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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Jenna S. on November 7, 2001, at 18:03:56
My pdoc has suggested lithium or valproate to augment the bupropion I'm taking for depression. I don't know which one to try, I don't like the sound of either of them... can anyone offer opinions on what it is like to take them?
I think lithium might make me more depressed, since I understood it to be more useful for mania, however my pdoc says it works well to augment antidepressants. Also I didn't know that valproate could be used for depression. I am not diagnosed with bipolar, but still I think a mood stabiliser might help me since my mental state is often apathetic and agitated at the same time. I have had very minor manic like reactions to some ADs before and to withdrawals as well.
Because of the agitation I feel and generally not being able to think straight or concentrate very well, I asked if I could try Ritalin. I'll find out on Friday if he will give me that, I somehow doubt it, they don't like the idea of ADD here in the UK :-(
I also asked about pramipexole, since I have never had a remission of anhedonia. I don't have much hope for getting that one either. So I will probably then have to choose between the lithium or valproate...
Maybe I am being a little pessimistic about my pdoc, he is actually one of the nicer ones I've seen.
Jenna
Posted by JohnX2 on November 7, 2001, at 19:40:44
In reply to Add lithium/valproate/something else for t.r. dep?, posted by Jenna S. on November 7, 2001, at 18:03:56
Hi Jenna,Its my experience that a mood stablilizer will not
worsen depression. Worse case scenerio it may
"flatten" your mood, the lows are less low and
the highs are less high. I haven't tried lithium
but it is statistically a good adjunctive medication.
Sometimes for bipolar it is necessary to have
a mood stabilizer for your brain chemistry to
respond properly to the antidepressant. Depakote
maybe a little easier to try 1st because of
side effect profiles and the monitoring of organs
required by lithium.Lamictal, of the anti-convulsants,
has a good track record of treating cylothymia and
and treatment resistant mood swings. It tends
to knock-out the lows without flattening the mood.
Good side effect profile too if dosed carefully
to avoid a rash.good luck,
john
> My pdoc has suggested lithium or valproate to augment the bupropion I'm taking for depression. I don't know which one to try, I don't like the sound of either of them... can anyone offer opinions on what it is like to take them?
>
> I think lithium might make me more depressed, since I understood it to be more useful for mania, however my pdoc says it works well to augment antidepressants. Also I didn't know that valproate could be used for depression. I am not diagnosed with bipolar, but still I think a mood stabiliser might help me since my mental state is often apathetic and agitated at the same time. I have had very minor manic like reactions to some ADs before and to withdrawals as well.
>
> Because of the agitation I feel and generally not being able to think straight or concentrate very well, I asked if I could try Ritalin. I'll find out on Friday if he will give me that, I somehow doubt it, they don't like the idea of ADD here in the UK :-(
>
> I also asked about pramipexole, since I have never had a remission of anhedonia. I don't have much hope for getting that one either. So I will probably then have to choose between the lithium or valproate...
>
> Maybe I am being a little pessimistic about my pdoc, he is actually one of the nicer ones I've seen.
>
> Jenna
Posted by Mitch on November 7, 2001, at 23:41:55
In reply to Add lithium/valproate/something else for t.r. dep?, posted by Jenna S. on November 7, 2001, at 18:03:56
> My pdoc has suggested lithium or valproate to augment the bupropion I'm taking for depression. I don't know which one to try, I don't like the sound of either of them... can anyone offer opinions on what it is like to take them?
>
> I think lithium might make me more depressed, since I understood it to be more useful for mania, however my pdoc says it works well to augment antidepressants. Also I didn't know that valproate could be used for depression. I am not diagnosed with bipolar, but still I think a mood stabiliser might help me since my mental state is often apathetic and agitated at the same time. I have had very minor manic like reactions to some ADs before and to withdrawals as well.
>
> Because of the agitation I feel and generally not being able to think straight or concentrate very well, I asked if I could try Ritalin. I'll find out on Friday if he will give me that, I somehow doubt it, they don't like the idea of ADD here in the UK :-(
>
> I also asked about pramipexole, since I have never had a remission of anhedonia. I don't have much hope for getting that one either. So I will probably then have to choose between the lithium or valproate...
>
> Maybe I am being a little pessimistic about my pdoc, he is actually one of the nicer ones I've seen.
>
> JennaHi Jenna,
I have taken both of them at different times for years for bipolar. In my personal anecodotal case Lithium did have a clearly more robust antidepressant effect than Depakote ever did. All you can do is try one and see what happens. Depakote seemed to have a better anti-anxiety effect than the lithium did however. Both of them can cause weight-gain and cognitive dulling. The lithium seemed to be worse for the *dulling* BTW. If you are stuck with these two to pick from-I would choose the lithium first and see how you tolerate it. If you are not very tolerant of it you will find out rather quickly! See if: 1) It indeed seems to *indisputably* help your depression and 2) Could I tolerate taking this for an indefinite period? If you can't say YES to both of these questions after about eight-twelve weeks on it, then consider dropping it and switching to Depakote.
Mitch
Posted by Cam W. on November 8, 2001, at 0:37:07
In reply to Add lithium/valproate/something else for t.r. dep?, posted by Jenna S. on November 7, 2001, at 18:03:56
Jenna - As John and Mitch have said, all the literature states that historically, lithium has the best track record as an adjunct in treatment resistant unipolar depression. I have seen it work for many people who have only had partial response to SSRIs and have seen a few of people successfully add it to bupropion (not as many as the SSRIs only because it has not been on the market as long; the success rate seems equivalent) You will have to drink plenty of water throughout the day, and try to keep your daily salt intake constant.
Lithium treats both the mania and depression in people with bipolar disorder (ie. cuts the top off of the highs and the bottom off of the lows). - Cam
Posted by judy1 on November 9, 2001, at 4:16:28
In reply to Add lithium/valproate/something else for t.r. dep?, posted by Jenna S. on November 7, 2001, at 18:03:56
Hi Jenna,
Both made me depressed (I take depakote because of the lower side effect profile) and I liked the suggestion of lamictal. Good luck- Judy
Posted by Cindylou on November 11, 2001, at 14:10:02
In reply to Add lithium/valproate/something else for t.r. dep?, posted by Jenna S. on November 7, 2001, at 18:03:56
Hi Jenna,
Try Lamictal.I am VERY treatment-resistant -- have been on and off ADs, APs, stimulants, and tricyclics for two plus years now. ... all seem to make me worse, or work for a few days, maybe a few weeks, and then I crash ...
Lithium made me extremely drugged out and all I wanted to do was sleep.
Finally, things are starting to turn around with Lamictal. I believe it is fairly new out there. I am feeling more stable than ever .. and as others have said, my agitation and anxiety are becoming less severe, while my depression/exhaustion is getting better.
I hope you find the right med for you. From experience, I recommend at least trying Lamictal.
cindy
> My pdoc has suggested lithium or valproate to augment the bupropion I'm taking for depression. I don't know which one to try, I don't like the sound of either of them... can anyone offer opinions on what it is like to take them?
>
> I think lithium might make me more depressed, since I understood it to be more useful for mania, however my pdoc says it works well to augment antidepressants. Also I didn't know that valproate could be used for depression. I am not diagnosed with bipolar, but still I think a mood stabiliser might help me since my mental state is often apathetic and agitated at the same time. I have had very minor manic like reactions to some ADs before and to withdrawals as well.
>
> Because of the agitation I feel and generally not being able to think straight or concentrate very well, I asked if I could try Ritalin. I'll find out on Friday if he will give me that, I somehow doubt it, they don't like the idea of ADD here in the UK :-(
>
> I also asked about pramipexole, since I have never had a remission of anhedonia. I don't have much hope for getting that one either. So I will probably then have to choose between the lithium or valproate...
>
> Maybe I am being a little pessimistic about my pdoc, he is actually one of the nicer ones I've seen.
>
> Jenna
This is the end of the thread.
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