Re: Dump everything? » sheilac

You must be feeling like hell that you should consider doing something so extreme. I am dubious of the advice you have been given.

I am sure that you want to feel better immediately, regardless of what it takes to do it. However, to do what has been suggested might set you back months. I don't believe that tramadol is enough of an antidepressant to treat your present condition. Wellbutrin seems like the wrong drug for you at any dosage. I can't be absolutely sure, though. I suppose being absolutely sure of anything with these brain disorders is elusive, especially for laymen like me. So, I will just say that I feel mood stabilizers are important for you if you are to ever see stability and achieve a depression-free life for yourself. Treating with a combination of Lithium + (anticonvulsant) is sometimes necessary, expecially when ultra-rapid cycling is present. Perhaps trying drugs that are not standard antidepressants makes sense to do first. I should think that Lamictal and Abilify would be effective for your bipolar depression, especially when used together. Both of these drugs have antidepressant properties. The NIH has published an article indicating that the combination of these two drugs reduces the odds of relapse.

If your doctor prescribes Abilify, be prepared for the possible emergence of anxiety, restlessness, and insomnia at the beginning of treatment. It looks like a mild form of akathisia, but usually disappears in a week or so. The Klonopin might help prevent this. I can't tell you what percentage of people experience this with Abilify. As with all antipsychotics, true akathisia is a possible adverse event, so I would work closely with your doctor to work through startup side effects and evaluate the more persistent ones.

The following article evaluates the potential for the combination of aripiprazole (Abilify) and lamotrigine (Lamictal) to prevent future episodes of depression in bipolar disorder, especially for patients with mixed-states. Terrence Ketter trained under Robert Post at the NIH, and is considered to be an expert in the use of mood stabilizers in bipolar disorder and is a pioneer in brain imaging.

Aripiprazole Plus Lamotrigine May Prevent Depressive Relapse in Patients With Bipolar Disorder

AMSTERDAM, the Netherlands -- September 1, 2010 -- Combination treatment with
aripiprazole plus lamotrigine reduced the rate of relapse to a depressive
episode in patients with bipolar I disorder who had had a recent mixed episode,
researchers reported here at the 23rd Congress of the European College of
Neuropsychopharmacology (ECNP).

Terence A. Ketter, MD, Department of Psychiatry and Behavioral Sciences,
Stanford University, Stanford, California, and colleagues compared treatment
with aripiprazole plus lamotrigine (n = 178) with placebo plus lamotrigine (n =
173) in 351 randomised patients.

We think that these are the first data showing that aripiprazole might have
something to do with preventing depression after a mixed episode, said Dr.
Ketter during a poster presentation on August 31.

Treatment was double-blind for aripiprazole and placebo, but open-label for
lamotrigine, and lasted for up to 1 year.

Patients entering the study had to have bipolar I disorder plus a recent manic
or mixed episode as defined by a total score >=16 on the Young Mania Rating
Scale (YMRS). Fewer patients in the aripiprazole group presented with a mixed
episode compared with the placebo group (43.8% vs 54.9%).

Before randomisation, all patients had received single-blind treatment with
aripiprazole 10 to 30 mg/day plus open-label treatment with lamotrigine 100 to
200 mg/day and had to maintain stability for 8 consecutive weeks, with 1
excursion allowed, except for the second-to-last and last visits. Stability was
defined as a YMRS score <=12 plus a Montgomery-Åsberg Depression Rating Scale
(MADRS) score <=12. An excursion was defined as a YMRS and/or MADRS score of
>12.

The researchers looked at the Kaplan-Meier relapse rate into a manic or mixed
episode over the 1 year of randomised therapy. They found that the relapse rate
was lower with aripiprazole plus lamotrigine treatment (11%) than with placebo
plus lamotrigine treatment (23%), although the difference was not significant
(P =.058).

When relapse into a depressive episode was evaluated, however, a post hoc
analysis showed a difference between treatment groups among patients who had
entered the study with an initial mixed episode. A significantly longer time to
depressive relapse was seen with aripiprazole plus lamotrigine treatment than
with placebo plus lamotrigine treatment (P =.041). This difference
was however not significant among patients who had entered the study with an
initial manic episode.

One of the best predictions of failure, i.e. relapse, seems to be the initial
mixed episode, said Dr. Ketter.

With the adverse event profiles, there were no surprises, said Dr. Ketter. No
new or unexpected adverse events were seen, and all adverse events that
occurred were consistent with the known profiles of aripiprazole monotherapy
and lamotrigine monotherapy, the researchers noted in their poster.

Funding for this study was provided by Bristol-Myers Squibb and Otsuka
Pharmaceuticals.

[Presentation title: Aripiprazole in Combination With Lamotrigine:
Long-Term Treatment of Patients with Bipolar I Disorder (Manic or Mixed).
Abstract P.2.e.021]

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

Re: Dump everything? » sheilac

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