Posted by Ron Hill on April 8, 2003, at 11:32:41
In reply to Re: Moodstabilizers or antipsychotics for BP II? » Ron Hill, posted by Krissy P on April 8, 2003, at 0:57:17
Kristen,
> My doc added Trileptal but only because I brought it up. My insurance doesn't cover it so I had to stop it after only 3 days.
How did the Trileptal make you feel during the three days you were on it?
I'm assuming that your insurance won't cover it because it is an off-label use of the medication? If this is the reason, they might change their determination if your pdoc sends them a letter spelling out the usefulness of this particular anti-epileptic drug for the off-label treatment of bipolar disorder. Your insurance company pays for Lamictal but not Trileptal? That seems weird. If I were you, I'd appeal the insurance company's determination.
> I am OFF of Effexor as of a week ago. She said it was not helping my mood swings and this:"Most BP's do not do well on AD's"
If she really believes this then why did she, in her next breath, put you back on Celexa?
> What do you think????
It’s dangerous to ask me what I think because I'm likely to tell you.
1) Commit yourself to a consistent exercise program. Track your workouts in your daily log (you are keeping a log, right?).
2) Go to class EVERYDAY and get your homework done. Your future depends on you doing well in school.
3) In my opinion, you still need to add more mood stabilization to your cocktail. Try to get your insurance company to pay for the Trileptal. If they won't, talk your pdoc into a low dose trial of a slow release lithium product.
4) I'm not a pdoc, so all of this is just a layman's opinion. However, if I were in your shoes, I would want to work toward the following cocktail:
Establish a therapeutic dose level of a first or second-line moodstabilizer (e.g.; lithium, Depakote, or Trileptal). Since you did poorly on Depakote, this leaves the other two.
Slowly ramp up the Lamictal dose and simultaneously discontinue the SSRI.
Once stabilized on the moodstabilizer and Lamictal, slowly try to remove the AP.
If the ramped-up dose of Lamictal does not provide enough antidepressant effect, then it may be necessary to add an MAOI or, perhaps, an OTC supplement that will treat the depressive side of your BP II.
Lastly, I would then try to discontinue the benzo.
Therefore, the target cocktail that I would shoot for, if I were in your shoes, would be a good moodstabilizer plus a ramped-up Lamictal dose with the possible need to add-on an MAOI or an OTC supplement to treat any residual depression. The difficult part, however, is getting from where you are now (medication-wise) to the target cocktail without getting your brainchemistry all jumbled up during the transition.
This is merely my opinion, and opinions are like butt holes; everybody's got one.
All my best to you Kristen.
-- Ron
poster:Ron Hill
thread:216188
URL: http://www.dr-bob.org/babble/20030407/msgs/217411.html