Posted by Ritch on January 26, 2002, at 10:43:19
In reply to Re: TCA's and BPD-Link? » Ritch, posted by Chloe on January 26, 2002, at 9:32:21
> Anyway, I can't really go down on the Celexa. She had me do this once before and it was awful. I need the SSRI for my ruminating thoughts and probably some impulse control. Other AD's just don't help with the obsessons. The TCA is helping with the scalp burning, but I have had to go down on that because I keep getting into very abusive, nasty rages, hostility, mixed states. And I can't go up on the lithium (and I am only at 112 mgs right now, which is not helping the cycling at all!)if I can't take the TCA at 20 mgs or above...
>
> So I was thinking of switching the Li(and pdoc also gave this option), for depakote which is supposed to be better for rapid cycling anyway.
>
> My feeling is that this is probably the way to go. Then I can stay on the Celexa and low dose ami(until the scalp pain is totally gone) but not have the added AD push from the lithium. The down side of depakote for me though is hair loss! My scalp and hair just can't get a break...
>
> Do you have any comments on my options, or other suggestions? I am still on the neurontin, 400 mgs. I think you had good result with dep and N together. Am I right?
>
> Option 1
> NO celexa
> 225-450 lithium(if tolerated)
> 400 neurontin
> 20 amitrip
> 10 valium
>
> Option 2
> 1.75 Celexa
> 250? Depakote
> 400 Neurontin
> 10-20 ami(until pain is gone, or keep on to help with sleep?)
> 10 Valium
>
> I really hope you are doing ok. It probably about time for a med adjustment for you too...The days are getting longer, have you noticed?
> Thanks,
> Chloe
>
> > Just an FYI, I am taking Celexa and have taken Celexa and/or Nortripyline recently and have found that Celexa and other SSri's can and have caused just as much or worsened *cycling* than TCA's do (I am BPII as well-and have been on several TCA's in the past), the difference is that TCA's have more tendency to *not* help impulsiveness like SSri's seem to help. It is interesting that your pdoc wants you to wean off the Celexa, did she mention any reasons why she thinks that might be the culprit for your troubles?
> >
> > Mitch
Hi Chloe,I would definitely consider option#2 and stay on the Celexa. Obviously you know the Celexa helps. Your pdoc probably thinks it is aggravating your cycling and wants to pitch it-it *does* aggravate my cycling as well, but for the same reasons you list I need to take a minimal dose (not really for depression-but for anxiety probs.).
You've had trouble before with lithium at doses that are going to be helpful. I found I have to get my dose up to about 450mg/day to really notice a difference-but for me those doses make me *really* foggyheaded and cause severe cramping and diarrhea.
The Neurontin also seems to help you (I think you said it does?). So you could leave that one in-and you appear to tolerate it ok.
So, the tiny dose of amitrip. is definitely helping your neuropathic pain, right? It probably is working together with the Neurontin on that one. It does help you sleep better. I was taking nortrip. with my Celexa before (also nortrip. and Zoloft) and it worked fairly well. The NE boost *can* increase the likelihood for raging behavior. I popped off a little more often than otherwise-but I could focus a *lot* better at work and it didn't make me anxious.
So...the only thing left to try is the Depakote... I would suggest it. I have extra 125mg, 250mg, and 500mg tabs around just in case. I didn't notice any increased hairloss on it. I *did* gain some weight though. You could try adding just 125mg to your current mix (ditching the lithium) and see what happens. I have to take 125mg-250mg every so often when I get a mild mixed state and it really helps that.
Yes, I am starting to have an increased level of agitation and may need to start taking some Dep. a little bit here myself. That goes away by the end of March and then I just deal with plain-old bubbly hypomania during April, March, and part of June-which I don't mind :)
good luck,
Mitch
poster:Ritch
thread:90799
URL: http://www.dr-bob.org/babble/20020124/msgs/91671.html