Posted by SLS on February 6, 2005, at 7:41:11
In reply to even the MOOD STABLIZERS seem to make me MANIC!, posted by bipolarspectrum on February 3, 2005, at 13:43:58
> Hi,
> Ive posted here for awhile.. i suffer from bipolar depression... alot of the ssris and snri's make me hypomanic... but so does lithium and lamotrigine!!! any suggestions??
> bps
> ps. I've tried carbazepine and valprioc acid and they unfortunately dont help my depression at allHi BPS.
It does not surprise me that lamotrigine has caused you to become manic. Although infrequent, it happens often enough that it should be well recognized as a possible outcome. The lithium thing has me scratching my head. (Maybe it's just dandruff) :-). With as many things as lithium does in the brain, I would find it difficult to confidently rule out a cause and effect. Does this happen when you are on lithium alone, or were you taking, or had recently taken, an antidepressant?
Can you describe in more detail how your mania presents? How severe does it get? Do you get delusional or psychotic? Try using the following as a guideline to see if what you experienced was truly a mania or hypomania:
http://www.mentalhealth.com/dis1/p21-md02.html
Becoming manic on antidepressants is not necessarily a reason to stop taking them. If no other type of medication will act to relieve you of a moderate to severe depression, it might be preferable to leave the antidepressant in place and treat the mania aggressively using a mood stabilizer and if necessary, adding either an atypical antipsychotic (Zyprexa or Risperdal) or a benzodiazepine like clonazepam. If you are bipolar II, lithium probably wouldn't work anyway as an antimanic. Depakote is a much better choice.
Your choices are to either try Remeron or Wellbutrin or possibly an MAOI if you haven't already, or go the route of using the SRI of your choice and treat the mania aggressively. You actually might find it quite easy to control with Depakote or perhaps Trileptal. If it were me, I would probably try Depakote 1000-2000mg first. You can use a loading dose of 1000-1500mg. If the induction of mania accelerates, however, I would then add Zyprexa 10mg to keep it in check, and perhaps contininue on to try Trileptal 600-1200mg and subsequently try removing the Zyprexa. Because of my experiences with depression and mania, and having taken into consideration the risks of developing EPS and TD, I have become an advocate of the use of APs in certain situations. If it seems you are to be stuck taking an antipsychotic, you could then opt to try substituting others should you find the side effects of Zyprexa undesirable. One should additionally take into consideration the risk for Zyprexa to induce diabetes. If you are already diabetic, you could try Seroquel 300-600mg or Risperdal 2-3mg. Zyprexa probably possesses a more potent antidepressant effect. I believe Geodon is contraindicated in your case. I think there is a good chance it would induce mania on its own.
Take things step by step.
Have you tried an MAOI yet?
What are your thoughts at this point?
- Scott
poster:SLS
thread:452482
URL: http://www.dr-bob.org/babble/20050202/msgs/453908.html