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Re: cycling? » med_empowered

Posted by Bob on December 2, 2005, at 17:12:23

In reply to Re: cycling?, posted by med_empowered on December 2, 2005, at 2:51:58

> hi! some depressions are like that--they vary by time of day. Its not something that docs seem to talk about a lot, but there's a lot of mention of it in the literature, especially the pre-SSRI days. Anyway, the first thing to do when you have depression in bipolar is to: up the mood-stabilizer or "optimize" the mood stabilizer, sually by adding another mood stabilier. My guess would be that upping the mood-stabilizer or adding Lamictal would be good first-line moves for you. It may also be that Lithium isn't the best mood-stabilizer for you; although Lithium has a protective effect against suicide, some people get better anti-depressant responses with Tegretol/Trileptal, Depakote, Lamictal, or the new atypicals.
>
> Antidepressants really aren't that great for BP disorders, particularly BP I disorder, so that should probably be something you do *after* working on the mood-stabilizer(s). Personally, I'd try adding Lamictal short-term, maybe also upping the Klonopin a bit (it can help some people with depression, and its pretty good for anxiety and bipolar disorders as well). This is also a time to bust out those obnoxious mood-charts patients are all familiar with and start charting...see if little interventions (avoiding caffeine/cigarettes at a certain point, changing alcohol consumption patterns, etc.) show any improvement. If not, you'll probably want to try more med jiggling till you feel better.

First off, thanks for your response. Well, I guess you're telling me something I don't want to hear, but has to be said. I've actually tried Lamictal (rash), and Depakote (severe, unremitting , heavy drowsiness for the year or two that I took it - only relieved somewhat by Welbutrin). Tegretol I tried also, but it wasn't a long trial, and I don't remember what happened. I guess that leaves atypicals, which frankly really scares me. I would certainly think that there would have to be something better than Li out there, but I've thought that about every drug that I've ever taken. I have to find some way to get my courage and/or motivation up and move forward.

 

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