Posted by SLS on August 20, 2015, at 8:07:27
In reply to my issues, posted by meffect on August 19, 2015, at 21:29:03
I agree with Eric that you need something to prevent the appearance of mania. It is bad to pulse antidepressants on and off or cycle dosages. So, adding a second drug to prevent mania makes sense. I happen to prefer Trileptal to Tegretol. Tegretol is more sedating and is more likely to produce agranulocytosis. Lithium had been considered to be the first choice in Bipolar I disorder for a long time. For bipolar II, Depakote was more likely to be the first drug chosen. I am still reluctant to go with high-dose lithium because of its potential to cause long-term damage to thyroid and kidney function at dosages that prevent mania. Besides, it makes me feel more depressed with flat affect and apathy. I take low-dose lithium 300 mg/day to help with depression and to possibly reduce the risk of contracting Alzheimer's Dementia.
It is no crime to take more than one drug at a time. Right now, no single drug has all of the pharmacological properties of the two drugs you might need to take. People who rail against polypharmacy don't seem to take this into account. People with severe hypertension sometimes need to take three or four drugs; each with a different mechanism of action (diuretic, ARB, CCB, beta-blocker). If one chemical substance did all four things, polypharmacy would might not be necessary. However, there is one major problem with this approach. It produces an inability to fine-tune the actions of each property separately.
Given your descriptions, I think you would do best leaving the antidepressanst in place and adding an anticonvulsant other than Lamictal, which is rarely sufficient for treating mania.
Actually, you might do well with a combination of Trileptal and Lamictal if you opt to discontinue the antidepressant.
Good luck.
- 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:1080722
URL: http://www.dr-bob.org/babble/20150806/msgs/1081540.html