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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by fires on August 11, 2005, at 16:18:25
I seem to have "Jane Pauley Syndrome". No history of mania/hypomania until age 50. No family history. Drug induced.
Effexor seems to have induced the mania. If Lamictal works as a mood stabilizer, do I dare try to add it back? Wellbutrin doesn't seem to be as good for me.
Posted by med_empowered on August 11, 2005, at 16:37:03
In reply to Effexor and Lamictal?, posted by fires on August 11, 2005, at 16:18:25
Hmmm...that's a tough one. Generally speaking, if you have mania/psychosis induced by a *specific* anti-depressant, you're probably better off using something else. If you have problem with anti-depressants in general (or you're not really sure, but you've had problems before), you're best off either avoiding anti-depressants, or combining them with a mood-stabilizer when *absolutely* necessary. Now, as far as mood-stabilizers go...Lamictal probably isn't the best one if you're trying to dampen mania, whether its from bipolar or some sort of drug-induced adverse reaction. Lamictal is unusually effective at treating bipolar *depression*, but its effects in controlling mania are much less robust...plus, all the clinical trials have focused on bipolar I and II; there isn't yet any agreement as to whether or not drug-induced mania is bipolar disorder per se, and, if it is, how to categorize and treat it...some docs just withdraw offending anti-depressants, give a benzo and maybe an atypical antipsychotic for a little while, and re-*sses the situation once the episode is over. Long-term treatment may or may not be necessary, and it may or may not involve long-term use of mood-stabilizers. Now, that said...part of the problem may be that Effexor is kind of a "cleaned up Tricyclic," and the old-school Tricyclics are known for causing "switches" and occasionally making otherwise simple cases of depression turn manic, psychotic, agitated, etc. So, you might be better off just avoiding the effexor or anything like it (cymbalta, the tricylics, etc.). If you're dealing with kind of treatment resistant depression that also gets screwed up by antidepressants, you might want to try an atypical antipsychotic at low doses. It should (theoreticallY) help the depression more than just an antidepressant AND assuming the dose was adjusted carefully, it would help smooth out any chemically-induced mania/hypomania/agitation/psychosis. Symbyax would be the obvious choice, but I'm kind of partial to Abilify+SSRI combos myself. The problem here would be that low-dose antipsychotics, especially the atypicals and especially atypicals combined with antidepressants, can sometimes push people into mania. No one knows exactly why, but it pops up in the literature...zyprexa, geodon, low-dose Stelazine, etc. can all push people into mania. On the other hand...if the dose of an aypical gets high enogh, you may as well be taking Haldol--the risks of drug-induced apathy, avolition, neuroleptic-induced dysphoria, etc. climb as your dosage escalates. In my experience, though (I have an odd variant of Bipolar Disorder--psychotic features, mixed-episodes, etc.), low-dose atypicals can "bump" up an anti-depressant for a few weeks, after which you can taper off the atypical and start playing with normal mood-stabilizers, lower the antidepressant dose, so on and so forth. Also, you might want to consider "off-label" depression treatments...stimulatns helped me a good bit without causing mania or anything; Ritalin or low-dose dexedrine/adderall could be helpful...these days, Provigil would probably be the stimulant of choice for most docs. Benzos help alot of people with depression; Ativan, Xanax, and Tranxene are helpful; Klonopin seems to make depression worse in many people, but it also helps people in some studies (I'd say avoid it though). IF you really want Effexor and you really want a mood-stabilizer, I'd recommend Trileptal...its effective, relatively well-tolerated...and there are no blood-tests. Beware, though, of cognitive blunting and "flattening" of emotions at higher doses; its very, very similar to Tegretol, so it carries those risks just as much as Tegretol does.
Posted by fires on August 11, 2005, at 17:19:40
In reply to Re: Effexor and Lamictal?, posted by med_empowered on August 11, 2005, at 16:37:03
Wow. That's a lot of info. to digest. Thanks.
I failed to mention:
SSRIs have been very bad for me.
I experience relatively mild hypomania. I'd rather have that than the depression that I've experienced, therefore I'm hesitant to take only a mood stabilizer.
I tried Zyprexa with Remeron, but had an episode of MDD while on those. Effexor relieved the depression in about 6 weeks.
I'm now tapering off of Klonopin. Provigil has been mentioned as an add-on to the Wellbutrin and Lamictal that I'm now taking. I'm only up to 75 mg of Lamictal.
Maybe I'll do OK on Wellbutrin 300 mg + 100-200 mg Lamictal. Parnate is the only other antiD that has worked for me, so it may be needed if I experience another episode of MDD. I can't be sure that Wellbutrin is keeping me from experiencing another MDD episode. (I can only know that for sure with meds that have brought me out of depression).
I can handle the Parnate diet, but I don't like the med. restrictions, especially the one for epinephrine.
My official Dx at this time is BP NOS.
This is the end of the thread.
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