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Re: gershon: quick fix or ? willow02

Posted by egershon on November 6, 2002, at 11:03:46

In reply to gershon: quick fix or ?, posted by willow02 on November 5, 2002, at 21:27:41

> I was recently diagnosed (2mo.s ago). I am BP 1 Rapid Cycler.
> Before I was diagnosed I was put on Paxil b/c I was severely depressed, and at 10mg/day for 4 days I was flying so high I just stopped taking it. Got too manic.
> After diagnosed, I was put on Lithium which barely helps. And I had to deal with some uncomfortable ultra rapid cycling which I suspect is from the Paxil - this went away after about a month, I think.
> The mild mania lasted for 2 months and was pretty bearable. Not severe. Got lots of work done. Didn't mind insomnia (more work hours, way more projects and creativity, and I didn't get tired) and had Klonopin just in case which helped.
> Then I crashed again which was unbearable.
> I knew how strongly Paxil affected me and told my temp pdoc that it probably wasn't a good idea though it was his first suggestion.
> Now I have been on remeron 15mg 1 week and I hate it. No noticable improvement, and my day is now only 12 hours because of the drastic sleep.
> My depressions generally only last 2 weeks anyway. Should I even be bothering with remeron? Or should I have tried the Paxil on the ultra-short term, knowing I was risking ultra rapid cycling/mixed states?
> I'm still depressed and for me the remeron makes life worse. Paxil is a super quick fix for me. Should I go for it? My pdoc is temporary and encourages me to make my medication decisions. I am at the point now where I just want to switch from remeron to paxil without consulting them first - but I could probably put a call in tomorrow. I just don't want to sound irrational or be a nuisance.
> It's just that I told them no to the paxil a week ago emphasizing the neg. side effects of rapid cycling and mania, but now I want that quick fix, and remeron seems a more long term thing, so why am i bothering to waste my time with it if my depressions are so short?
> I am also on lithium and it is not working. this is so frustrating. We are going to work on the mood stabilizer after the anti-d. and I just feel like I made the wrong choice with the anti-d. How do you think my pdoc will feel if I call with a reversal after going to the trouble of starting on remeron? Because he's only temporary I am not sure if he knows my depressions are so short... and remeron definitely seems long term, so in effect I am suffering the side effects for a week while my depression should be petering out of its own accord. On the other hand, the paxil would abolish the depression but I don't know how drastic this high would be now that I'm on lithium or how severe the side effects afterwards. any advice?
> Willow02

Rapid cycling is usually managed with mood-stabilizing anticonvulsants. Lithium by itself is not as effective, although it may be used along with the anticonvulsants. Because of the possibility of inducing mania or worsening rapid cycling, it is better to try to avoid antidepressants if possible. However, this is not possible when the depression is severe and non-responsive to the Lithium or anticonvulsants. Lastly, some patients do better with atypical antipsychotic agents as well.




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