Posted by Ritch on March 21, 2002, at 22:40:39
In reply to Very upset and confused-please help, posted by Peter on March 21, 2002, at 2:26:31
> Ok, here's the deal. I went back to my normal pdoc today whom I've been seeing since 1997. He had already discussed everything with the other pdoc -Donald Klein- who I went to see for a second opinion. As a stated earlier, Dr. Klein recommended that I taper off everything and start Lithium and a little depakote. My pdoc today told me that we can do this if I want, and it might be good for me, but he reminded me that I have a very mild bipolar case (with some hypomania and depression), and that the reason he never put me on Lithium is because it is more effective for BPI patients with acute mania. So he always thought, since I have more mild, mixed states, that the anticonvulsants would be better for me, even though they have more sedating properties than Lithium. Depakote was too sedating for me, but he really thinks the drug I'm on now, Neurontin, would be great for me because it's 'lighter' than depakote, can even-out mild bipolar mood swings, and it targets anxiety, and I'm a really anxious person. In addition, it has a very low side-effect profile, and there are no excess precautions like with Lithium (looking out for dehydration, etc.) and no blood tests required, because it all goes straight out the urine, with no kidney retention. So before we discuss me going on lithium any further, he wants me to increase my neurontin dose to a more therapeutic level and see how I tolerate it for the next few days. I'm now on 700mg daily and he has me going up to 900mg daily. It would be great if such a generally mild drug works well for me, so I can stick with it. But what concerns me is I'm also on adderall (20mg XR in the a.m. and 10mg regular early p.m), which he prescribed me because I was falling into depression from the early sedating effects of the neurontin!! Not to mention my klonopin 1.5mg daily for anxiety. So I've really got a cocktail here of 'off label' uses (adderall for depression, etc.). And the adderall is wierd-it makes me feel good, gives me drive and motivation, but also sometimes makes me very withdrawn and obsessive. But I like it; it just disturbs me a bit because it sometimes makes me feel a bit 'high' and that reminds me of my drug addiction years, and the association makes me feel guilty and wierd. On the other hand, even though it's a complex, perhaps unconventional cocktail, it might work well once the Neurontin is stablized at a higher dose. It gets confusing, but do you think it's worth it to stick with this combo with a chance that Neurontin might be good for me, in which case I wouldn't have to do the big shift over to Lithium, which is obviously a more heavy-duty drug? I'm trying to weigh the pros and cons of both sides and I just get more and more confused. What's the better choice? Any advice? Sorry and thanks.
> Peter D
Hi Peter, What about leaving your Adderall the same, and your Neurontin the same and just add on a *little* Depakote. Maybe 125mg at bedtime and see what happens. I have just restarted dexedrine lately with Neurontin+Klonopin and adding on the 125mg of Depakote at bedtime improved my sleep and settled me down anxiety-wise the next day. I have tried 250mg Depakote at bedtime and I sleep just a *little* too much. But, I am only taking 5mg dexedrine a day. Maybe if I increased to 250mg depakote at bedtime and also increased the dexedrine to a 10mg spansule midday...Mitch
poster:Ritch
thread:98867
URL: http://www.dr-bob.org/babble/20020318/msgs/99363.html