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Q: Do the Dangers Outweigh the Benefits in this Treatment Plan?
Dr. Phelps,
Hopefully you will have a chance to give me an
opinion based on a nutshell history over the past 5 years. I
have been struggling with severe depression and generalized anxiety
disorder (mood cycling) and was recently diagnosed (after many
psychiatrists, therapies and meds) as Bipolar II (fits symptoms
listed in your psycheducation.org site to the "T"). Have tried Paxil
(terrible withdrawal), Celexa, Serzone, Xanax, Effexor, amyltriptoline,
imiprimine, Wellbutrin, Depakote (had liver and diarrhea problems),
Serequel, Topamax, Lexapro (last 4 simultaneously), Lithium (extended
release but had kidney and TSH problems), Neurontin, Klonopin, from what I can remember off hand (several of these at high doses) and nothing worked beyond ~2 mths (temporary improvement may have been mood cycling, not the
medications). I am currently ramping up on Lamactil VERY slowly (currently
at 75 mg), Valium (helps anxiety), I have hyperlipedimia (Triglycerides in 1000-2000 range), high cholesterol, (all eliminating Zyprexa) and have experienced
significant weight gain. Liver enzymes are also high (not on statin, ect). I have started an exercise regimen (does help temporarily), diet, nutritional supplements for the last month but nothing has helped
the depression (severe) and anxiety(severe)
cycling.
My doctor is recommending we try dextroamphetamine
(5-10mg/day, we are just starting on a minimum dose to determine
value, dosage & effectiveness), valium to counteract the anxiety and
continuing Lamactil, but I have fear of amphetamine, Valium and
dependence issues. Have you ever heard or had success with this angle of
treatment and do the dangers outweigh the benefits? I seem to be running
out of options!!!!!!
Thanks
Michael
Dear Michael --
I'll just add some medications to consider among these options, as to comment
directly on your doctor's plans without knowing you and your history better
would be inappropriate. I will in the process refer you to a very lengthy but
superb
interview with Dr. Husseini Manji, one the world's bipolar experts, and the
expert on what causes bipolar disorder, in which he comments on amphetamine
approaches in bipolar patients. He is so well informed, I hope you'll enjoy the
whole thing as well as those remarks on stimulants.
As for other medications to consider: there is
Trileptal (oxcarbazepine), sort of a carbamazepine lite, but less likely to
bother your liver than carbamazepine itself; and certainly fish oil is worth
looking at although it doesn't have enough "oomph" in my experience, but might
be useful as an add-on; and I have finally been able to get a few patients going
on Zonegran (zonisamide), as an alernative to Depakote that actually seems
associated with weight loss, rather like Topomax, but perhaps with less
cognitive impairment, although there is a rash risk here as well and you'd have
to wait until lamotrigine was either clearly in place and tolerable, probably
several months, before adding Zonegran. But from the sound of things that might
be worth looking into, as a Depakote-like effect to replace the Valium-group,
should you end up havig to use those in the short run (although I'm not sure I'd
even start, given that Klonopin only worked for a while, and that's about the
best in this role, in my experience, for not developing tolerance and becoming
merely something useless one has to try to taper off). Good luck with all that.
You'll find some more info' on all those choices in the table on the
Mood
Stabilizers page on my website.
Dr. Phelps
Published April 2005
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