![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Eileen on January 25, 2000, at 14:02:49
My 17-year old daughter was been diagnosed about 6 months ago with severe depression and mild ADD. She was on several anti-depressants, most recently Effexor (225 mg) plus 15 mg Dexedrine for impulse control. Neverthless, she made a 2nd suicide attempt last week. She's okay, physically, but very flat, depressed, and unable to control her impulses. She has huge mood swings, but her new psychiatrist doesn't "see an underlying psychosis" or think she's bi-polar but will evaluate. He mentioned something called "Bi-polar 2," and "Bi-polar other" (or something like that), and is suggesting the possibility of putting her on Depacote (vs Lithium). He said if she is bi-polar, the antidepressant alone could make her condition worse. Does anyone out there have any insight into this? Thank you!
Posted by Noa on January 25, 2000, at 16:59:35
In reply to Depacote and effexor, posted by Eileen on January 25, 2000, at 14:02:49
Depakote is used a lot for bipolar 2, alone or in combo with an antidepressant. I know a teenager who had huge mood swings and angry outbursts who was much calmer and smoother on depakote and prozac.
Posted by Cam W. on January 25, 2000, at 23:09:21
In reply to Depacote and effexor, posted by Eileen on January 25, 2000, at 14:02:49
> My 17-year old daughter was been diagnosed about 6 months ago with severe depression and mild ADD. She was on several anti-depressants, most recently Effexor (225 mg) plus 15 mg Dexedrine for impulse control. Neverthless, she made a 2nd suicide attempt last week. She's okay, physically, but very flat, depressed, and unable to control her impulses. She has huge mood swings, but her new psychiatrist doesn't "see an underlying psychosis" or think she's bi-polar but will evaluate. He mentioned something called "Bi-polar 2," and "Bi-polar other" (or something like that), and is suggesting the possibility of putting her on Depacote (vs Lithium). He said if she is bi-polar, the antidepressant alone could make her condition worse. Does anyone out there have any insight into this? Thank you!
Eileen - Noa is right, I have seen good results with Depakote (divalproex) and antidepressants, especially the SSRIs (like Paxil). Since Effexor blocks serotonin reuptake like the SSRIs and has less effect on norepinephrine reuptake than once thought, you could consider Effexor's action to be SSRI-like. SSRIs can augment (add to) Depakote's action with very little chance of manic switch. (Manic switch is when an antidepressant causes a bipolar patient to switch from depression to mania quite rapidly). SSRIs are considered safer than the older tricyclic antidepressants (TCAs) like Elavil or Tofranil with an estimated manic switch rate in Prozac of maybe 3 to 4% (probably even lower). I have not heard of an instance where Effexor has caused a manic switch.
This combination should be okay and it is well worth having your daughter give it a try.
Good luck and take care. Cam W.
Posted by Cam W. on January 25, 2000, at 23:45:56
In reply to Re: Depacote and effexor, posted by Cam W. on January 25, 2000, at 23:09:21
> > My 17-year old daughter was been diagnosed about 6 months ago with severe depression and mild ADD. She was on several anti-depressants, most recently Effexor (225 mg) plus 15 mg Dexedrine for impulse control. Neverthless, she made a 2nd suicide attempt last week. She's okay, physically, but very flat, depressed, and unable to control her impulses. She has huge mood swings, but her new psychiatrist doesn't "see an underlying psychosis" or think she's bi-polar but will evaluate. He mentioned something called "Bi-polar 2," and "Bi-polar other" (or something like that), and is suggesting the possibility of putting her on Depacote (vs Lithium). He said if she is bi-polar, the antidepressant alone could make her condition worse. Does anyone out there have any insight into this? Thank you!
>
> Eileen - Noa is right, I have seen good results with Depakote (divalproex) and antidepressants, especially the SSRIs (like Paxil). Since Effexor blocks serotonin reuptake like the SSRIs and has less effect on norepinephrine reuptake than once thought, you could consider Effexor's action to be SSRI-like. SSRIs can augment (add to) Depakote's action with very little chance of manic switch. (Manic switch is when an antidepressant causes a bipolar patient to switch from depression to mania quite rapidly). SSRIs are considered safer than the older tricyclic antidepressants (TCAs) like Elavil or Tofranil with an estimated manic switch rate in Prozac of maybe 3 to 4% (probably even lower). I have not heard of an instance where Effexor has caused a manic switch.
>
> This combination should be okay and it is well worth having your daughter give it a try.
> Good luck and take care. Cam W.Eileen - Sorry, checked my notes and Effexor has a 0.5% chance of manic switch, but this is reduced significantly when used with a mood stabilizer (Depakote). The potential for inducing mania is still very slight and I still think this is a good combination. Cam W.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.