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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by sac on June 5, 2006, at 6:34:14
Hello All,
I've been struggling for years to find the best combo of meds to treat my bipolar II. It is very frustrating and I have been on them all...Depakote, Lamictal, Neurontin, Gabitril, Seroquel, Zyprexa, Abilify, Geodon, etc. etc. etc. I've have the most success with Lithium ER (Eskalith or Lithobid brand works better for me)
Trouble is, I've also been on numerous AD's to treat my bipolar depression, right now I take 20 mgs. Prozac and only 300 mgs. Lithobid. I still cycle and it is really affecting my quality of life that I sometimes just want to end it all. ( I am a 38 yr. old female with two children so this is not an option but that's how I feel sometimes) I don't go more than 1 month without seeing my psychiatrist. 10 years ago I only had to be on Prozac and see him every 4 months or so and I was fine. Everything has changed now. I am unstable. Should I drop the Prozac??? is that causing the cycling?? Do I need to up the lithium although my main problem is depression this seems counterintuitive but I don't know. Any help or shared experiences would be greatly appreciated. Thanks so much. -Stacey
Posted by SLS on June 5, 2006, at 8:46:51
In reply to Are SSRI's the problem? Continuous mood cycling, posted by sac on June 5, 2006, at 6:34:14
Hi.
> I've been struggling for years to find the best combo of meds to treat my bipolar II. It is very frustrating and I have been on them all...Depakote, Lamictal, Neurontin, Gabitril, Seroquel, Zyprexa, Abilify, Geodon, etc. etc. etc. I've have the most success with Lithium ER (Eskalith or Lithobid brand works better for me)
> Trouble is, I've also been on numerous AD's to treat my bipolar depression, right now I take 20 mgs. Prozac and only 300 mgs. Lithobid. I still cycle
Can you describe your cycle and what you experience?
I doubt 300mg of lithium will do much to prevent cycling. You should probably be on a dosage that provides a blood level of at least 6.0 mEq/L. Have you tried combining lithium with Lamictal? The NIMH has published studies indicating that this combination treatment works well to prevent relapse of bipolar I. I'm not sure if they tried it for bipolar II.
What about Tegretol or Trileptal?
It is part of traditional thought that antidepressants will precipitate or exacerbate cycling in people with bipolar disorder. However, some people are actually stabilized by SSRIs. I guess it makes sense to try mood stabilizers first and add antidepressants if necessary. If you are ready to try other antidepressants now, I would suggest that you look at Parnate at some point. It seems to be particularly effective in treating bipolar depression. Emsam has not been available long enough to evaluate its usefulness in bipolar disorder, but I would not rule it out.
- Scott
Posted by Phillipa on June 5, 2006, at 12:58:14
In reply to Re: Are SSRI's the problem? Continuous mood cyclin, posted by SLS on June 5, 2006, at 8:46:51
Scott are you thinking of trying EMSAM? Love Phillipa
Posted by SLS on June 5, 2006, at 14:08:45
In reply to Re: Are SSRI's the problem? Continuous mood cyclin » SLS, posted by Phillipa on June 5, 2006, at 12:58:14
> Scott are you thinking of trying EMSAM? Love Phillipa
I am encouraged by the reports that people are submitting here. I don't think it will be the next thing I try unless my doctor becomes very enthusiastic about it. I guess my thoughts right now are that Emsam is probably less effective than Parnate. Since, I don't respond adequately to Parnate, I probably won't respond to Emsam. Different is different, though, so I can't really cross Emsam off my list.
- Scott
Posted by sac on June 5, 2006, at 20:44:36
In reply to Re: Are SSRI's the problem? Continuous mood cyclin, posted by SLS on June 5, 2006, at 8:46:51
Thanks for your response. I forgot to mention, I have tried Tegretol and Trileptal. I was on lamictal for quite a while but eventually realized that I felt anxious (especially in the PM and I would start ruminating and obsessing about things) I don't have that problem off lamictal so that's how I ended up with Lithium. I've done well with it so far but my blood level is only .5, I suppose maybe I should be on a least 600/day. I always think that since lithium is "anti-manic" an increase would worsen my depression???
Posted by SLS on June 6, 2006, at 8:02:37
In reply to Re: Are SSRI's the problem? Continuous mood cyclin » SLS, posted by sac on June 5, 2006, at 20:44:36
> Thanks for your response. I forgot to mention, I have tried Tegretol and Trileptal. I was on lamictal for quite a while but eventually realized that I felt anxious (especially in the PM and I would start ruminating and obsessing about things) I don't have that problem off lamictal so that's how I ended up with Lithium. I've done well with it so far but my blood level is only .5, I suppose maybe I should be on a least 600/day. I always think that since lithium is "anti-manic" an increase would worsen my depression???
Lithium definitely makes me feel worse at dosages above 450mg. It has a tendency to flatten affect and produce amotivation and perhaps apathy as well. There are people who take 1500mg who don't experience any of these things.
- Scott
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