Posted by cybercafe on January 27, 2003, at 0:05:00
In reply to Re: New to Depakote-Can someone tell me how it works?, posted by juanantoniod on January 26, 2003, at 18:25:15
> Cybercafe,
>
> I appreciate your input. It seems irrefutable that lithium is what I should be on. However, I'm kind of at the mercy of my pdoc on this, but he does listen to me. If the Depakote/Lexapro addition to my regimen doesn't work, then maybe I can move on to a real trial of lithium, and perhaps rechallenge wtih Lamictal (I got the rash the first time).
>
> Although I've tried the trycyclics, based on your suggestion from the treatment guidelines, perhaps I should try them again.
>
> Either way, it seems like I have a few more medication options before going to ECT.
>
> Best wishes to you,
>oh well... on the bright side, depakote has a decent
side effect profile... if i become hypomanic again, its probably the drug i'll choose first
> Antonio
>
> > > Hi, Amy,
> > >
> > > Thanks for your reply. I appreciate your input because I was kind of wondering the same thing. However, my recent journal search showed that the current care standards indicate that people with treatment resistant depression should be on lithium. So, maybe as Tony said, Depakote is being used because it is better managed and tolerated than lithium.
> >
> > 1) my guess is depatoke is better tolerated than lithium
> > 2) depatoke has no anti-depressant properties
> > 3) lithium does have anti-depressant properties
> > 4) the anti-depressant properties of lithium are thought to be serotonin re-uptake inhibition, so some argue simply increasing the dose of your SSRI might provide the same benefit
> > 5) i have heard nothing of depatoke being used for unipolar depression... only bipolar... lithium is popular as an augmentation strategy for TRD
> >
> > the protocol for treatment of TRD i think is
> >
> > try 2 SSRIs
> > if there is a partial response, augment with
> > 1) lithium (popular, old school)
> > 2) T3 or T4 (popular, old school)
> > 3) stimulants (not so popular)
> > 4) atypical antipsychotics (somewhat popular)
> > 5) buspirone (havnt heard much)
> > 6) another antidepressant from a different class
> >
> > if there is no response, try antidepressants from other classes
> >
> > tricyclics (more for melancholic)
> > MAOIS (very good! esp for vegetative/atypical depression)
> >
> > other new stuff like wellbutrin, remeron, effexor, etc etc
> > lamictal?
> >
> > there are very well documented standards put out by psychiatric associations
> >
> > good resources?
> > 1)clinical guidelines for the treatment of depression, canadian psychiatric association
> > 2)practice guidelines for the treatment of depression, american psychiatric association
> > 3) "if at first you don't succeed, try and try again....", thase and rush
> >
> > thase and rush actually defined numerical stages of treatment resistance
> >
> > i can't remember most of this stuff since it turns out my treatment resistance was the result of misdiagnosis, and i lost interest in TRD,sorry :(
> >
> >
> > depakote stabilizes moods, occassionally works for anxiety (not me), does not have an antidepressant effect...
> > i think probably every other mood stabilizer beats depakote for antidepressant effect
> > i'm talking lithium, carbamazepine, lamictal, neurontin, zyprexa, you name it
> >
> >
>
>
poster:cybercafe
thread:137244
URL: http://www.dr-bob.org/babble/20030125/msgs/137724.html