Posted by Ritch on May 28, 2003, at 22:31:25
In reply to Re: A few more questions Mitch » Ritch, posted by nmk on May 28, 2003, at 15:29:44
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> > Nicole, FIRST, find out *which* antimanic agent actually works the best for you (lithium, Teg, Trileptal, Depakote, etc.) The reason I say that is it could be possible that the Trileptal isn't doing diddly-squat for you. Just because it is *supposed* to work-doesn't mean that it will. Some of the newer AED's can actually trigger mania. After you figure that one out, then work on what antidepressants and what dosages are tolerable and workable.
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> Thanks Mitch for your advice...as always it is greatly appreciated. I like your approach and will work with my doc in finding the right AED first. Just a few more questions, please, please...(you should charge a fee you know):)
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> *I have been on Trileptal 1200 mg for about six weeks now. Would you consider this a fair trial and is it time to move on?
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> *What about increasing the Trileptal? (my doc says some of his pts. are at a much higher dose). Since I am at such a high dose now I don't know if it is futile to play the waiting game with a higher dose. Plus, I don't know if my tummy could take it.
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> *Is there an AED that is better suited for rapid cycling?
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> *Is there an AED that has been known to have more antidepressant qualities that others? What about anxiety?
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> *Just to play devil's advocate...you suggested to find the right AED before messing with the AD's, right? How will I know if the Trileptal would have worked without my current AD's or with different ones?
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> Sorry again for the barrage of questions. My pdoc hasn't returned my call and I don't see him for another week.
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> Take care,
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> Nicole
Nicole, your "devil's advocate" question is the best one. I thought about reposting after I submitted my response because of that. The antidepressants could definitely be wigging you out. It just seemed like 1200mg was a LOT of Trileptal (for *me* it would be-but that's different), so..therefore, etc., made me think that the Trileptal wasn't exerting much of an antimanic or anticycling effect. The Straterra doesn't sound like much at 18mg, but Zoloft inhibits liver enzymes which would tend to increase the Straterra. Also, the most Zoloft I could ever stand (despite finding it a very effective and useful med however) was 25mg/day and that was only for about a week. I was on just 12.5mg/day for many months. Maintenance-wise I could bet by on 12.5mg every third day... SOOOOO, the first most logical thing would be to back off the last med add-on you tried before everything started to get haywire-was it the Straterra? If so, maybe drop it to those 10mg tabs and see if things get better. Zoloft-wise you might cut the dose in half. IOW, leave the Trileptal the same and just cut either the Straterra or Zoloft in half (preferably the last one you added or increased) and see what happens. If you feel stable enough to be a guinea pig! Then you could see if it helps-if not-then look at the Trileptal and assess what merit it has. good luck-Mitch
poster:Ritch
thread:229544
URL: http://www.dr-bob.org/babble/20030525/msgs/229855.html