Started a Mood Stabilizer & Wants to Stop the Benzodiazepine
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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?


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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