Posted by Scott L. Schofield on March 6, 2000, at 10:24:11
In reply to Thank you for your help, posted by Janice on March 3, 2000, at 11:44:30
> I am a rapid cycler with 2 regular cycles a week - 1 in the middle of the week (the high), and the low during the week-end. This weekly rhythm cycles on an annual cycle. So my complete picture of my depression is related to light and sleep, which I do my best to manage with regular sleep and light therapy, which help. Still though, I generally have a mild to moderate depression during the fall and winter. So far anti-depressants have only contributed to increasing my highs and lows.
>
> I currently take 600 mg of lithium (which I will be increasing shortly). Not only does it stop my highs, it also has been the best anti-depressant I've used. I also take 25 mg of Dexedrine for ADHD (this actually helps decrease my cycle).
> So my questions:
>
> Does lithium lose efficacy over time?
>
> Are there other mood stabilizers that act as anti-depressants?
>
> Are there other medications that act as anti-depressants for rapid cyclers other than ADs?
>
> Which ADs are least likely to increase rapid cycling?
>
> Do many rapid cyclers find complete relief of their symptoms?
The suggestions you received as to which mood-stabilizer to use for treating rapid-cycling bipolar disorder are good ones. You would be very fortunate if any one by itself does the job. Rapid-cyclicity is difficult to treat. Most of the more recent strategies involve using combinations of mood-stabilizers, with or without antidepressants. If you are not experiencing much in the way of side-effects with lithium, you should probably stay on it. If I were in your position, I would first try adding Depakote to the lithium, and then Neurontin into the mix. It would be a good approach to add them one at a time to establish the efficacy of each - even if you only experience a partial improvement. This is important information that may aid you in choosing teatment options in the future. If no go, I would switch from Neurontin to Lamictal, or simply add Lamictal to the other three, if your doctor has no objections, I think it would be smarter to add it. It would save a lot of time by reducing the number of permutations necessary to test all the combinations by using only two at a time. "If you throw enough shit against the wall, some of it is bound to stick". Remember that when using Lamictal in combination with Depakote, you must cut the dose of Lamictal by half. You must also start with a smaller dose and increase it more slowly. This is because Depakote interferes with the body's attempt to get rid of it. You want to avoid provoking the body into producing a potentially dangerous reaction. This reaction usually appears first as a rash. Follow the schedule of titration suggested by the PDR. The average effective dosage of Lamictal for bipolar disorder is 200mg. if one is not taking Depakote (the range for epilepsy is 300- 600). You may want to use half of this dosage - 100mg, If you start feeling great, maintain the treatment regimen for a while. Later, you can discontinue one drug at a time to weed out those that are not contributing to your remission.One thing that sounds suspicious to me is that you describe that your "down" period always occurs on weekends. It is unlikely that your cycle is exactly 168 hours (7 days) long. At some point, I would think that there would be a phase-shift that would cause your cycle to move forward or backward through the week. You may want to take notice of how your sleeping habits may change between Friday and Monday. Perhaps such a change upsets your internal clocks. It might be a sort of jet-lag type trigger. I don't know. If you are going to bed late and waking up late (retarding the cycle), this may possibly be the cause of the depression. That there is some seasonality associated with your condition may indicate that your circadian clocks are vulnerable
Good Luck.
- Scott
poster:Scott L. Schofield
thread:25437
URL: http://www.dr-bob.org/babble/20000302/msgs/26115.html