Posted by SLS on February 16, 2006, at 7:35:25
In reply to Re: Mixed state, posted by blueberry on February 15, 2006, at 17:40:54
> I had a mixed state and it was NOT fun. Very scary. What ended it in a hurry was depakote 500mg extended release. It began working the first day for me. I don't use it any more, but I do keep it onhand just in case. If you were to try it though, it has to be done carefully with lamictal because it will effectively double the lamictal blood level. You would have to cut the lamictal dose in half at the same time you start depakote.
>
> I've been on lamictal. I've been on lithium. I've been on antipsychotics. I've been on benzos. For me, nothing compares to the rapid stoppage of a mixed state better than depakote.
Yes.I was going to suggest Depakote 1000-1500mg or Zyprexa 10-20mg to treat the mixed-state acutely. Then, one can adjust dosages downward if indicated or begin to build a prophylactic regimen around other drugs. It is possible that introducing anti-manic drugs will result in a residual depression. If the depression does not resolve within a month, I would then consider the addition of an antidepressant like Zoloft. However, one must be fairly confident that the mood stabilizers or anti-manics being used will minimize the risk of a switch into mania.
I know someone for whom an antidepressant was essential to bring about a stable remission from a mixed state. She spent nearly a year suffering from an irritable mixed-state depression with racing thoughts while her doctors struggled to avoid antidepressants. The irritability and racing thoughts resolved once she was hospitalized and an antidepressant introduced. No switch ensued as she continued to take a mood stabilizer that had previous proven itself effective enough to treat her hypomamia.
There is such a thing as depression with racing thoughts that can be confused for a mixed-state hypomania. Antidepressants are almost a necessity to treat this condition. It probably represents a bipolar-spectrum disorder.
- Scott
poster:SLS
thread:609799
URL: http://www.dr-bob.org/babble/20060212/msgs/610177.html