Dr. Phelps:
 Hello! i just came across this sight whilst 'googling' lamictal, trileptal and  kidney/cholesterol  issues. I was diagnosed just last year with BP II, and  apparently, according to my doctor, had been erroneously treated for plan old  depression most of my adult life. That being said, she started me on a course of  moodstabilizers--lamictal, Tripleptal and seroquel tossed in there for sleep and  anxiety. I recently started having extreme bilateral peripheral edema, and am now  going to start undergoing kidney analysis as apparently i have been leaking  protein from my urine for over a month. In addition, in this past year my  cholesterol has gone from 200 to 400. While there is some high cholesterol in my  family--all are mystified. I am 42, lean, pretty much vegetarian (fish) exercise,  no smoke,no drink. But i am told, like many BP's do tend to overdo coffee :-).  (better than the stuff i used to do in the 80's)
 So i guess i am just sending this 'message' in a bottle for any feedback. My new  psychiatrist had concerns about all of this and lamictal (i had gotten up to 400  mg) so i am now 2 days 'clean' from that. Seroquel had gotten up to 200 mg due to  lots of personal anxieties (alleviated by getting OUT of a relationship with a  nice Borderline) so now i am off of that. Trileptal is at 1800 mg/day. I will  probably have to have a kidney biopsy. My fear is that i will get taken off all  meds and have to wing it but i also want to heal my kidneys. My doc just put me  in 5mg of lexapro to keep some depression at bay.  And while i am here, i was curious, the psychiatrist who originally diagnosed my  BP (which is no shock, as my father was Bipolar I with three to four Major manic  episodes) said that due to my  misdiagnosis, i will always have to take some type  of antidepressent as that is what my brain is now 'used' to--any feedback on that?  Thanks to anyone who might have some information or perhaps direct me to another  resource! I am quite distressed!
Thanks,

Sincerely,



Dear Ms. R -- 

You raise several important questions here. First of all, you may find it useful to note that Trileptal it is quite commonly associated with peripheral edema, and there should have been a clue about this in your bloodstream sodium levels, which this medication causes to decrease, very commonly. If you had normal sodium levels, it is much less likely that the edema would have been coming from Trileptal, and that perhaps is the reason why your doctor was looking at Lamictal. However, if you're levels were not normal, this could be quite a simple matter and not a kidney problem. I presume your doctors know all about this, and that therefore the answer is not so simple, but you would want to make sure before worrying about your kidneys.

Secondly, as regards going on Lexapro, and this idea that you will always have to take some type of antidepressant. Your doctor may know something that I do not, as I have only your history here on which to proceed. However, his interpretation I think it may reflect his experience rather than evidence we could turn to in the psychiatric literature. It could be that he is concerned that your depression will remain a significant target, just as it was before all this.

In any case, it is useful to remember that there are at least nine antidepressants which are not "antidepressants" as such. Among them are Lamictal and Seroquel, but that still leaves seven others you could consider for long-term management when the edema is better understood. Here is a list of those nine "antidepressants" that are not antidepressants.

Good luck with all this.

Dr. Phelps



Published March, 2007