![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by HOK on April 28, 2003, at 10:58:38
Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.
2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.
Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
HK
Posted by Ritch on April 28, 2003, at 12:56:43
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
> Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
>
> Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
>
> I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
>
> 1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.
>
> 2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.
>
> Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
>
> HK
>
Hi, I would change one thing at a time if possible. So, I would stick with the Lexapro for the time being for sure. I'd go for some lithium augmentation first off and see how that goes. Get your thyroid checked-get TSH, etc., before you start the lithium. If your TSH is greater than 2.0 discuss adding some Cytomel or thyroxine with your pdoc. I'd take your time with the lithium on the dosage and see how you tolerate it. Maybe just 300mg/day for awhile and see how you do. Depakote can definitely be depressogenic and porkogenic if not combined right or the dose is too high at the wrong time, etc., etc.
Posted by COLIN WALLACE on April 28, 2003, at 13:52:51
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
Hok,
Let's face it-it's quite bewildering to sift through all the masses of contradicary reports, findings and recommendations concerning BP11.
It's taken me three years(and the usual differing diagnoses)to get anywhere close to nailing the damn thing.
I was determined, at one point,to phase out AD's completely, in the hope that this would eventually settle my mood crashes and temper spells etc.
I had some great success with Lamictal monotherapy(9 months or so), particularly once I hit 300mg. Unfortunately, I also have crippling SAD to contend with, and Lamictal by itself just can't manage to fend it off.
I was never able to tolerate any AD by itself, but I've found that, under the cloak of Lamictal,I can get away with 10mg Prozac daily.
Boosted the Lamictal no end.No swings or irritability whatsoever-just the reverse in fact.If I find it necessary, I'll add a small amount of lithium.But the AD stays put, whatever.
My point is that, in principle it may be a great idea for BP11's to throw in the towel with AD's, but in practice, for major depressives like myself, it's just impossible- and dangerous too-and associated with a high rate of relapse(depending on what you read of course!!)Good luck,
Col.
Posted by COLIN WALLACE on April 28, 2003, at 13:55:25
In reply to Re: Help: Ron, Scott, Mitch...recently dx Bipolar II » HOK, posted by COLIN WALLACE on April 28, 2003, at 13:52:51
Posted by nmk on April 28, 2003, at 14:48:10
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
HOK,
I know your message wasn't intended for me but I had to write considering that I am in the same boat. It looks like I am dealing with a BP II diagnosis after one year of drug trial hell. I recently had a complete thyroid profile and everything came back normal (it was low 15 months ago after delivering a baby and I was on thyroid meds).
I also seem to go from feeling "normal" to feeling agitated, anxiious and depressed and these moods cycle every few days. I am up to 1200mg Trileptal, which is my target dose, and have been on this dose for the past two days. I am also on 50 mg of zoloft and 18 mg of strattera and like you, am wondering if I should ditch the AD's since I have no idea what they are doing. I don't know if they are exacerbating the symptoms or what. I think Mitch makes a good point....work with one med at a time.
Anyway, I hope you keep me posted as to what is helpful to you.
Take Care,
Nicole
Posted by MelD on April 28, 2003, at 18:04:21
In reply to HOK, you have written my story, posted by nmk on April 28, 2003, at 14:48:10
I just had to respond because i have the same dx and have tried what feels like about everything under the sun over a period of almost 20 years. Since the beginning, my pdoc recommended an MAOI, but i was afraid it. I finally agreed in desperation and am doing very well on Parnate. The depression relief is amazing, the anxiety has subsided and i am having no trouble with the diet. I know you are already considering a lot of options, but i have to recommend giving an MAOI a shot. Best of luck with whatever you decide.
Posted by amy_oz on April 28, 2003, at 18:59:11
In reply to Re: HOK, you have written my story, posted by MelD on April 28, 2003, at 18:04:21
I'd just like to say me too. I know I have suffered atypical depression on and off for years esp in winters. Last year i went through a massive anxiety, agitated state for a few months then crashed into a severe atypical depression. Some pdocs diagnosed me with anxiety/depression and medicated me accordingly. I got virtually no relief until I was rediagnosed as BP and after a few differnt trials and settled on 40mg citalopram (Celexa) + 1500mg Valproate (Depakote)
+ all the usual multivitamins, fish oil etc etc
I really think you should try a AD + a mood stabiliser combo.Good luck to you.
Amy
Posted by HOK on April 29, 2003, at 10:14:00
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
Mitch, Colin, Nicole and Amy, thanks for the input. I'm going in next week and we'll see how it goes. On whatever changes the doc suggest, I'm going to do them slowly and one at a time, as recommended. Mel, I'm glad to hear that there is a safe bet in an MAOI. My doc and I have discussed it as well as sort of a "break open in case of emergency" resort, and if this round of trials with stabilizers doesn't work, then it's quite comforting to know that they are there and that they work effectively.
Any other advice on what I should bring up in session to start to choose a new mood stabilizer + AD combo, it would be quite appreciated. Will keep you all posted. Thanks
HK
Posted by Ron Hill on April 30, 2003, at 14:58:46
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
HK,
Sorry to take a couple days to respond. Looks like you’ve already got some good feedback. I’ll merely add my two cents to the thread.
> Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
It’s my opinion that the first step in solving a problem is to clearly define the problem. In other words, getting the dx nailed down (as best one can) is of upmost importance. For example, I was initially misdiagnosed as ADHD and spoon fed a bunch of Ritalin and SSRIs. Because of this wrong medication (resulting from a misdiagnosis from an inept pdoc), I was pushed into a full blown mania causing me to lose my engineering career, spend beyond my means, and generally speaking, act kind of weird. The wrong medication can be way worse than no medication. Getting the dx correct is very important.
> Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
I’d say continue to do your homework. Please check out the following links if you haven’t already done so:
Watch Dr. Bowden’s presentation on Grand Rounds:
http://psychiatry.uchicago.edu/grounds/030303/
Read the relevant portions of the American Psychiatric Association 2002 Guidelines on treatment options for bipolar disorder:
http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
Dr. Phelps specializes in bipolar disorder: His web site has good information but the site is not very user friendly. You’ll have to click around to find all the good information on the site:
http://www.psycheducation.com/
>I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
>
> 1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.HK, you might have to use trial-and-error procedures to determine which mood stabilizer is best for you. For me, Depakote caused me to gain 30 pounds, gave me a rash, and made me more depressed. I’ve been on a low dosage of Lithobid for almost four years and it works well for me. YMMV.
If you try lithium, I’d recommend using a slow release product and start at a low dosage. The side effects are much less (or non-existent) in the lower dosage range. I take 600 mg/day which correlates to a blood level of 0.4mEq/l (in my case). Perhaps you could initially shoot for a blood level in the range of 0.4 – 0.6 mEq/l. As you probably know, the current thinking is that lithium has some neuroprotective properties, particularlly in the lower dosage ranges.
2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.The debate over whether or not bipolar patients should take antidepressants, and more specifically SSRIs, is controversial. Some (like Colin) seem to tolerate SSRIs while others (such as myself) do not.
In my case mood stabilization was relatively easy using Lithobid, but the treatment of depressive side proved to be much more problematic. I tried most of the SSRIs in conjunction with Lithobid (also in conjunction with Depakote prior to starting Lithobid). The pattern was roughly the same for all of them. They all almost immediately induced hypomania which lasted any where from a few days to a couple of weeks, followed by brief period of good AD effectiveness, but then, in the end, all of the SSRIs interfered with my dopaminergic pathways and left me unmotivated, anergic, anhedonic, and severely emotionally blunted.
Please take time to read about the AD Controversy on Dr. Phelp’s web site. Here’s the link:
http://www.psycheducation.org/bipolar/controversy.htm
I’m currently treating the depressive side of my BP II disorder with OTC supplements and, so far, it’s working. If the supplement approach poops out, then I will have to go back to the drawing board. I have made a list of medications to try if this were to occur. Here is my list presented in order of preference:
Medications to Possibly Try:
Add-on another Moodstabilizer:
Tripetal
NeurontinDopaminergic Medications:
Selegiline (low dose)
Provigil
MirapexMAOIs:
Parnate
Nardil
SelegilineBenzodiapines:
Long acting (e.g.; Klonopin) daily or short acting PRNAtypical Antipsychotic (low dosage):
Zyprexa
Respridol (sp?)> Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
Best wishes HK. Hey, what ever happened with your trial of sublingual deprenyl?
-- Ron
Posted by HOK on May 2, 2003, at 14:26:08
In reply to Re: Help: Ron, Scott, Mitch...recently dx Bipolar II » HOK, posted by Ron Hill on April 30, 2003, at 14:58:46
Ron,
thanks so much for the very thorough response. I am in such eager anticipation of what my doc has to say next week in the first session since being given the Bipolar II dx. It sounds like I'm going to be entering a few rounds of med experimentation, but I'm definitely hopeful of finding something that works without making me into an invalid.
As for the selegiline, unfortunately, my doc said that I should discontinue it until we have a chance to explore adding in a mood stabilizer first. He said I could most likely add it back in later. I'm really unsure if it was having any negative effects on me since I blame a lot of my irritability on the Lexapro I've been taking.
Anyways, once I get on Lithium or a mood stabilizer, I hope I can hit you up for some answers on what to expect. I'm sure I'll have a lot of questions! Take care,
HK
> HK,
>
> Sorry to take a couple days to respond. Looks like you’ve already got some good feedback. I’ll merely add my two cents to the thread.
>
> > Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
>
> It’s my opinion that the first step in solving a problem is to clearly define the problem. In other words, getting the dx nailed down (as best one can) is of upmost importance. For example, I was initially misdiagnosed as ADHD and spoon fed a bunch of Ritalin and SSRIs. Because of this wrong medication (resulting from a misdiagnosis from an inept pdoc), I was pushed into a full blown mania causing me to lose my engineering career, spend beyond my means, and generally speaking, act kind of weird. The wrong medication can be way worse than no medication. Getting the dx correct is very important.
>
> > Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
>
> I’d say continue to do your homework. Please check out the following links if you haven’t already done so:
>
> Watch Dr. Bowden’s presentation on Grand Rounds:
>
> http://psychiatry.uchicago.edu/grounds/030303/
>
> Read the relevant portions of the American Psychiatric Association 2002 Guidelines on treatment options for bipolar disorder:
>
> http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
>
> Dr. Phelps specializes in bipolar disorder: His web site has good information but the site is not very user friendly. You’ll have to click around to find all the good information on the site:
>
> http://www.psycheducation.com/
>
> >I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
> >
> > 1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.
>
> HK, you might have to use trial-and-error procedures to determine which mood stabilizer is best for you. For me, Depakote caused me to gain 30 pounds, gave me a rash, and made me more depressed. I’ve been on a low dosage of Lithobid for almost four years and it works well for me. YMMV.
>
> If you try lithium, I’d recommend using a slow release product and start at a low dosage. The side effects are much less (or non-existent) in the lower dosage range. I take 600 mg/day which correlates to a blood level of 0.4mEq/l (in my case). Perhaps you could initially shoot for a blood level in the range of 0.4 – 0.6 mEq/l. As you probably know, the current thinking is that lithium has some neuroprotective properties, particularlly in the lower dosage ranges.
>
>
> 2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.
>
> The debate over whether or not bipolar patients should take antidepressants, and more specifically SSRIs, is controversial. Some (like Colin) seem to tolerate SSRIs while others (such as myself) do not.
>
> In my case mood stabilization was relatively easy using Lithobid, but the treatment of depressive side proved to be much more problematic. I tried most of the SSRIs in conjunction with Lithobid (also in conjunction with Depakote prior to starting Lithobid). The pattern was roughly the same for all of them. They all almost immediately induced hypomania which lasted any where from a few days to a couple of weeks, followed by brief period of good AD effectiveness, but then, in the end, all of the SSRIs interfered with my dopaminergic pathways and left me unmotivated, anergic, anhedonic, and severely emotionally blunted.
>
> Please take time to read about the AD Controversy on Dr. Phelp’s web site. Here’s the link:
>
> http://www.psycheducation.org/bipolar/controversy.htm
>
> I’m currently treating the depressive side of my BP II disorder with OTC supplements and, so far, it’s working. If the supplement approach poops out, then I will have to go back to the drawing board. I have made a list of medications to try if this were to occur. Here is my list presented in order of preference:
>
> Medications to Possibly Try:
>
> Add-on another Moodstabilizer:
> Tripetal
> Neurontin
>
> Dopaminergic Medications:
> Selegiline (low dose)
> Provigil
> Mirapex
>
> MAOIs:
> Parnate
> Nardil
> Selegiline
>
> Benzodiapines:
> Long acting (e.g.; Klonopin) daily or short acting PRN
>
> Atypical Antipsychotic (low dosage):
> Zyprexa
> Respridol (sp?)
>
> > Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
>
> Best wishes HK. Hey, what ever happened with your trial of sublingual deprenyl?
>
> -- Ron
>
Posted by johnj on May 2, 2003, at 17:04:53
In reply to Re: Ron...recently dx Bipolar II, posted by HOK on May 2, 2003, at 14:26:08
"Thus even mood experts disagree about how much caution to use when considering antidepressants for a patient with mild, or subtle, or vague hypomanic signs such as:
severe insomnia (as opposed to decreased need for sleep, a more accepted sign)
moderate irritability (as opposed to profound, irrational, impulsive acts of anger)
anxiety or agitation (possibly the most important risk factor for suicide in mixed depressed states)
a patient who endorses "racing thoughts", but does not volunteer this complaint "
Ron:
This is exactly the way I feel. I had alternating days of good and bad this week. Basically, I feel good and then don't sleep that night or have short sleep that leads to a terrible day like today. I get so tired that the next night I sleep ok and have a decent day.It is so hard to tell if my mood is euphoric in an abnormal sense (I always thought it seemed normal, but don't know anymore). Before I had the panic attack that lead to depression I was in great spirits and slept sound. Could someone develop bipolar at the age of 27? Does the disease morph?
I am so thankful to have a job, but the pesonnel problems in our department are wearing me down. I feel I am on the verge of having a major depressive episode if I stay here. The fear of losing my job or feeling I am not cut out for society is scary and knocks me down further. I sometimes feel sorry for my wife since this affects our relationship and I hate like hell to hurt her. I guess I am so tired. After today I think I need to give up the Mg and see what happens. I was hoping it would replace my benzo, but something wacky is happening with the Mg. It is going to hurt to give it up, but the spaciness I am getting, especially after eating, is horrible. I just want to sleep and wake up to this whole thing just being a bad dream. You take care Ron, I don't know how we all carry on. Send me a prayer would ya
johnj
Posted by katia on July 28, 2003, at 2:37:26
In reply to Help: Ron, Scott, Mitch...recently dx Bipolar II, posted by HOK on April 28, 2003, at 10:58:38
> Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
>
> Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
>
> I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
>
> 1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.
>
> 2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.
>
> Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
>
> HK
>
hi,
I'm recently in the same boat as you. I've recently been dxed as BP NOS (somewhere between II and mixed) with bad depressive states. After going through (like Nicole) a hell year of drug trials that didn't work, I"m here now on nothing getting ready to try Depakote. (I'm terribly frightened of the potentially fatal rash however, esp. after seeing that website showing pictures). I too am wondering if this will be enough considering that my main problem is depression.
Just checking in and seeingwhere you are and how the past couple of months have gone.
Katia
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