Q:  Is Husband's "Dimming" Due to Meds

Dear Dr.
My husband is a BP1 rapid cycler. (ultra rapid-5-6 cycles/daily) He's on 1400mgs/daily of Carbatrol. (5'6, 140lbs)   Wellbutrin was added to counter the fatigue and mild depression, but discont. for causing too high highs.
Blood count looks ok, but there is a marked increase of getting sick.  Episodes are infrequent.  Still waking unrefreshed at 4am, needs to nap during the day.   My husband seems emotionally 'dimmed' and has no desire to do anything.  He wants off the meds. because he feels a distinct lack of emotion.   Is this dimming due to the meds.?
Can the dose be increased any further without compromising his health?  Is it time to try a new drug?   What about the thyroid treatment?

Thank you for your time!
 

Dear Erica -- 
Yes, I have seen patients of mine that seemed "dimmed" by Tegretol even at lower doses, although I agree with trying to push the dose to 1200 at least to see what it can do -- but then backing off and going to something else if side effects occur, and you do seem to be describing potential side effects.  However, so far his doc' is doing very standard sensible things: a recognized mood stabilizer; backing off the antidepressant in recognition of increased manic symptoms.  So, you and I should both be careful not to backseat drive here with perhaps less than the full set of information to go on.  As long as the doc' seems to be responding to your husband's concerns about side effects, you may have to sit back and see what they decide.  I tell my patients' family that they can call and leave me voicemail if they are concerned about symptoms or side effects -- then follow up on those reports with the patient her/himself.  If this doc' is okay with that approach, perhaps you could leave information regarding your concerns, noting that you might be missing something and just wanted the doc' to be aware of what you're seeing and hearing.  Good luck with all that. 

Dr. Phelps