Have you tried Klonopin (clonazepam)? What was your reaction to it? What about the other benzodiazepines (BZD)
I really can't account for your reaction to mood stabilizers. There is a phenomenon known as disinhibition. It occurs sometimes in people who take BZDs. In a minority of people, instead of producing calmness, these drugs produce agitation and rage. This is what is known as a paradoxical drug reaction. BZDs act on GABA receptors and turn them on (opens the lock). Perhaps you are having s paradoxical disinhibition reaction to anticonvulsants, whose actions are to increase GABA activity. Your guess that an increase in noradrenaline (NE) activity would make you feel better is an interesting one. If you feel that strongly about it, you can explore trying desipramine. Desipramine is a very effective tricyclic antidepressant that works on NE only.
Have you tried Abilify (aripiprazole)? What about Saphris (asenapine)? Abilify can increase dopamine (DA) activity without producing the receptor desensitization that DA agonists can produce. For some people, Saphris can produce an antidepressant effect without cognitive blunting. My doctor really likes Latuda (lurasidone) better than Abilify for depression, but I have yet to see someone do well with it. However, my doctor sees lots of patients, so I would not discount his opinions.
The lithium thing is interesting. Like many of the anticonvulsants, it can be anti-manic and perhaps anti-dopaminergic. It is interesting that Lamictal is the least effective anti-manic agent, and it is also the least deleterious to you. I wonder if you might need something that is pro-dopaminergic. I would look at Abilify, Wellbutrin, and MAOIs if depression is still an issue. If an anxiety disorder is present, Nardil would be the better choice. However, I would look to Abilify first so as to avoid the food and medication restrictions that are necessary when taking an MAOI. Note, however, that Abilify can produce mild akathisia at first, but it usually dissipates. Some people experience a more severe reaction, though, that requires discontinuation.
I'm sure you will find an answer. It just might take more trial-and-error. In the meantime, you can try taking N-acetylcysteine (NAC). It has the potential to act as a mood stabilizer, but it can take several months for it to take effect. Omega-3 fatty acids in the form of fish oil (60% EPA; 40% DHA) is another substance that might be helpful. Inositol is a supplement that can help stabilize neuronal membranes and has been shown to be helpful in bipolar disorder for both mania and depression.
After saying all of that, I am still confused by your situation and cannot make any recommendations at this point.
- Scott
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