Q: Do These Meds Lose Effectiveness
Hi. I am BP II. I take Lamictal (150mg), Keppra (750mg),
Topamax (50mg), and Folic Acid (2mg). He also gave me Seroquel to take
only as needed only for a short time, I suppose for sleep and irritability or
anxiety (he worries about those drugs causing movement disorders so he doesn't
give them very long). I have begun seeing a psychologist as well, acknowledging
that although I do likely have a biological problem, I think I could benefit
some therapy. We'll see.
I recently went to my university health clinic and got some kind of run of the
mill blood and urine tests done, including thyroid. I thought it wouldn't
hurt to have it sent to my psychiatrist and see what he says. I am also
wondering if I should be tested for that genetic problem where your system
retains too much iron which can cause depression and fatigue. I admit I am
obsessing about medical problems, but it is out of desperation.
What do you think about my prescriptions? I feel rather fatigued in the
day time, possibly from the Topamax, but I think it helps me sleep (and I am not
taking the Seroquel by the way).
Also, do these medications continue to work long term, or do they lose
effectiveness like some antidepressants?
Dear Mark --
Interesting combination: three of the most recently discovered medications
for bipolar disorder (Keppra is perhaps not even quite yet discovered, in terms
of published data on it's effectiveness). The Topomax is a good candidate
for the daytime fatigue. I don't know about Keppra, haven't used that one
yet; I'm watching the data for a while yet.
Your doc' is clearly a "modern" type,
and I admire the concern he added about Seroquel even though the movement
disorder problem is more typically associated with the old generation
antipsychotics. My personal preference is to start with more well known
agents, although maybe you've had all those in the past (here's a list of
Do these medications lose effectiveness? Well,
some people see symptoms return while taking them. Is that the medication
losing effectiveness, or the bipolar disorder somehow changing over time?
In general I think the latter is a better model, because usually what we end up
doing is using more medications over time; ie. it's not like just switching to
an equivalent dose of a similar agent (to the extent that we know what that
is) will usually work. Rather, we end up adding another, then later trying
to taper the first one, and then discovering that both are necessary to
maintaining stability -- commonly, at least.
Published March, 2003