Posted by SLS on February 5, 2005, at 16:29:02
In reply to Re: meds for agitated depression?, posted by med_empowered on February 5, 2005, at 12:53:48
> hey there! Psychitrists are only now catching up with what we patients have known always: it isn't always as simple as depression OR mania; sometimes they overlap in various ways...this has been recognized in bipolar disorder (the creatively named "mixed state"), but has long been ignored in the not-so bipolar. Anyway, I would personally give a mood-stabilizer a try w/ an antidepressant. Since you're in a mental state with seemingly contradictory attributes, you may want to try the short list of antidepressants considered OK for bipolar disorder....this means that, unlike the last poster, I seriously recommend leaving TCAs alone, at least for now. Wellbutrin, Effexor, Celexa/Lexapro, etc. would probably be good first-line antidepressants. In terms of the mood-stabilizer, I'd go for Lamictal, since it's got antidepressant properties. I'd avoid antipsychotics or the antipsychotic/antidepressant combo Symbyax. Klonopin in the day and an occassional sedative at night may help, too. Good luck!
Hi.Here's a case where a thorough interview with the patient is necessary to come to a differential diagnosis. Is the illness an agitated unipolar depression, for which a TCA has the best chance of treating, or bipolar disorder, where a TCA is, by traditional thought, contraindicated?
I am not a doctor, and Spriggy has not described in much detail how the disorder manifests, but it sounds to me more like agitated unipolar depression than bipolar disorder mixed-state. Spriggy states that SSRIs make the depression worse. I guess it would be a good exercise to list specifically which SSRIs have been tried as well as Effexor. Perhaps Remeron would offer an alternative. Perhaps nortriptyline. Lamictal sounds like a good idea. If Spriggy were to enter an anxious suicidal state, I would look to the temporary use of Zyprexa. It can make a good bridge to the next treatment. Zyprexa possesses anxiolytic and antidepressant properties and is usually a rather clean drug in terms of cognition.
- Scott
poster:SLS
thread:453592
URL: http://www.dr-bob.org/babble/20050202/msgs/453688.html