depression it was found that:
- The effect size for the response rate was sizeable (more than 50% of people showed a positive response)
- The risk of sedation was low (only 4% above placebo)
- Lurasidone didn’t cause weight gain
The Downside of Lurasidone
The unfortunate thing about lurasidone is its dosing instructions. It’s a medication that has to be taken with a meal of at least 500 calories (like ziprasidone) at the same time every day (yes, you have to do this for the medication to work). This is highly inconvenient, trust me.
And someone pointed out to me there are also a significant number of drug interactions to worry about.
Bottom Line with Lurasidone
Personally, I’m very excited this new treatment has been approved because it means that more people will become aware of its usefulness. While previously, anyone could have been prescribed this medication off label, now people like general practitioners (family doctors) will likely become aware of this drug’s new indication and be more likely to prescribe it.
While I’m not a fan of antipsychotics, I will say that I tried this one and in my completely-biased-single-person-only-opinion, it had very few side effects when compared to other antipsychotics (see list of side effects here). The fact that you have to take it with a meal is a pain, but completely worth it for a drug that works and doesn’t cause weight gain.
So I say this drug is a big win for people with bipolar disorder. But, like I said, that’s just my biased opinion.
(Molecule image and FDA logo provided by Wikipedia.)
Well, here we are in 2015.. late 2015 and I’ve been to see a NEW psychiatrist. Well, actually, it’s a Psychiatric Nurse Practitioner but they are supposed to know what they are doing, right?
Again… I must give life’s history of all things mentally ill. I must give long list of all meds that I’ve taken, what happened and why am I not on any now?
I mentioned Thorazine and how I had it when I spent a month in a hospital. I noted how it was awesome to just knock down all intrusive thinking and well, thinking in general. To that, I was greeted with “well, we do not prescribe the big T to anyone here!” Yes, she said “big T”.
I have a seizure disorder, hypertension, elevated blood sugar and elevated high cholesterol. I get prescribed, again, Latuda. I am even given a 3 week amount of samples and told to cut the 20mg tablets in half, to start. I am to take it at night, I was told and with food, I was told… but no explanation as to why.
So, much info given as to it’s supposed awesome attributes… it’s still horrifically expensive, not sure it’s safe to cut the tablets in half and according to it’s leaflets… it’s cautioned for those with seizures, hypertension, elevated blood sugar or elevated high cholesterol. I told the woman, she prescribed it anyway.
Hmm… I have heard about weight gain from 2 people that were taking this new drug, then got off of it. Sounds too good to be true, and lately heard of the insane cost of the drug. Way out of my Medicare Part D league. I hope it can work for long-term treatment if needed and not do horrible things instead, like most other drugs seem to.
My Dx is BPII “w/some borderline aspects”. GAD, PTSD, disabled, take wellbutrin, prozac, topomax, clonazepam. Quit Seroquel.
I have officially given the finger to the poisons lithium and Seroquel (quetiapine) as treatment for anything. I have taken them on different occasions in my BP career. The last times were the worst and the last. Seroquel was the last that I was taking, and just gave it up this Sunday because I guessed that it was causing me the massive daily anxiety attacks and agoraphobia that I was trying to rid myself of with taking 200mg in the day. I took 400mg at night, and stopped all of it. The anxiety attacks stopped the next morning. I feel a manageable mania (before going off), but no anxiety, no depression… a HELL of a lot better than before! It’s unbelieveable to have felt bursts of happiness this week that have been hard to figure out, since it’s been so long without them!
Let the weight melt off… I see my meds Psych next week and he’s cool w’it.
Don’t give me a lecture (anyone) about going off meds. I know damn well what I’m doing and have done it before… have 21yrs experience with meds and my Dr.
We really need comparative effectiveness research! Not that everyone will respond the same, but we might know which drugs are more likely to help which people and cause which side effects. I am really getting tired of all of this trial and error prescribing.
Good news about a new approved bipolar med. There still seems to be room for improvement: a med that doesn’t have to be taken at the same time daily with food; a med that doesn’t cause double vision and dizziness at a certain level (oxcarbazepine, which I take), a med that doesn’t cause weight gain (lithium). But it’s only been relatively recently that there were effective meds for most bipolar people, which is a huge step; forward.
I was prescribed Latuda BEFORE it crossed over for Bipolar depression. My practitioner did not say a word about having to eat a 500 calorie or more meal but did mention it’s lessor probability of having a rash and/or itching.
What the person also did not tell was one of the seemingly prevailing adverse reactions is something akin to tardive dyskinesia. In that I’ve had that with Ability and Compazine, I didn’t dare take it and said so, at next appointment.
It also is horrendously expensive when you have no money & absolutely no insurance and no, no one spoke to me about any possible manufacturer discounts.
nor did the provider tell me that it was actually, initially at the time, created for adult schizophrenia
all I was told was that it had a lessor probability of rash and itching, which is typically what I receive with a lot of ADs (along with other things)
My doctor put me on Latuda during a hospital stay. I love it. I didn’t know about it being required to take with food. I usually do, but I was surprised none the less. It works very well for me
Hi Legina,
It ticks me off to no end that you didn’t know the correct dosing instructions. Doctors that don’t give patients information like that tick me the heck off. Definitely read up on the drug (the drug leaflet will tell you about the meal requirements or follow the link I linked to in the article about the side effects).
– Natasha Tracy
Me again. Is there a way for us devoted readers to start a new thread? I’m wondering if any of us BPD folks have ever had blood or tissue samples tested for Mercury and also are there any published studies linking the two? My apologies in advance if this is not the appropriate place to ask.
Cam
Hi Cam,
I don’t have a problem with you asking the question but you might do better if you ask it over on Facebook: https://www.facebook.com/BipolarBurble
– Natasha Tracy
Interesting. I used to be on olanzapine and I had to beg my previous therapist to take me off it. It made me gain 15 lbs, feel sluggish, have trouble getting up in the morning, and for some reason, it also gave me horrible acne breakouts.
I’ve been on a Lamotrigine-Sertraline combination ever since. My current therapist tried switching my Lamotrigine with Divalproex, but it didn’t work out so well. My swings became worse. I suppose it’s a case of finding what works best for you.
Well, we’ll see. If you don’t have insurance or you’re not rich, good luck.
I’ve just started on Medicare and I wonder if they would touch it?
I’ll try to cheer up now.
Natasha, do you have any information or experience with Saphris??
Cameron,
I do not have such positive things to say about asenapine (Saphris). Somnolence (tiredness) is the major problem and it does have associated weight gain (dizziness and headache are common).
Just FYI, asenapine actually isn’t terribly new it’s just newly-approved (relatively speaking) for schizophrenia treatment. (There was an issue with companies being bought out interrupting research.) And, if memory serves, there’s actually been a negative trial on asenapine and bipolar depression (but that’s just my memory, I could be wrong).
http://reference.medscape.com/drug/saphris-asenapine-999301#4
– Natasha Tracy
Thanks Natasha. The absence of weight gain is a significant plus to consider.
Interesting to learn of a new drug med for BPD. My psychiatrist has me on Oxcarbazepine [Trileptal], saying it’s more effective for moderate-severe cases of BPD. Trileptal is commonly used for epilepsy, but works to stabilize mood. I just thought I’d share :)
I meant to say more effective than lithium…
Who conducted and paid for this study?
Hi Cameron,
Presumably the drug company. That’s what happens when you’re seeking FDA-approval. Approval was based on two double-blind placebo-controlled studies.
– Natasha