Posted by med_empowered on May 14, 2005, at 7:43:24
In reply to Re: OH, so i can take a lithium-med_empowered, posted by woolav on May 14, 2005, at 6:36:34
hey! What form of Bipolar disorder do you have? Is there rapid cycling involved? The tricky thing about bipolar is that it often requires a combination of a number of meds--often 4 or more--to get everything (depression, anxiety, mania, etc.) under control. Prozac would **not** be my first anti-depressant or even SSRI to pick for anyone who has even a hint of bipolar....it has a bad rep for inducing mania and it has a freakishly long half-life. Its also a relatively mild anti-depressant, side-effects aside; you get more oomph out of Paxil and Zoloft. Wellbutrin and Effexor are common favorites for bipolar disorder...Wellbutrin doesn't seem to induce mania too often, and Effexor is strong enough to handle resistant depression. Cymbalta is emerging as a fav. med, too. If you're heavy on depression, the problem may be getting the lamictal dose just right (your doc should increase it very slowly) and also adjusting the other meds. If you've never been full-fledged manic or had psychosis or attempted suicide, switching from Lithium--which prevents suicide but tends to be more effective against mania than against depression--to something else, like Depkote, Tegretol, or Trileptal (maybe even Keppra) might be helpful. Another thought: Symbyax came out recently. Its a zyprexa-prozac combo...the zyprexa prevents mania and helps with the depression. If you have diabetes, a weight problem, or have had problems with anti-psychotics, it probably isn't the way to go. Based on my own experience, I'd think replacing the lithium with Abilify (low risk of diabetes/weight gain, relatively low EPS risk and unique profile are its selling points) would help. The standard starting dosage ranges from 10-15mgs, but lower dosages can be useful, especially if you're not currently psychotic. Anyway, assuming that went well, the next step would be to *sses how your depression responds: if positively, you could probably keep everything and then wait a while. If not so positively, the next step would be to replace or augment the Prozac (my thought: zoloft+wellbutrin), adjust the lamictal as needed, and see what happens. Atypical anti-psychotics seem to have anti-depressant effects (especially Abilify and Zyprexa)...these effects seem to be more pronounced when used in conjunction with an anti-depressant. If desired, the Abilify could be withdrawn after the depressive episode stops, and another mood-stabilizer (my vote: trileptal, with increases in the lamictal) could be used to replace it. Anyway, good luck!
poster:med_empowered
thread:497440
URL: http://www.dr-bob.org/babble/20050510/msgs/497657.html