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Q: Started a Mood Stabilizer & Wants to Stop the Benzodiazepine
Bi-polar II. I take prozac gave me a euphoria for a good while then
depression returned and was very lethargic and starting sleeping during the day.
gained weight. BUT! kept panic at bay and helps with obssessive thinking. know
just added trileptal. I take a benzo also . would like to get off benzo's .
what's a better course of action?
thanks,
Dear R' --
Your story sounds like you've taken the common step of adding a mood stabilizer
(Trileptal) to your antidepressant, which is how many, many people begin
treatment for bipolar II (they were diagnosed with "depression" first and
treated with the antidepressant, then somebody begins to think "this might be
bipolar", and the mood stabilizer is added).
So, my main thought for you is this: you're basically at the very beginning
of treatment for Bipolar II. There are many paths you might follow, but in
general, from where you are now, the idea would be to increase the mood
stabilizer until you do not have symptoms, if that's possible without too many
side effects. If side effects are a problem as the Trileptal dose goes up, you
can add
another mood stabilizer,
and if that works very well, then later you and your doctor can try gradually
tapering the Trileptal to see if the second mood stabilizer might be enough on
its own.
This too is a very common series of steps. In the long run, if you find a
mood stabilizer that works well, at that point in time you will probably find it
rather easy to taper off the benzodiazepine -- where if you did that now, it
might be much harder to succeed and your symptoms could get somewhat worse. This
is because the benzodiazepine, though it is not a "mood stabilizer", still can
help some, while you are waiting to get your mood stabilizer working
properly.
Then, finally, later, you will work with your doctor to decide whether to
keep the Prozac, or gradually taper it off. Tapering off used to be the standard
recommendation. But now there is just a little bit of research that suggests
staying on may be better for some people. You can read about this
controversy on my
site, but work closely with your doctor in making that decision.
That's the usual order in which I would proceed. However, your doctor may
have good reasons for a different approach. There is no clear "standard" way of
doing things from where you are. Good luck to you.
Dr. Phelps
Published October, 2003
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