Posted by SLS on April 4, 2001, at 23:09:35
In reply to Re: New mood-stabilizers ? » SLS, posted by cole on April 4, 2001, at 20:49:01
> I wanted to thank you for your response re: serzone and my boyfriend, I read him all the responses and he liked your explanation the most. He seems to be doing pretty well on the stuff now & has adjusted to the urge to express himself.
I'm glad that the situation was "simple" enough to resolve itself. Wonderful.
> I have a question regarding my own med happenings, and it relates to the mood stabilizer business. In an earlier post I was wondering why I've kept crashing on remeron every few months and requiring an increase in my dosing to restabilize. I've gone from 45 in october to 60 in january, and needed to take it up to 75 a little over a week ago.
I think it is reasonable to try 75mg of Remeron for a few weeks. I cannot comment on the probability of your responding to it, but you are almost done completely exploring it. Did it help at all at any point?
> My pdoc mentioned that my depression is "cyclic" in my last visit when I was asking about the problem.
What is it about your case that is cyclic?
> Loosmrbls responded to the earlier post suggesting that I was actually bipolar II and needed a mood stabilizer. I've never experienced true mania, unless you consider the agitation/aggression I experienced from zoloft.
Loosmrbls could be right. However, agitation is listed as a possible side effect of Zoloft.
Sometimes, when someone is just beginning to respond to an antidepressant, irritability and anger can emerge. However, if your reaction to Zoloft included impatience with people, constant movement, rapid or pressured speech, fits of rage, and reduced need for sleep, then a diagnosis of bipolar II needs to be considered.
> My depression is very strong though, and I suffer from significant anxiety (I do drive like a bat out of hell when anxious) with the depression.
I don't know what to make of this. The driving while anxious thing is suspicious as being consistent with a mixed-state hypomania, a type of bipolar II in which depression and hypomania occur simultaneously. However, I don't know how often this sort of driving thing can happen with unipolar depression. I don't experience it, but my depression is very anergic - I don't have enough energy to be anxious and drive fast.
Do you ever get an acid-stomach?
> Should I look into a mood stabilizer?
I don't know.
If it is determined that you have a bipolar-type disorder, a mood-stabilizer would probably be an important part of your treatment. Some people have symptoms that are similar to bipolar disorder but do not meet the strict criteria established for this diagnosis. Recently, the term "soft-bipolar" has emerged to describe these otherwise undefined bipolar-type presentations.
What other drugs have you tried?
> What would work with remeron, ritalin (as needed to study), and small amts of trazodone? Provigil and wellbutrin made me feel completely disconnected, if that lends any clues.
I think these clues would ring a bell with somebody here, but I can't come up with anything concrete. If you decide to try a mood stabilizer, I would recommend Lamictal (lamotrigine). It has significant antidepressant effects and is claimed to be effective for treating rapid-cyclicity. It has few side effects at the dosages used for depression and bipolar disorder. The one very important thing to remember is to start Lamictal at a low dosage and increase it very gradually. Doing so will prevent a rash-reaction that occurs infrequently but that can be serious. I currently take 300mg of Lamictal. I find it helpful. You will probably be recommended every possible drug except those you have already tried, but Effexor or Parnate sound good to me. Parnate is an MAO-inhibitor, a drug that is better left for later because it requires a special diet. There are numerous eligible alternatives. It might make sense to add Effexor to Remeron at this point, as it is considered a potent combination. You might be able to lower the dosage of Remeron if it works. Just keep an eye out for mania (or have others keep an eye out for you), just in case you have the potential for it. I'm not saying that you do.
> I do have a box of adrafinil that I haven't tried either, but that's more of a stimulant.
A great many people have had success with adrafinil. It really cannot be lumped into the same category as the convential "stimulants", and does not seem to act identically to its sister drug, Provigil.
> Any ideas would be much appreciated, I want some good ideas before I talk to my doctor.
Oh, I wish you would have specified "good" ideas before I wrote anything. I'll have to leave that for someone else.
Sincerely,
Scott
poster:SLS
thread:58657
URL: http://www.dr-bob.org/babble/20010403/msgs/58728.html