acthar and bipolar

[lisams]

I have been discussing with my neuro what treatment to have if i have a flare. i had prednisone once and had an awful reaction. he doesn't know much about acthar and so doesn't want to consider it. he thinks i might have the same problems as far as mood as with prednisone. has anyone with MS and bipolar used acthar and did you have any mood reactions?

[MyGirlsMom]

Lisa,
My neuro likes Acthar Gel and has had good success with it recently. He said that it is very expensive and insurance won't typically cover unless the person has had problems with traditional steroids. He had a patient that had numbness for years and after AG treatments, he is much much better.

I am curious to see others response....hopefully there will be someone who has taken this before and can provide more insight.

MGM

[Redwings]

Hi lisa:
I've never used Acthar Gel and I'm not bipolar. But since no one else has responded to your question, I'll address the technical issues.

Acthar Gel is adrenocorticotropic hormone (ACTH). It's a naturally occurring hormone that stimulates the body to produce its own corticosteroids. And corticosteroids are corticosteroids, whether natural or synthetic. So the effects (and side effects) of the natural steroids are the same as the effects (and side effects) of the synthetic steroids, like prednisone and prednisolone. You can read about them in the prescribing information (http://www.acthar.com/files/Acthar-PI.pdf).

Your doctor is correct: because the possible side effects are the same, you might have the same problems with mood regulation on Acthar as you had on prednisone. Whether someone else with bipolar disorder did or didn't have trouble with mood regulation on Acthar can in no way be taken as an indication of whether you will or won't. Even if 10 bipolar people who took Acthar respond and say they had no mood problems, you could be the one who goes psychotic.

The Acthar prescribing information says:
"Use of H.P. Acthar Gel may be associated with central nervous system effects ranging from euphoria, insomnia, irritability ... mood swings, personality changes, and severe depression, to frank psychotic manifestations. Also, existing emotional instability or psychotic tendencies may be aggravated."

The National Multiple Sclerosis Society says:
"ACTH may produce mood changes and/or mood swings of varying intensity. These mood alterations can vary from relatively mild to extremely intense, and can vary in a single individual from one course of treatment to another. Neither the patient nor the physician can predict with any certainty whether the ACTH is likely to precipitate these mood alterations."
From http://www.nationalmssociety.org/abo...cth/index.aspx

If you research the effects of steroids like cortisone and prednisone on bipolar disorder, you'll find that the consensus is that mixing bipolar disorder and steroids is unwise. When patients with bipolar disorder must be treated with steroids, they're sometimes hospitalized so that any mood instability can be quickly managed in a controlled environment. So one of the plans you can discuss with your neuro is that steroids (or Acthar) be reserved for only severe relapses, that you be treated inpatient, and that you're monitored closely after release. With a plan like that in place, you'll be better able to be "safely" treated with steroids if the situation warrants.

[lisams]

thank you, those are all good points and i had decided that prednisone or acthar would be a last resort. hadn't thought about hospitalization. might bring that up with my doctor.