Posted by SLS on June 15, 2005, at 7:00:27
In reply to Re: Trileptal 600mg » SLS, posted by emme on June 14, 2005, at 23:48:10
Hi Emme.
I apologize for the tone I took with you in my last post. I was frustrated that you aren't doing well, and that so many treatments seemed to be excluded from consideration. Now I see that they have been considered and understand more why they have not been placed high on your list of things to try. I guess I poked at you just to make sure. Sorry. It is hard to watch someone else suffer if you think there is something available to treat the illness that they haven't tried yet. I like you, so I think I was overly stiff with my tone.
Again, I apologize.
> If my doctor doesn’t have any more appealing ideas, I think I’ll try to reopen discussion on the tricyclics and prozac for starters. I make no promises yet on the MAOIs.
Obviously, I didn't have an appreciation for the fact that you have had suicidal ideations in the past. Perhaps your doctor could give you only enough TCA medication to last one week at a time if there are safety concerns. Weekly visits over the first three weeks is probably indicated anyway. You might like nortriptyline better than desipramine. For me, it has always seemed like a milder drug with more mood brightening effect.
I think your short-term plan makes a lot of sense. I think I would have tried Prozac again at some point because I never gave it a fair trial at dosages above 20mg.
Do you think your acting out by throwing things is a sign of a mixed state, or is it due to the irritability that can often accompany depression? When I was younger and the depression was first beginning to manifest, irritability was a primary symptom. I do believe I had my fair share of acting out. However, although I hadn't experienced any overt manias, perhaps the irritability and rage indicated a bipolar temperament or bipolar diathesis.
I'm glad you have not completely excluded MAOIs. I guess it is my hopes that you will respond to them as robustly as I did when I first began taking them. It was in 1987 that I was brought into remission with a combination of Parnate and desipramine.
If what you experience as irritability is actually episodes of rage, you might consider returning to Trileptal or Tegretol if you have not responded fully to antidepressants or if it persists afterwards.
Don't forget about Keppra. I had a consultation with a doctor who found it enormously effective for one of his bipolar patients who cycled between mixed states and depression. He found that it was effective for her as monotherapy.
Paradoxically, many people report irritability as a startup side effect with Keppra.
On another note, I am getting scared that I am beginning to plateau with Trileptal. I know that I can be very impatient with a drug unless I am convinced that there is a trend towards improvement beyond a month of the beginnings of a response.
The doctor I spoke to didn't say exactly how long it takes for the cognitive or affective side effects of Trileptal to dissipate, but he gave me the impression that it doesn't linger for very long at all. I find that it comes in waves. I don't recall it being present yesterday at a dosage of 600mg. This morning there is a slight residual. I believe it will pass completely. I did feel something positive even at 300mg, so perhaps you can find utility in a relatively low dosage.
I'm really hoping you get well *soon*. You deserve it.
- Scott
poster:SLS
thread:511101
URL: http://www.dr-bob.org/babble/20050611/msgs/513028.html