Any Other Things to Try if Ensam Does Not Work?
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Q:  Any Other Things to Try if Ensam Does Not Work?

Hello Dr. Phelps!

I have been diagnosed with Bipolar x 7 years. Also unipolar depression and OCD about 13 years ago. The OCD has been fairly well-controlled with therapy. Tried most meds under the sun and now am doing well on the Emsam Patch. I take Emsam every other day 9mg--every day made me a bit manic. My doctor today reduced the Emsam to 6mg every other day because of my continued complaint of hypersomnia. He said he does not want me on Provigil because of the stimulant effect. I am hoping this works, but are there any other things that you know of that I can try if it does not? I consider my depressive side to be atypical--except for mood reactivity. I've gone back and forth over the years  between hypersomnia and insomnia--otherwise, I am atypical to a tee.

I also take Lithium ER, 450mg TID (recent level, 0.88), Seroquel 100mg, @HS. I had 8 ECT Tx in January 2007, with minimal help--the Emsam really did do the trick.

I am starting a new job soon, I'm a nurse, I need to get to work on time! Thanks for a great site.

 Dear Barbara --

You have been working on getting this treatment refined for a long time. Any suggestions I might make should be discussed with your psychiatrist and considered only with caution.

However, there is a really nifty idea for you to consider, particularly when the target is wobbling back and forth between too much and too little sleep. There might be a way to tune this up without changing any medications, by focusing on your circadian rhythm. Recently considerable evidence has suggested that disturbances in circadian rhythm are a major ingredient in the bipolar mood problem.

For starters, I would recommend that you read the page on my website about "dark therapy" for rapid cycling bipolar disorder. Although this is only a single case report, it beautifully illustrates a principle, namely that it may be possible to have a "mood stabilizer" effect just by manipulating the timing of light and darkness. At the end of that as it you will find it a longer one about Light and Darkness in Bipolar Disorder, which presents some fascinating research (in plain English, I hope) and culminates in the possibility of a very simple tool you can use to try to tighten up your circadian rhythms (it costs about $50, but at least it does not work it is very unlikely to have harmed you except for that expense).

So the bottom line is: start with nonmedication approaches that might be able to influence your sleep pattern. I hope it works; if not, I am sure you will find it interesting anyway.

Dr. Phelps

Published October, 2007


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