Grogginess & New Job
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Q:  Grogginess & New Job

I am a 44 year old male with bipolar disorder. I take Effexor XR 300 mg; Depakote 2000 mg; Abilify 10 mg; Lamictal 100 mg. I take 1000 mg of Depakote; 10 mg of Abilify; 100 mg of Lamictal at 9 p.m. I wake up between 6:30 a.m. and 7:00 a.m. but then fall back to sleep or doze until about 9 a.m. I am groggy until about 10 a.m. in other words, I am tired about 12 hours a day.

I'm starting a new job after being on disability for a year and am very concerned  about waking up and functioning. It seems that any antipsychotic that I've taken, like risperdone, seroquel and zyprexa, have done the same thing to make me sleepy.

Is the abilify the culprit? What about the Lamictal? If I take the meds any earlier, I fall asleep so early it affects evening meetings and my social life. I'm very frustrated and could really use some help.

Thank you.

Dear Michael --
Here I'll have to be very careful as there's a risk you might just act on what I say as opposed to working with your doctor, who obviously will know your history (e.g. the risks of something getting out of control if you change a medication) where I do not. So, I think I'll just recommend that you talk with your doc' about this problem, and ask for her recommendations. If things are going reasonably smoothly, e.g. getting to where you could go get a job now, there's a tension between not wanting to risk that versus trying to get rid of some side effects. There are a couple of candidates on your list for this side effect you're experiencing. I think your doc' would probably agree with me on the principal one, which is the one I'd try turning down, by tiny increments (the manufacturer makes a tiny pill for that one, a quarter of the usual pill size, so you could walk your way down in dose by very small increments to see if things were better without getting any worse). That's what I'd try. Ask her about the idea, all right? Good luck!

Dr. Phelps

Published July, 2004


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