Posted by zonked on September 22, 2011, at 20:36:27
In reply to maybe low-dose lithium?, posted by Christ_empowered on September 22, 2011, at 1:59:39
> I'm feeling *so* much better on 200 lamictal and 15 abilify. Its only been a little while on 15 abilify, but I already feel more clear-headed and happy.
>
> Now, here's the thing: my main problem is psychotic depression. Recurrent, severe psychotic depression with everything that goes along with it (anxiety, paranoia, blah blah blah). I've had a few episodes that could qualify as mixed, and one long, drawn out psychotic episode that got me diagnosed Bipolar I w/ Psychotic Features. I also have dissociative episodes when I hit the higher points (or mixed areas) on the mood chart.
>
> Abilify has been great to me, really it has, but I'm wondering if maybe its time to go another route. I don't want TD and I don't want to be tranquilized forever.
>
> Do you think a LOW dose of Lithium+Lamictal would help the psychotic depression? I could still have the Abilify on hand for any mixed/manic episodes. I have to say, though, that my "crack up" (mixed/manic/psychotic episode) followed a long period of psychotic depression; I almost feel as if a switch was made inevitable by having such a low mood for so long. Does that make any sense at all? I feel that with proper management of the psychotic depression and control over psychosocial problems, I might be able to avoid a future psychotic break.
>
> What do you guys think? Of course, the absolute easiest thing to do would be to try lamictal monotherapy, but I don't know if my doc is up for that; she already said 400 was too high a dose, so it looks like I'm probably going to need at least 1 additional medication to make it through OK.
>
> Thanks in advance.
>CE: I empathize with you. Your posts show intelligence, insight, clarity of mind and thought... If I had psychotic features, or a psychotic disorder I would probably fight with myself every day because I think those drugs are nasty. But it is, perhaps, something you must do until better treatments are available.
How consistent has your psychosis been, how did it evolve? If it's consistent, you may be stuck with the Abilify until drugs to treat psychosis with more novel mechanisms make it through trials.
I believe there is a specifier in DSM-IV-TR for "occasional" psychotic features. Like brief reactive psychosis... but, if off APs, you are psychotic much of the time I would not dump or taper the Abilify if I were you.
And if I were in your shoes with your diagnosis, Abilify (or perhaps Latuda) would be the only drugs in that class I'd be willing to put in my body.
You know yourself - given your history, how quickly might psychosis emerge in the absence of APs? What damage might it do? Is it infrequent/occasional or pretty dominant?
I've done enough reading on the topic (yes, mental health issues I don't have interest me too) to know there's nothing out there that can prevent psychosis except APs, mostly because I (quietly) felt so sorry for a brilliant friend I have in Real Life who has BP1 with psychotic features, and I thought "she's killing her brain with Seroquel. There MUST be something else."
I'm afraid there might not be.
Be careful, and good luck. Ask your closest friends what they think.
-z
poster:zonked
thread:997474
URL: http://www.dr-bob.org/babble/20110914/msgs/997569.html