Posted by Ritch on January 19, 2003, at 9:41:45
In reply to Very Confused-need some advice, posted by Peter on January 18, 2003, at 23:35:00
> Hi all:
> Well, My pdoc gave me a script for nortriptyline 5 days ago because I was so depressed and anxious and the lamictal I had been taking for months wasn't kicking in. The thing is, my mood suddenly started improving without my taking the nortrip. So I asked my doc what to do and he said my improving mood was probably a sign that the Lamictal was in fact helping me, but I had just needed a bit more time for the zoloft I had dropped the week before to get out of my system. In addition, I had just reduced my adderall by 10mg (40 to 30mg) the day before he prescribed the nortrip., so that reduction also might have been beginning to 'unmask' the lamictal benefits.
> So he told me to NOT begin the nortrip., and see how I feel over the next week. However, within 2 more days, I started getting into that awful funk again, and I began to just get very irritable and depressed. So I have no idea what to do. I described in another post that my pdoc, whom I've been seeing since '97, has diagnosed me with cyclical moods-mild bipolar, but also differing degrees of SP and other anxieties. You see, at first we were hoping that the Lamictal could end up covering a broad spectrum of my symptoms and thus alleviating the need for me to take 7 meds-that it could simplify my cocktail.
> On the other hand, a doc I went to recently for a consultation diagnosed me with 'depressive-anxiety' and NOT bipolar. My normal pdoc had said that I start getting impulsive and ovrdrinking after a few months on an SSRI because of a hypomanic switch. But the consultation doc said that's no real evidence that I'm bipolar-I could just react badly to long-term SSRI treatment-so she recommended that I try a TCA. It wasn't until the awful depression I was experiencing that my original pdoc sort of caved in and decided to go for the nortrip. with me-but he said that if his theory over the years is correct about my bipolarity, TCA's are WORSE than SSRI's when it comes to manic switches. So I just thought it would be best to put the nortrip aside and give the lamictal more time-that is, UNTIL these terrible day-to-day extreme depressive episodes started hitting me!
> Now I'm considering just taking the damn pill so I could at least begin to be functional again. But I worry that if MY pdoc is right, even if I feel better for a spell, I might go ballistic or something after a few months. So I don't know what to do-if I should start the nortrip or try 'waiting it out' a bit longer with a chance that what I'm experiencing are just residual zoloft withdrawel symptoms or something (been off of zoloft for a bit over 2 weeks, and I'm only on 50mg lamictal). So I don't know if I'm experiencing severe bipolar swings (in which case taking the nortrip isn't a good idea) OR medication-induced mood swings (bad reaction to the lamictal, etc.), OR if I'm just very symptomatic now with varying degrees of depression/irritability/anxiety that are unrelated to bipolarity (which would correspond with what the consultation pdoc said). Any opinions? Likewise, does nortrip help with irritability or worsen it? Cause it's the really irritable kind of depression I've been experiencing lately. Thanks and sorry for the length.
> Peter
Peter, I would follow your current pdoc's advice about not taking the nortrip. just yet. From what you say in this post it really does sound like rapid-cycling bipolar. You mentioned dropping the Adderall a bit and things improving somewhat. It also sounds like SSRI's are setting you off badly as well. You might talk to your pdoc about another dose-reduction of your Zoloft (if you haven't stopped it already), and dropping your Adderall back to 20mg for a while and see if you improve some more. Hope this helps some..
poster:Ritch
thread:136494
URL: http://www.dr-bob.org/babble/20030119/msgs/136528.html