Posted by JohnX2 on April 5, 2002, at 18:15:34
In reply to JohnX and BarbaraCat, posted by Jackd on April 5, 2002, at 16:21:52
Hi Jack,Its good to hear from you again, sorry to see that things are still a bit up-n-down.
> Hey guys, just wanted to fill you in again, and hopefully get some more input. Here's a recap of what I've had and what's been happening: I have ADD, anxiety and depression. I have tried Wellbutrin and Remeron, the first of which threw me into a severe hypomania, followed by a long dark depression. About 8 months later, I tried Remeron, 60 mg a day. It worked great! For two months I felt "right" and everything was going great, until I noticed a cycling that gradually got worse and worse until I was really depressed (even more so than I usually am). This lasted a few months. Now, I have finally realized that I am most likely bipolar, for a number of reasons and empirical evidence. So I have now restarted Remeron, 30mg a day, along with Lithium which I have just now reached 1200mg a day after about 3-4 weeks (i think). I have been feeling OK... functional, but have still been cycling (several times a day, and very subtly). I have been more stable since going up to 900, and hopefully 1200 should be even better.
>Its good to hear that the lithium is helping out some this is a good sign!
> So here are my questions this time... should I even be on an antidepressant if I'm bipolar II? What if the lithium just slows the inevitable slide towards depression that antidepressants all seem to cause? Are there better options for rapid cycling (or is that just cause by having the Remeron in the mix)?
>I think you have a lot of room to improve your situation Jack. As far as the cycling goes, you can do a few things (I'm wondering what your pdoc thinks?):
- see what the Li bump does for you
- A Depakote augmentation
Depakote is an *execellent* 1st line treatment for cycling in bipolar. It also has anxiolytic properties for many. This may definatly relieve agitation and cycling. You can add this quickly to your regimine (it can be dosed up rather rapidly).
- Lamictal. This is a favorite of many. The downside is that it takes a long time to dose up to a thereaputic level, but you may be able to take lamictal without an AD, or a very low dose of an AD. Also lamictal has benign side effects for many and has good AD profiles for a mood stabilizer (I take lamictal).
- Try a trileptal augmentation, maybe a 2nd choice mood stabilizer to augment after Depakote.
- Drop the AD. Well this one is controversial. Ideally for treating bipolar, one may want to start with the mood stabilizers and then slowly add in the ADs (at least this is my pdocs opinion).I dunno, given your current state, it sounds like maybe you could give a quick run of a depakote add-on to the Lithium if the lithium bump doesn't work well for you. After that , you may consider changing strategies and trying a medicine like Lamictal.
Lithium, Depakote, and Lamictal are all good medicines for Bipolar, but who will do well on which medicines is trial and error. And the antidepressant question is very hit or miss.
I get a really robust AD response on Wellbutrin, almost too good, but it doesn't hold. Same thing for Zoloft. I've tried every angle to make these medicines work, but it just doesn't happen. The only AD that can hold for me is Serzone, that's just me!
Personally I'm a very biased Lamictal advocate. I feel it is a very good base medicine to have. It may not do all the work for you, but it should smooth out most of the roller coaster with a good side effect profile.
But you have invested a lot of time in Remeron + Lithium, so maybe wait that out and add on Depakote or Trileptal if you are still cycling (quicker response). You could slowly add in Lamictal too (go for the long term play). But the Depakote may be better for agitation.
Sorry I can't give concrete answers. Just gotta go through the trial and error and work closely with your doctor.
So what do you think?
BTW, when you feel well on the ADs, be honest, do you feel "better than well" i.e. quite euphoric?
Best Wishes,
John
> I think John was right about my anxiety having something to do with "mixed states", because the Lithium seems to generally be helping it. Basically, I'm all out of answers, and just remaining on Lithium seems like a bleak answer to my problems. I want to feel happy, vibrant, CONTENT. Is that possible for a bipolar person?
>
> P.S. I also take 18mg of Concerta and 1mg of Klonopin a day.
poster:JohnX2
thread:102030
URL: http://www.dr-bob.org/babble/20020402/msgs/102058.html