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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by tonyz on March 3, 2010, at 12:17:43
Checked into the hospital as an outpatient several weeks ago - I 've been doing every other day to give myself more time -- insurance runs out soon.
Sleep has been a real issue I've talked about that before.
Here's the deal I've had many incidents of depression, always high anxiety that could be described as hypomania - required sleep medication etc.
Seroquel doesn't seem to have much effect on me as a sedative at this point in the 100-200mg range.
The current meds are
Lithium 600mg
Clonazepam 1-2 mg
Nortriptyline 50mg
Seroquel 100 mgDoc is thinking of adding depakote; he said if it works it will work very quickly. If it doesn't work it won't do any harm.
He is afraid of increasing the Nortriptyline because he thinks the serotonin effect may be activating. I am not so sure.
In the past I've always got better with a tricyclic.
He tells me each episode is different and what worked before may not work now.
Last year when I got well I was taking seroquel 50-100mg, Nortriptyline 125mg valium and lithium. When the lithium was added that did the trick. If you luck at some of the studies an augmentation with lithium boosts the response of the AD as well as the time it takes to act. So I am wondering if it was just the lithium as an adjunct or the fact that I'm really bipolar 2
I've never made any wild decisions, or sadly had any creative bursts of productivity or insight, but I have had feelings of feeling really good. But realistically once your depression lifts don't you feel great?
If you've made it this far you have a lot of patience and I thank you. Here's my question:
Let's assume and AD is needed and consider the possibility that the NT may be activating here are some ideas:1) Instead of taking the Nortriptyline at bedtime split the dose 1/2 in the am and 1/2 in the pm and increase to the therapeutic range which for me is 100-125mg
2) Consider another AD maybe SAM-e although that maybe a bit risky given the other combinations.
3) Try the depakote
Sleep is unstable now, normally I would wake up during the night and fall back to sleep in 5 mins.
After sleeping 3 hours a night for about 3 days, I think I got about 6+ hours sleep by taking 1mg of clonazepam at bedtime and then another when I awoke around 4am.Today I am fuzzy but at least I got some sleep.
I would have liked to avoid the benzos but that is the only thing that works now. Once the depression lifts the sleep usually stabilizes but it will take several months to get of the benzos.
So which option would you recommend??
Posted by Phillipa on March 3, 2010, at 12:37:01
In reply to What if I'm not bipolar 2, posted by tonyz on March 3, 2010, at 12:17:43
So you are bipolar? Then mood stabalizer personally irreguardless of diagnosis if benzos allow sleep take them. Not all get addicted. Maybe tolerant after 40 years like me but now need less. Love Phillipa
Posted by morganator on March 12, 2010, at 1:58:13
In reply to What if I'm not bipolar 2, posted by tonyz on March 3, 2010, at 12:17:43
Sounds like you may be having a mixed episode.
Did your doctor mention anything about Depakote affecting Nortiptyline blood levels, or vice versa? You can take them together, I just think you need to adjust the dosage of each accordingly.
I would try the depakote and try taking Nortriptyline in split doses. Maybe try the depakote first though.
Whatever you do, definitely stay on Lithium. There is actually recent evidence that suggests Lithium and Depakote combined have a higher success rate than either taken alone.
Good Luck
Posted by tonyz on March 20, 2010, at 8:15:35
In reply to Re: What if I'm not bipolar 2, posted by morganator on March 12, 2010, at 1:58:13
No doc never mentioned depakote, but thanks for your suggestion. I don't have any confidence in this doc, he is obsessed with diagnosing everyone as bipolar. First thing he did was reduce my Nortriptyline which exacerbated my depression. I'm seeing someone else now, so hopefully things will get better
This is the end of the thread.
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