Posted by cache-monkey on March 19, 2006, at 2:00:06
In reply to mixed states, posted by med_empowered on March 17, 2006, at 23:10:47
Thanks!
It seems like mixed states are pretty tough to treat. And they're no fun to experience either.
I do like the thought of Keppra. I think that or Tegretol will be my next try. The Neurontin seems to be ramping up the manic side of things. Hard to tell b/c I also tried to go off the low dose (~50 mg) of Li a couple days before. Between the two changes, I hit an incredibly debilitating mixed state. Mind just running around in circles non-stop.
I'm going to have to reinstitute the Lithium for the time being, maybe for good, and kidneys/UT be damned.
As far as the combos, it just seems to overwhelming. The really tough thing is that I'm in a kind of high-performance job and it's so hard to go through extended periods where my cognitive function is nixed. That makes me really scared to give, say, Depakote or Trileptal another go-round.
But life is so overwhelming in a mixed state that I'll have to go back through the list pair-wise (and then triplet-wise) if there's nothing that adds on/replaces low-dose lithium alone.
Ugh. I hate this.
~cache-monkey
> mixed states are tough, in part b/c for a long time they weren't well-recognized; "clasicc" bipolar I disorder involves discrete episodes of (euphoric) mania and (intense) depression. With the increasing attention towards bipolar II, there's also been interest in the mixed states of various sorts of bipolar.
>
> Keppra might be good--it seems better for the mania end of things (some people report depression on it), but its pretty "clean" in terms of drug-drug interactions. Also, I think benzos can be helpful--if nothing else, they help slow things down a bit so you're less likely to do something stupid.
>
> If you can't tolerate 1 mood-stabilizer @ full dose, perhaps you could mix? Mixing mood stabilizers happens sometimes in BP--for some people, multiple mood stabilizers are a better option than adding in antidepressants or benzos. Some combos: depakote/Lamictal (anti-depressant action from lamictal, plus anti-manic action), lithium+(tegretol, depakote)--strong anti-manic action; might also be a good call in cases of bipolar depression before trying an antidepressant; Anti-convulsant (tegretol, trileptal, keppra, depakote, possibly phenytoin) plus atypical antipsychotic (the AP can be used short-term or longer-term, as-needed)--anti-manic action, possibly some anti-anxiety/anti-depressant action, as well. The only combo I'd avoid w/o even trying is Lithium+antipsychotic, since that can make side effects from both meds more intense (back in the day, some cases of permanent brain damage were reported with haloperidol+lithium combos; no one really knows how safe these combos are long-term or what kind of subtle cognitive deficits they could produce).
>
> Good luck!
poster:cache-monkey
thread:621113
URL: http://www.dr-bob.org/babble/20060315/msgs/621920.html