Your experience appears to be a great deal like a hypomanic episode. However, there is a chance that your experience is not a manifestation of bipolar disorder, despite the overlap in symptoms. For exammple, some people experience psychotic reactions to prednisone. This happened to my grandmother. She never displayed any kind of mental illness previously. Officially, bipolar disorder can be diagnosed when a drug produces mania, but only if the mania persists after the culprit drug is withdrawn.
I'm glad that lithium is helping. For bipolar disorder, I have seen a combination of Lamictal + Trileptal effectively treat mania and depression at the same time. It brought the person into years of remission. He discontinued his Trileptal due to financial concerns, and became floridly manic mixed-state very quickly. He began gambling and swore he won a trillion dollars on the Internet. His doctor gave him samples of Saphris. Within three days, the mania subsided, and I was able to have a conversation with him.
The NIMH likes Lamictal + lithium for bipolar disorder.
At what dosage does Lamictal begin to affect you negatively? I found that the Teva brand of generic lamotrigine did not work as well as Lamictal. However, adjusting the dosage upwards helped. Perhaps you would respond better to Lamictal by using a dosage that is lower than that you find effective with the generic. If not, then you really need to find a substitute that has antidepressant properties.
What dosage of lithium are you taking? How are you reacting to it? Is there anything you don't like?
Are you taking an antidepressant? I forget.
Which antidepressants did you like best?
If it has been established that you have bipolar disorder, you might profit from a combination of a mood-stabilizer and an antidepressant. Some people respond better to SSRIs, and some better to SNRIs. You might consider opting for a treatment regime that includes an atypical antipsychotic with antidepressant properties. You may not need a mood stabilizer or lithium. I do better with Abilify, it but can produce anxiety, insomnia, and restlessness early in treatment. These sometimes disappear completely. They did with me. Reluxti is related to Abilify chemically, but is supposedly less apt to produce akathisia-like symptoms. Saphris is a interesting drug. I have seen it work wonders in a case of schizoaffective disorder, bipolar type. It acts as an antidepressant for her. It is being used in combination with Navane. Interestingly, my doctor says that Saphris is helpful in cases where paranoia is involved. Geodon is unpredictable, but can act as an antidepressant.
So...
If a reduced dosage of Lamictal proves inadequate, I would consider adding something to address mania at the higher Lamictal doasge. You could add:
1. An anticonvulsant mood stabilizer. I prefer Trileptal in your case.
or
2. An atypical antipsychotic with antidepressant properties.
or
3. Lithium at anti-manic / mood stabilizing dosages.
For me, Abilify has provided antidepressant effects. Additionally, I have not had a manic episode since beginning it, despite taking drugs that often produce mania. It goes well with the Lamictal 300 mg/day I am taking. I don't do well without Lamictal. However, I never had a manic reaction to it. Lamictal might be unworkable for you.
If Lamictal + lithium doesn't work, develop a plan. I'm sure you can come up with a variety of them.
For instance:
Move forward only if the previous treatment failed.
1. Continue Lamictal at lower dosage.
2. Add Trileptal.
3. Increase dosage of Lamictal.
3. Add an atypical antipsychotic with antidepressant properties.
4. Discontinue Lamictal.
5. Add antidepressant.
6. Discontinue Trileptal.
7. Switch antidepressants.
What are the ideas that you and your doctor were considering?
Hang in there!
- Scott
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