Though I have not officially been diagnosed with bipolar disorder, I have
struggled with cyclical depression for about 4 years (I am now almost 21). I was
originally taking Celexa and a low dose of Ripserdal. However, this spring
it seemed that my cycles were not improving and probably getting worse. Based on
a suggestion from a doctor, I was weaned off both of those meds and am now
taking 200mg of Lamictal.
However, it seems that I will need an additional medication to prevent my cyclic
depressive symptoms. Based on the information that I have gained from your
website and your book, I am hesitant to go back on an antidepressant. Due to
this concern, my doctor suggested I try using paliperidone on an "as needed"
basis (when I am not doing well or anticipate not doing as well.) I found
limited information about this med in reference to bipolar since it is still
fairly new. I was wondering if you have had any experience with this medication?
Dear CB --
Generally I try not to use new medications for as long
as possible, so the somebody else's patience can find out what the real problems
with the medication are. However, in the case of paliperidone, this medication
has actually been around for 15 years -- or rather, its parent medication has.
This is just the first metabolite of risperidone. So there is less to worry
about as regards unknown risks down the line. Risks we have already known about,
such as increasing levels of prolactin, are the same for this as they are for
risperidone, the manufacturer has already indicated.
Published December, 2007
Therefore one could wonder "why should I use paliperidone, then? Why not just
use risperidone?" So far I have not heard a good answer to that question.
Risperidone will not become available as a lower-priced generic until late 2008,
but at that point one would have to have a major reason to use paliperidone
instead of risperidone.
Meanwhile, if the idea is that Lamictal alone at 200 mg is not preventing
cycling, the options you need to examine are all those which have mood
stabilizing properties, perhaps giving me a slight edge to those with
antidepressant properties as well. Such options include simply increasing the
dose of Lamictal, which does often work better at higher doses than at lower
doses. Or lithium, which in low doses as an add-on booster can be very effective
with few or no side effects and very little risk (at least compared to some
other alternatives). Or really any other mood stabilizers should be considered.
Note that on my updated
of mood stabilizer options, risperidone is not really amongst the "mood
stabilizers" as such. It is an anti-manic but it has no randomized-trial
evidence thus far for antidepressant or mood-maintenance benefits.
The point is, there are still plenty of things to consider before you have to
look at going back on an antidepressant. Here are at least nine such
antidepressant-but-not-antidepressant options -- as well as risperidone, if
it works well and does not cause any trouble. That ought to give you plenty to
discuss with your psychiatrist. I hope that might be helpful.