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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by phidippus on August 29, 2015, at 21:37:33
I am currently taking Lithium, Abilify and Vyvanse. I added Brintellix about two months ago and now find myself manic: irritable, pressured, with racing thoughts.
Should I A) Cut the Brintellix (40 mg) down and use 5 mg Zyprexa to treat the mania or B) add Carbamazapine?
I'm using the Brintellix to treat OCD.
Eric
Posted by SLS on August 29, 2015, at 23:14:43
In reply to Manic. Help!, posted by phidippus on August 29, 2015, at 21:37:33
> I am currently taking Lithium, Abilify and Vyvanse. I added Brintellix about two months ago and now find myself manic: irritable, pressured, with racing thoughts.
>
> Should I A) Cut the Brintellix (40 mg) down and use 5 mg Zyprexa to treat the mania or B) add Carbamazapine?
>
> I'm using the Brintellix to treat OCD.
>
> EricYou might want to consider Zyprexa as an emergency anti-manic agent and then begin trialing things like Depakote or Trileptal. Zyprexa can work literally overnight. Anything lower than a 10 mg dose will probably give you mediocre results. You know the anticonvulsants better than I do, so I'm sure you have ideas of your own. I really do like Trileptal over Tegretol, though.
Good luck.
- Scott
Posted by SLS on August 29, 2015, at 23:30:53
In reply to Manic. Help!, posted by phidippus on August 29, 2015, at 21:37:33
Oh, yeah. Regarding the dosage of Brintellix. For me, because of my history of treatment resistance, I would choose to remain on the 40 mg/day if 20 mg/day didn't work. You must then be prepared to remain on something to keep another fire from starting (kindling). Perhaps at some point in the future, you can discontinue the anti-manic agent and see how you do. I have become manic on both Parnate and Nardil, for which the intervention was to add Depakote or Zyprexa. I was then able to discontinue the ant-manic agent and remain free from mania thereafter.
I observed Topamax to be effective in controlling a mixed-state hypomania at a dosage of 100 mg/day. The only thing is, to avoid the precipitation of cognitive impairments, you have to start low - 25 mg/day and increase the dosage by only 25 mg per week. It works. I reached 200 mg/day and it was very, very clean. Of course you need to screen for the induction of kidney stone formation, which is dosage dependent. I think a blood test can assay carbonic anhydrase activity, but I'm not sure.
- Scott
Posted by Horse on August 30, 2015, at 3:09:58
In reply to Manic. Help!, posted by phidippus on August 29, 2015, at 21:37:33
Add zyprexa and tegretol. My intuition.... Tegretol is also good for neuropathic pain (do you still experience that?). If Brintellix is working for OCD...maybe see if you can keep it on board.... If mania does not respond to zyprexa, then reduce Brintellix or switch it out.
Good luck!
Posted by Zyprexa on August 30, 2015, at 9:09:27
In reply to Re: Manic. Help! » phidippus, posted by Horse on August 30, 2015, at 3:09:58
I agree with the zyprexa! Best thing for mania and racing thoughts. Abilify won't do anything for that. I don't know about lithium.
Posted by Christ_empowered on August 30, 2015, at 11:45:46
In reply to Manic. Help!, posted by phidippus on August 29, 2015, at 21:37:33
I"d take a nice 5-10mgs zyprexa plus a benzo at bedtime and see how that works.
Posted by phidippus on August 30, 2015, at 14:57:05
In reply to Re: Manic. Help!, posted by SLS on August 29, 2015, at 23:30:53
So you were able to stabilize on an added anti-manic than stop it?
Topomax makes me terrifically anxious...
Eric
Posted by phidippus on August 30, 2015, at 15:17:45
In reply to Re: Manic. Help! » phidippus, posted by Horse on August 30, 2015, at 3:09:58
I did exactly as you suggested and, voila, it worked. I did not know carbamazapine was good for neuropathic pain as well (I have it in my feet).
Eric
Posted by SLS on August 30, 2015, at 23:08:14
In reply to Re: Manic. Help! » SLS, posted by phidippus on August 30, 2015, at 14:57:05
> So you were able to stabilize on an added anti-manic than stop it?
>
> Topomax makes me terrifically anxious...
>
> EricHi Eric.
Yes. I was able to discontinue Zyprexa after a few days while retaining Nardil. With Parnate and desipramine, I used Depakote instead. I believe I took 2000 mg as a loading dose and remained at 1000 - 1500 mg/day thereafter. Within a few weeks, I was able to taper and discontinue the Depakote and continue taking the antidepressants.
Of course, this is just me. I know this goes without saying, but I decided to say it anyway.
:-)
Man, I really would like to see you get well and remain well. I don't think it is a bad strategy to keep the offending drug(s) and balance it out with antimanics or mood-stabilizers. When I became manic in 1987 after 6 months of complete remission, it was standard practice to discontinue the antidepressants. The thing is, Zyprexa and Depakote didn't exist. Because I had become so refractory to treatment, several of my doctors hoped they could get me manic and then treat the mania. When you are down to your last few alternatives, I don't think it makes sense not to do this. You could opt to add the anti-manic now and then reduce your dosage of Brintellix down to 20 mg/day before discontinuing the antimanic. However, my guess is that if 20 mg/day didn't work before, it won't work now.
With me, Depakote works so quickly, that I can go right to it and squash the mania within two days. Zyprexa would probably work on a wider population of people, so if there are no reasons why you must avoid this drug, it might make sense to try it first. I swear it can work overnight,and it doesn't have the tendency to leave one mildly to moderately depressed as Depakote sometimes does. I find Zyprexa to be clean and without sedation. Obviously this is not true of everyone.
I'm still waiting for my crystal ball and magic wand to arrive from Amazon.
Good luck.
- Scott
Posted by SLS on August 30, 2015, at 23:23:56
In reply to Re: Manic. Help! » phidippus, posted by Horse on August 30, 2015, at 3:09:58
> Add zyprexa and tegretol. My intuition.... Tegretol is also good for neuropathic pain (do you still experience that?). If Brintellix is working for OCD...maybe see if you can keep it on board.... If mania does not respond to zyprexa, then reduce Brintellix or switch it out.
>
> Good luck!This was a great idea!
- Scott
Posted by phidippus on August 31, 2015, at 15:24:22
In reply to Re: Manic. Help!, posted by SLS on August 30, 2015, at 23:08:14
So, basically what I did is take 5 mg of Zyprexa and added 800 mg of Tegretol.
My mania has dissipated and I notice I feel quite good with the Tegretol-very even. I think I'm going to stay on the Tegretol, only because there is an improvement in affect and very little in the way of side effects. This way I'll definitely be able to stay at 40 mg on the Brintellix.
Unfortunately, I had severe depressive symptoms when I was on Depakote and anger issues even at a 2000 mg dose.
I love Zyprexa-its the duct tape of medications.
>Man, I really would like to see you get well and remain well.
Having OCD and bipolar is a real bitch-the medication for one destabilizes the other!
Eric
This is the end of the thread.
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