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
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
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
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.
Published October, 2007