Posted by SLS on March 10, 2013, at 8:40:49
In reply to RETRY - please help, posted by gpznos on March 10, 2013, at 7:02:50
> Hi all
>
> After my hospital stay (ECT) ended almost 2 months ago I have been home waiting to get well enough to start working.
> (As previously the last 5 years) there have been periods of 6-7 days of feeling normal/good and then the usually 4-6 days of being depressed, some crying etc. and some days in between of mixed state.I think you might need to focus more on mood stabilizers like Trileptal and Depakote, or even Topamax. Some people with rapid-cyclicity find Keppra useful, but I have not seen it used regularly. Increasing your dosage of lithium might be necessary for your mixed-states, but that is not certain. For depression, 300 - 600 mg/day can help. For bipolar mania, 900 - 1500 mg/day is usually required. Lamictal can help with depression, but might not put the breaks on the manic component of a mixed-state. Using a drug like Abilify often helps with depression, and might even prevent mania.
Marplan can be effective, but I don't think you will glean any benefit from it until your dosage is increased to 40 - 60 mg/day. MAOIs are a good choice for bipolar depression. I like Parnate. Marplan was not as effective for me as Nardil, although its side effect profile was more favorable. Your doctor might be slow to increase your dosage because you are currently taking a TCA. You should get a blood level of nortriptyline if you haven't already done so. I need 150 mg/day to keep me in the therapeutic range. However, it is possible to take too much nortritpyline because it has a therapeutic window. For some people, it works at 75 mg/day, but not at 150 mg/day.
Your diurnal pattern of feeling worse in the morning and feeling better later in the day is usually associated with melancholic depression, and is often treated with TCA. Remeron can work, too. (Remeron made me feel worse). However, bipolar depression can present with an admixture of symptoms. It is as if it were a hybrid of melancholic and atypical unipolar depressions. This describes me. Atypical symptoms predominate, but there is a great deal of anxiety and no mood reactivity. Perhaps this is why a combination of MAOI + TCA has worked so well for my bipolar depression in the past.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1039965
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