Posted by gpznos on March 10, 2013, at 12:19:05
In reply to Re: RETRY - please help » gpznos, posted by SLS on March 10, 2013, at 8:40:49
> > 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.
>
>
> - ScottThank you for your answer, Scott.
I might have used the wrong word here: When I wrote "mixed state" I was not talking about manic. I am NOT manic (and BTW have no anxiety).By "mixed state" I meant periods where my mood is between feeling normal and depressed, where I am not way down depressed but not real good either, as you wrote maybe "melancholic" could be used to describe this.
I tried Lamictal for more than a year but it did not solve this cycling problem. And I was on 750 mg Lithium 2 months ago and at that dose I never got to the "normal" feeling at all, it was to numbning. I have had several Nort dosage controls done and I am in the therapeutic window.
The thing you wrote about Remeron as a possible drug against melancholic is interesting. But is it safe to take with Marplan? According to my pdoc it is not safe but he wasnt 100% sure about this.
poster:gpznos
thread:1039965
URL: http://www.dr-bob.org/babble/20130308/msgs/1039987.html