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Re: LITHIUM, as the sole AD? Mitch

Posted by SLS on October 4, 2001, at 9:47:36

In reply to Re: LITHIUM, as the sole AD? Chloe, posted by Mitch on October 3, 2001, at 23:46:47

> > Now, I seem to be much more agitated and meds like SSRI's can zap me into a mixed or hypomanic state. I have had hypomanic reactions to a few drugs, one being Geodon (along with EPS) So, I guess treating me is more complicated now. It's also a terrible shame that I can't take the AP's, new or old anymore due to EPS and TD.
> >
> > One last thing, I thought this internal buzz and pulsing was from the Celexa. But I am finding it's still with me. I don't feel like I have to be moving, but it does give me an anxious feeling. Like I am "alive" inside. This is quite annoying, and I wish it would resolve. But somehow, I think it's here to stay. Will I ever feel calm and NOT depressed???
> Hi Chloe,
> I am in a similar situation as yourself. I have the best response with SSRI's for non-seasonal (intra-cyclical) bipolar depression and anxiety, but they exacerbate hypomania more than any other AD's. I can't take ANY (conventional or atypical)AP's due to EPS symptoms. My question is: Have you ever had a trial of an MAOI? I feel strongly that I could have a positive response to one. Tranylcypromine is indicated for bipolar depression and there is supposed to be fewer "switch" rates with MAOI's generally than SSRi's as a class. My pdoc is afraid of them and the last pdoc I had (a few years ago) was afraid of them too. Personally, I think I just saw the word "lawsuit" reading backwards in their eyeglasses. I realize the current "thinking" is "aggressive" use of mood stabilizers w/o AD's, but I am also skeptical. I have comorbid anxiety disorders that aren't helped much by without an AD. Have you had a trial of any MAOI's?
> Mitch

Hi Mitch.

There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.

I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.

I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.

- Scott




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