Posted by bleauberry on May 18, 2012, at 8:52:45
In reply to Re: Wellbutrin yuk - old meds... » bleauberry, posted by SLS on May 16, 2012, at 6:03:52
You ask some tough questions Scott that no one on the planet has any answer to. I'm just saying, I do not buy the premise that someone must descend into deep depression induced by a new med in order to come out well on the other side. I just don't buy that. Does it happen? Sure. Not reliably. Some of those people we can visit at the gravesite. Suicide is always a real risk in the back of my mind, so when I see someone's depression significantly worsened, I get all kinds of red flags and alarms going off.
Personally I have had a few situations where a med or herb felt great at the start, quickly turned into very bad, and stayed very bad as long as I was on it. Why or how, no clue. My best guess is it must have something to do with feedback mechanisms or receptor sensitivities, either of them adjusting too far in an undesired direction. But in 0% of my cases did it ever turn around to better. So I admittedly have a little bias on the topic. It's just that as I think back on pbabble, I'm having a hard time recalling anyone that felt deeply worse at the start but then got a robust response when they toughed it out. I just haven't seen that, not enough to remember anyway.
I like the idea of abilify in this situation.
> > Hey that sounds great.....take a pscyhiatrict patient and put them on a med that makes them a lot more depressed and keep them on that med. Yeah right. Ok. Not me.
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> How long would you allow SC's current depression to continue following the discontination of Trileptal before reinstating it so as to prevent mania? It has already demonstrated efficacy. Mania isn't always that easy to treat.
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> Sometimes, the only way to manage an acute manic episode with a mood stabilizer is to cause a subsequent mood shift towards depression. This oscillation is the natural course of the illness, and is often temporary. Perhaps a drug like Abilify can avoid this sequalae. It would be interesting to study this. It may not be the Trileptal that is perpetuating the depression, but the switch into depression that the drug originally facilitated by resolving the mania. However, SC reported feeling great for awhile immediately upon starting Trileptal. How would one interpret this? The depression appeared later.
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> I guess the quickest way to determine the role that Trileptal plays in SC's depression is to discontinue it, although it can be argued that her already reducing the dosage to 75 mg is tantamount to doing this. If the depression continues post discontinuation, then it might be a good idea to restart Trileptal at 300 - 600 mg/day and begin to treat the depression more aggressively with drugs such as Lamictal and Abilify. If this tactic doesn't work, then it might be time to add an antidepressant.
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> It is critical to prevent the mania from reemerging. If it recurs, then the whole process, including a switch into depression, must begin again. If it turns out that Trileptal is not tolerated, some other strategy must be employed to prevent the mania.
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> - Scott
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poster:bleauberry
thread:1017948
URL: http://www.dr-bob.org/babble/20120508/msgs/1018173.html