Posted by med_empowered on December 2, 2005, at 2:51:58
In reply to cycling?, posted by Bob on December 2, 2005, at 1:21:13
hi! some depressions are like that--they vary by time of day. Its not something that docs seem to talk about a lot, but there's a lot of mention of it in the literature, especially the pre-SSRI days. Anyway, the first thing to do when you have depression in bipolar is to: up the mood-stabilizer or "optimize" the mood stabilizer, sually by adding another mood stabilier. My guess would be that upping the mood-stabilizer or adding Lamictal would be good first-line moves for you. It may also be that Lithium isn't the best mood-stabilizer for you; although Lithium has a protective effect against suicide, some people get better anti-depressant responses with Tegretol/Trileptal, Depakote, Lamictal, or the new atypicals.
Antidepressants really aren't that great for BP disorders, particularly BP I disorder, so that should probably be something you do *after* working on the mood-stabilizer(s). Personally, I'd try adding Lamictal short-term, maybe also upping the Klonopin a bit (it can help some people with depression, and its pretty good for anxiety and bipolar disorders as well). This is also a time to bust out those obnoxious mood-charts patients are all familiar with and start charting...see if little interventions (avoiding caffeine/cigarettes at a certain point, changing alcohol consumption patterns, etc.) show any improvement. If not, you'll probably want to try more med jiggling till you feel better.
poster:med_empowered
thread:584423
URL: http://www.dr-bob.org/babble/20051126/msgs/584432.html