Q:  Psychotic Episode from a Bad Cocktail?

Thank you so very much for this superb resource.

I have been clinically depressed for years, Paxil, then Effexor, which helped tremendously.  About two years ago, I was diagnosed with bipolarity, which went outrageously out of control, so bad that I lost my job and career.  (Rabbis don't act out, even if they do not engage in acts of moral turpitude.)  Doc put me on Lamictal along with the Effexor, and it did miracles.

Saw the doc two weeks ago, and he wanted to tinker a bit because he was not satisfied that I was doing as well as I could.  Put me on Topamax, from which I was nauseated 24-7.  Two days ago, he switched me to Trileptal, 150 AM, 300 PM, I guess a pretty tame dosage -- along with the Lamictal and Effexor.

By yesterday noon I was an emotional mess, crying almost uncontrollably.  Last night was horrific:  hallucinations, nightmares, crying out for my deceased mother, uncontrollable crying, repeated apologizing to my bewildered  wife.

Of course, this happened on the weekend.  All I could rustle up was the oncall doc, who told me to keep up the 150 AM, drop the 300 PM, until I could see my own doc.

Sorry for all the elaboration, but my essential concern is that I have not found any of these radical side effects to Trileptal discussed on the Web.  I am feeling a little better, but am petrified to even take a nap for fear of another of these psychotic episodes.

My health otherwise?  Just a real bad cold for which I am taking Tylenol, nothing else.

Have you heard of these radical side effects from Trileptal when taken in tandem with Lamictal and Effexor.

I pray that this is just a bad cocktail, because if not, I am desparately out of control and am petrified.

Most grateful for any insight, please.
Appreciatively,


Dear Rabbi __ -- 
Haven't seen that effect even close even once, so I'd conclude "bad cocktail", at least for you.  Mind you I'm referring to Trileptal itself, not in combination like this, as I haven't used such a combination.  My mind goes quickly to wondering about the Effexor plus lamotrigine, vs. lamotrigine without Effexor, and how that might work for the "fine tuning" -- but I leave that to you and your doc'.  

Dr. Phelps

Published April, 2004