Posted by Ron Hill on September 13, 2009, at 23:08:07
In reply to Re: St John's Wort on Bipolar II » Ron Hill, posted by fattoush on September 13, 2009, at 19:47:17
Fattoush,
First and foremost, I want to apologize for using over generalizations in my previous post.
> I don't know the comprehensive list of anti-epileptics but here is what I tried.
There are a bunch of them available now. One or more might help you.
> I tried Depakote, which I gave up on because of fatigue, excessive sleepiness, weight gain, and hair loss. I took it a long time ago, more so for my migraines than my depression. I wasn't that depressed back then so I can't comment on its effectiveness on depression.
I hated Depakote for the same reasons you list, plus it made me even more depressed.
> I've also tried Topamax, again for migraine, three separate times. Every time I took Topamax, I went - long story short - crazy. I was jittery, belligerent, teary, suicidal, etc.... The reason I gave it so many tries was its effectiveness as a migraine prophylactic. The latter times I tried it, it was with other meds on board and at lower doses, so I thought I'd have a different reaction.
Your migraine and depression comorbid disorders make your case much more difficult to treat.
From what I've read, and as you know, Topamax is the best med available as a migraine prophylactic. I wish you and your doc could find an add-on medication that would allow you to take topiramate. I'm not a p-doc, but the symptoms you list sounds to me like a lack of serotonin. Did you try any serotoninergic medications as an add-on to Topamax?
The risk of taking an SSRI is that it could switch you into mania or hypomania. The over-the-counter products 5-HTP and SAM-e might help take the edge off of topiramate. But again, there is a risk of inducing mania or hypomania.
What about another approach; have you ever tried a benzodiapine with topiramate?
Have you ever had a hypomanic episode?
> I've tried Lamictal and though I could tell from as soon as 50 mgs that there was some improvement (I felt serene) it was also aggravating my headaches. At just 75 mgs, I felt that my head was stuck in a vice around the clock, seven days a week.
Because of rashes, I have to ramp-up Lamictal at a rate of 5 mg/wk or less. Have you ever tried to very very very slowly ramp-up topiramate and lamotrigine together while keeping the low dose lithium in place? When I say ramp slowly, I mean at a snails pace.
> I am quite sure that Lithium has been effective on my depression and I am definitely not BPI. I know that a lot of literature states Lithium as better on mania but many psychiatrists, three I've consulted, believe it is quite effective on depression. I know that there's been support for it doing away with suicidal ideation and that is what happened in my case.
You are right. I apologize for over generalizing.
> I also know that I am better at higher doses, less depressed, but I can't tolerate the higher dose because I get very tired and short of breath.
Me too; I hated theraputic dosage levels (900 mg/day) of lithium. For me, I never received any antidepressant effect from lithium.
You sound very intelligent. Do you have the time needed to do your own research? If so, do you know some of the web sites to get started on?
I'd like to help you to the extent that I can.
As listed below, I take three AEDs and an MAOI antidepressant.
-- Ron
dx: Bipolar II with ultra rapid cycling and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
poster:Ron Hill
thread:916539
URL: http://www.dr-bob.org/babble/20090912/msgs/916982.html