Posted by SLS on March 5, 2016, at 14:33:00
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 12:23:37
> > > > a psychotic reaction to drugs indicates Bipolar Disorder I *if* the manic reaction persists after the offending drug is discontinued.
> Here's where I'm confused. When the offending med (parnate) was dc'd, I was no longer manic.When was Geodon first added relative to your discontinuation of Parnate?
> Still think I'm bi-polar I?
I am still leaning in that direction. I am taking into consideration your description of your traveling. It really depends upon how you answered the question regarding the timing of Geodon administration.
Have you ever tried Lamictal? If you think you are bipolar, I would consider adding Lamictal for the long term to help with your present depression and protect you from future depressions. Lamictal is a "bottom-up" mood stabilizer that acts on low mood to raise it to euthymia. It acts much like a antidepressant. Conversely, drugs like Trileptal, Depakote, or lithium are "top-down". They help to cap mania and lower mood to euthymia. If rapid cycling ever becomes a problem, you might consider combining Lamictal with a top-down mood stabilizer. I don't foresee this happening to you, though.
IF Nardil doesn't work out, you might end up back on Parnate. If you remain on Zyprexa, you can add back methylphenidate since you liked how you felt on the combination. As an alternative, you can add Lamictal to Parnate immediately so that you arrive at a therapeutic dosage of Lamictal as quick as possible. It can take 6 weeks to reach at a therapeutic dosage (200-300 mg/day).
----------------------------------
One possible aggressive scenario:
1. Continue Zyprexa.
2. Begin Nardil on day 1 and titrate to 60-75 mg/day.
3. Begin Lamictal on day 1. It takes 6 weeks to reach a therapeutic dosage (200-300 mg/day) using a very gradual titration schedule. Screen for the emergence of a rash-reaction.
4. Add methylphenidate or amphetamine if necessary after being on Nardil 75 mg/day for 3-4 weeks.
5. Return to Parnate if necessary following a 14 day washout beginning from the last dose of Nardil.
6. Continue Lamictal.
7. Continue methylphenidate or amphetamine.
8. After you have been euthymic for an extended period of time, you might decide to discontinue the stimulant, Nardil, and Zyprexa - in that order.
9. Remain on Lamictal to prevent future relapses into depression.
* This is meant to give you ideas. It might not end up being the exact protocol that you find yourself following.
----------------------------------
Hopefully, adding Nardil to Zyprexa will be sufficient. Simple is good. Take one day at a time. Make one decision at a time. Be patient.
One time when I became manic on Nardil, adding Zyprexa worked within 12 hours and I did not feel at all slowed-down. Actually, Zyprexa gave me an increase in thought clarity. I wish that I had continued to feel that way.
What are your thoughts?
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1086626
URL: http://www.dr-bob.org/babble/20160131/msgs/1086753.html