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Update, and Please Help

Posted by smart.drug on January 16, 2009, at 20:28:15

Alright, Bipolar 2. Currently on these:

Lamictal 300 mg
Provigil 200 mg
Lovaza 4 caps
Cerefolin NAC 1 cap

I was on Cymbalta, but it made me flip. I had some Seroquel lying around; the high dose made the agitation worse. I'm so scared of Seroquel now that I'll never touch it again. You see, while taking the Cymbalta, I was switching over from Seroquel to Zyprexa. The plan was to go from 200 mg Seroquel to 5 mg Zyprexa. My agitation was so bad that I took 10 mg of Zyprexa. But in less than four weeks, I gained ten pounds; the amount of weight isn't the problem, but the rate at which I gained it. If that wasn't enough, I went to my regular MD for my yearly physical and found that my LDL had shot up to 160! There's no way I can keep taking the Zyprexa.

Let's backtrack a step. Seroquel made me feel sedated, while Zyprexa made me feel refreshed in the morning; so I liked the Zyprexa better, and that was why I was trying to switch over. The Cymbalta was prescribed because I had anxiety and bodily fatigue and all-over aches and pains.

Now, let's put it all together. Physically, I can tolerate Seroquel, but I hate the way it makes me feel. I like the way Zyprexa improves my sleep quality (I don't like the way it causes cognitive deficits), but I can't physically tolerate it. I was willing to wait around for the Cymbalta to kick in, but it made me agitated (mixed episode.)

And now, here's what I need. A strong mood stabilizer, an anxiolytic, and sleep-enhancer. The agent or agents cannot have the capacity to cause large amounts of weight gain, interfere with memory or cognition, or have additive potential. Am I asking for the impossible?

I've been thinking about a combination of low-dose fluoxetine (5-10 mg), buspirone, guanfacine, and Rozerem (or possibly melatonin itself.) At low doses, fluoxetine is a 5-ht2c antagonist, like olanzapine, and in combination with melatonin agonism may enhance sleep quality. And I'm hoping that the combo of buspirone and guanfacine can be both anxiolytic and focus-enhancing for me.

Any better ideas?

P.S. Oh, wait... no mood stabilizer. I haven't thought of a mood stabilizer.


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poster:smart.drug thread:874413
URL: http://www.dr-bob.org/babble/20090104/msgs/874413.html