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Re: Just saw my pdoc I'm mad! » akc

Posted by Cam W. on December 10, 2001, at 19:34:46

In reply to Just saw my pdoc I'm mad!, posted by akc on December 10, 2001, at 15:30:54

Akc - Sorry, I just finished 7 days of work in a row; 6 of those were 12 hour days; and I just quit my new job of 2.5 months. Also, I haven't been able to log on to PB for the past couple of days.

I don't think a whole dumping of all your meds is a good idea. I have been thinking about your mix, which is fairly standard, as far as treating the symptoms that you describe go.

I don't think that Geodon™ (ziprasidone) replacing the Seroquel™ (quetiapine) is that good of a trade-off. I may suggest to a pdoc who was doing this to try a low dose of Risperdal™ (risperidone) first; or maybe Zyprexa™ (olanzapine). These latter two antipsychotics are better for depression and ruminations than the former two.

As for switching lithium for Depakote™ (divalproex), I am not sure that the Depakote is as good an overall antidepressant as lithium (although many may disagree with me, on this point). Depakote might be worth a try, though. One doesn't know if something works until one tries it.

I would like to see more doctors try a Lamictal™ (lamotrigine) + Topamax™ (topiramate) combination. I have seen this used with Zyprexa in a case of severe, refractory bipolar depression. It did work for at least the first few months, but I had left my job with Mental Health, and I don't know if the good response has been maintained over the long term.

Most studies say that you should always use a classical mood stabilizer (eg. lithium, Depakote, or Tegretol/carbamazepine) with the newer agents (Lamictal, Topamax, and Neurontin/gabapentin). There are only a few studies using the newer agents in monotherapy, or in combination with themselves. I am not sure if these combinations work long term or not.

These are my thoughts on your drug mix. - Cam


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poster:Cam W. thread:86487
URL: http://www.dr-bob.org/babble/20011202/msgs/86517.html