Posted by bleauberry on June 20, 2010, at 11:07:13
In reply to Been there done that...need advice, posted by Drof on June 17, 2010, at 17:38:58
I don't know, it's all so hard. I have no idea why that abilify dose is so high. It's usually better as an antidepressant in the 2.5mg-10mg range. Higher than that it turns into more of an full-fledged antipsychotic with the predictable dulling effects. Not what you need. Zyprexa in my opinion is a far better mood stabilizer/antidepressant. But mileage varies, so no way to know. You've probably already tried it anyway.
Lamictal 300mg also seems too high to me.
I think with bipolar symptoms we face the difficulty of squashing down the highs, but not doing it so heavily as to push us into apathy or depression. Did it ever occur to you that the meds themselves could be the culprits causing the depression? And that the adderall is countering the dulling/depressing side of those meds?
Lexapro 40mg. Geez, I would be depressed too. Talk about too much serotonin. I would be a lifeless blob with that much serotonin reuptake inhibition. Again, the adderall does a good job of overcoming that, temporarily.
I see two problems here. First, too much inhibitory stuff going on...lamictal, abilify, lexapro...due to the dose sizes and the actual med choices. Second, nothing on the other side to balance it out. Except for adderall. It balances things out somewhat, you feel better, right? And then it wears off, back to the over-inhibitory state.
If you were not on any meds, I probably would favor something like this:
Prozac 20mg-60mg
Zyprexa 5mg-10mg
Ritalin extended release 20mg-80mg.
And if highs still not under control, 300mg-600mg lithium.I have not clue of your history though. As you said, been there done that. It's hard. I just basically wanted to say I do not see your current cocktail as being favorable to you. I mean, with all those meds, and you still get depressed? What does that say for lexapro's performance. Nothing good. No idea what benefit you perceive in stability from lamictal or abilify, but what good are they for your depression? Zero. Maybe even making it worse or causing it.
I definitely would not add anything to this cocktail. I witness that mistake far too often at this board. Someone is already on 3 or 4 meds that are not working. Logic would say, dump those crappy meds. But no, let's pile another one on top of them, as if the new med can somehow have the power to overcome all the bad ones. It can't. Next thing you know, someone is here with a laundry list of 4 to 8 meds and they are feeling so crappy they can barely survive. Makes no sense to me. It is, I admit, an easy and deceptive trap to fall into.
I would say if you are going to get another med, one of the current meds has to go bye-bye. A direct replacement, one for one. No more add ons. Even in the Star*D program with their high number of remissions, the highest amount of meds in any given situation was 3, most either 1 or 2. Don't pile more on top of ones not working.
Just thinking out loud.
poster:bleauberry
thread:951355
URL: http://www.dr-bob.org/babble/20100615/msgs/951592.html