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Re: paradoxical effects on mood stabilizers and atypic

Posted by linkadge on July 24, 2021, at 11:42:33

In reply to paradoxical effects on mood stabilizers and atypic, posted by porkpiehat on July 23, 2021, at 21:01:07


As I have mentioned before, my mother is going through a difficult time too. We are looking at long term care. She had a very abrupt relapse in her psychiatrics symptoms last summer which landed her in the hospital. Unfortunately, she has been deteriorating. I disagree with what the psychiatrists are doing, but ...

To your situation...

First off, Topomax is not (in my opinion) a mood stabilizer. There is scant evidence that it really helps prevent mania or depression and it is not approved for either of these.

Topomax raises GABA. Raising GABA can sometimes cause disinhibition. SSRIs by themselves can cause disinhibition (via reducing activity in the prefrontal cortex). Sometimes older people (or those with psychiatric disorders) already have prefrontal hypofunction (hence the apathy).

Antidepressants and anticonvulsants don't always mix well together. Interestingly, I feel that the noradrenergic drugs sometimes mix better with anticonvulsants.

If citalopram is causing apathy then change it. I would recommend trying nortriptyline. I would drop the topomax. If there is clear evidence of bipolar then use a real mood stabilizer. Otherwise try a different antidepressant.





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