[alex55]

How to keep this short? Ha. I don't know. Bear w/me pls.

I was diagnosed almost a year ago when Effexor pulled me out of a bad depression and then sent me to that gray area between hypo and mania. I started with Lamictal (long depression history) and a number of failed trials at controlling the hypo from hell. Finally, Lithium - wonderful!!! Then it made me sick big time. Ended up doing a very slow titration the second time using Seroquel to tide me over. I had a lot of mild mixed states along the way. My pdoc refers to the on-again-off-again as cycling, but we're not talking rapid cycling, more like meds aren't dialed in. I've also felt that for about six months there's been some dysthymia lurking. The last time I saw my pdoc, we talked about lowering Seroquel. I want it down to no more than 50mg for a few reasons. Pdoc also said that if I start to cycle, she wants to drop Seroquel altogether and add 300mg Depakote.

I am on 200mg Lamictal, 900 mg Lithium (.8), and 50mg Seroquel. The Seroquel was 100mg 10 days ago, and I just dropped to 50mg two days ago. The month before I dropped the Seroquel I felt pretty good - my Lithium level getting into the therapeutic range had everything to do with it!

Now, I am feeling more depressed than dysthymic. I suspect the Seroquel reduction might have a little to do with it. I also have some stuff going on that has me really worried, and there's a chance that I might get some bad news next week. I know that's playing with my mood. I am vacillating on whether to call my pdoc for a med change or to wait it out. I don't really like the Depakote idea, and really don't want to do anything beyond a minor med tweak.

So, at long last, here are the questions.

Could halving 100mg Seroquel significantly effect my mood?

Does the Lamictal increase instead of Depakote add-on make sense?

What's the deal with adding Depakote, anyway?

Would you see your pdoc, or would you try waiting it out longer?


Thanks for making it thru this long post!

[mel1]

Seroquel has some mild serotonin activity, so that could account for depression. Maybe, dunno. I take 300 Lamictal. I see you are taking 2oo.
it makes more sense to me to up your Lamictal dose and see if that works before adding a whole new med. My pdoc only likes to make one change at a time. I did a fast med. overhaul when I was inpatient, but i had severe suicidal depression. If you are able to exercise, that could make a huge difference. But, as I haven't in two weeks almost, because of not severe depression, i understand if you can't.

[OreoKitty]

I know you posted about the seroquel decrease on a different thread. Are the side effects too much to put up with if you went back to 100mg.
Also, Lamictal doses are listed up to 500mg if you want to try to increase it. (I'm on 600mg. My tolerance is high.) I'd rather try going up on the Lamictal than start Depakote. Give the Lamictal a shot.

When's your next date with your pdoc? If it is not soon, maybe call her. And tell her you are uncomfortable with the addition of Depakote. Also do you have a tdoc? Might be helpful if you've got something stressful happening in the next week or two.

But this is from a total nonprofessional. Medication is such a personal chemistry thing.

Good luck and be nice to yourself,
Oreo

[alex55]

Thanks! Yes, Seroquel side effects at 100mg are a real problem (I wake up when it peaks due to congestion and body temp disregulation). I'd like a life in the evening, too. It's not such a problem at 50mg, and I'm okay staying here.

My only concern about increasing Lamictal is that it might tip off some hypo. I think I'd rather risk that than add Depakote, but the hypo possibility doesn't thrill me because it'd ripple to more Li or, ha, add Depakote. Idk, Idk, Idk. What to do? What to do? Ugh. I'm trying to be proactive before anything gets out of hand. I just don't want to jump the gun.

I think I'm going to give it a couple more days and see how it goes. Maybe it's mostly med withdrawal (ha, 50mg) and will go away. Yes, I have a tdoc and we are discussing the other stuff going on.

Does anyone know what low dose Depakote is known for doing? (General question. I know that no one here can say specifically what it'd do for me.)

[Velvet Elvis]

Seroquel is one of the only meds specifically approved for the depressive side of bipolar, so it makes a lot of sense that it would help there and that pulling back on it could make it worse.

Lamictal does have an AD effect so increasing it could well help with that.

While depekote can help with both the high and low end, it's more commonly used as an anti-manic.

Do you have any specific reason to think that increasing the Lamactil would make you hypo? Somebody here said that every time they increase their dose on it things destabilize a little bit but then come back together, btw.

[alex55]

Velvet Elvis, on Aug 14 2007, 03:56 PM, said:

Do you have any specific reason to think that increasing the Lamactil would make you hypo? Somebody here said that every time they increase their dose on it things destabilize a little bit but then come back together, btw.

It's the combination of decreasing Seroquel and increasing Lamictal that has me a little concerned about hypomania. It wasn't until I got to my present dose of Lithium that the severe hypo v. minor mixed ping-pong stopped (eight months later). I was way too hypo/mixed while titrating up on Lamictal to say how the titrations effected me. A little destabilization maybe.? I'm not worried about a week or two of slight destabilization. I can deal with that. I just don't want to restart the battle I just finished.

Thanks for the reminder that Depakote is more of an anti-manic. I suspect that my pdoc is thinking that if I do anything more on the mania side, she'd rather add something else than raise my Li levels to 1.0. That would make sense, at least.