Posted by Emme on September 19, 2004, at 8:34:03
In reply to Bipolar Disorder Question. Can You Help Me?, posted by Mr.Scott on September 18, 2004, at 22:21:27
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> I have a bipolar disorder. I also have a psychiatrist who is wishy washy and ambivalent to say the least.
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> I am far more frequently depressed (like 85-90% of the time I'm unhappy but I believe some of that is due to the consequences of my mood disorder rather than the disorder itself), and I have never had a full blown Mania. My hypomania's have only been induced by antidepressants and stimulants and rarely debilitating except for the inevitable crash. It was hard to sleep and I was euphoric or agitated and impulsive on Nardil and Prozac and a little bit on Ritalin as well for a few weeks until they stopped working or actually made my depression worse! Tricyclics may me want to kill myself immediately. I may have experienced more pure maniclike symptoms when I was younger and then my first clinical depression was at age 16. I also have a seasonal component.
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> After years of drugs (now in recovery) and meds my response to Antidepressants is generally a very quick hypomanic reaction (within 1 day for sure every time) followed in a few days by an enduring mixed state (lots of agitation, mood shifts, irritability, grandiosity, being a dick, and still being depressed and tired).
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> The disappointing thing about all this is my doctor's essential throwing up of his hands. I can't take Lamictal due to rash. I currently take 25mg of Zoloft and .75mg clonazepam and when I tell you I suffer I'm not lying.
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> Wouldn't straight lithium or maybe Depakote + Antidepressant make sense here?
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> I'm asking for help with this matter because I can't seem to get it fixed on my own, and I don't really know what I want from my doctor, but obviously I'm not getting it.
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> Surely someone who has had an unconventional or misdiagnosed bipolar disorder can share there experience with me...I hope.
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> ScottI agree with the above poster- sounds like BPII. Or BPIII. If your pdoc is throwing up his hands, you need a different doc. Badly. There are many options you haven't exhausted:
- MAOIs and Wellbutrin are not known for inducing cycling. Include a mood stabilizer.
- Try an AD plus Li.
- I'd be a bit surprised if Li or depakote alone did it for you. But, you never know.
- Consider the anticonvulsant Trileptal.
- Sooshi has great success with Zonegran, a newer anticonvulsant.
- Lamictal: Depending on what your rash was like and how quickly it resolved, you might think about a retrial. You can use 5 mg tabs for an ultra-slow titration. Not to be done w/o much thought, but if you can't find anything else that helps, at least discuss it. Don't be discouraged if you need extra AD on top of Lamictal.
- I have mostly depression, but like occasional seroquel for highly anxious states. I doubt you'd use it alone, but it might be helpful in combo w/ something else.
- Consider dopaminergic drugs for bipolar depression. My pdoc has had good luck with Mirapex. I think the jury's still out on memantine, but it's worth thinking about.
- If you're sluggish, a little provigil or selegiline might perk you up. Even a low dose of selegiline (5-10 mg) is good for some people. Other need higher doses.
- Consider swapping the clonazepam for xanax, which is supposed to have some AD properties.
Good luck.
Emme
poster:Emme
thread:392467
URL: http://www.dr-bob.org/babble/20040915/msgs/392554.html