Cocktail Ideas? Need to change

[lemonflavor]

I'm going to see my pdoc in a little less than a month. He's always open to ideas and knows I do a lot of research. Since adding Risperdal to my cocktail I have been having mild hypomania for 3-4 day cycles followed by 3-4 days of more depression and/or anxiety. This is a better state than I was in before the Risperdal because I'm not going lower but have the mild highs which are really nice.

I'll just make a list and ideas and please let me know what you think:

I'm taking:

Lexapro 7.5mg - keeps night terrors and panic attacks away

Clomipramine 75mg - great for digestive system, otherwise get diarrhea from anxiety, also helps with sleep and depression a little <-- THIS MAY BE POOPING OUT ON ME though, which other TCAs have done in the past

Remeron 3.75mg - for getting to sleep

Risperdal - .25mg - helps with energy which is huge problem, I may try .5 but it's nauseating

Propranolol - up to 60mg per day, less when I'm more up

Ativan - up to 5 mg per day, most at night, only 2-3mg when I'm up

He understandably doesn't want me on any more drugs that this.

He has suggested Lithium in the past which might even me out but I was reluctant. I could switch it with Clomipramine but I'm afraid my digestive system will go all haywire again and I won't sleep. Or maybe Abilify wouldn't be as nauseating as Risperdal, would provide constipation (a good thing), energy and I could take more of it? Not sure. Let me know what you think or if you have other ideas.

I'm also not sure how to present the energizing effects of Risperdal to my doctor. It's such a good thing and the hypomania doesn't seem to be problematic. Mainly a lot of energy and racing thoughts with some irratibility near the end. No bad judgement, delusions, psychosis etc. I don't want to scare him.

Thanks.

P.S. I've tried Buspar, Lamictal and Wellbutrin which were all like placebo, Lexapro is the best SSRI for me, I've been on nearly all the others and Effexor which pooped and Remeron also pooped but 3.75 helps with sleep. Seroquel and Zyprexa  were like death.

[ncc1701]

Heya lemonflavor,

Not sure what your symptoms are, but that is a long list of meds.

You sound hypomanic at present, which as AM said to someone on a different thread, is not depression, not normal, and not good.  Or something like that, I'm paraphrasing.

Cyling q4days is not good for your life, function, or brain.

Be straight with your psychiatrist, he sounds open-minded.  He knows you and likely will have an idea how hypomanic this is for you, etc.

You're not going to like my first suggestion, b/c I have it as *my* next choice of meds (when/if the Lamictal craps out), and I don't like it either, b/c I hate getting blood drawn.

Lithium might indeed straighten out a lot of the mood stuff and might decrease your need for other meds.

Or, valproate (Epival or Depakote).

Or Abilify, which in early days looks good (we don't have it in Canada, but it looks good).

Jillbelle just had a really positive hospitalization where she met a psychiatrist who is also a pharmacist.  He simplified her meds list.  See if your guy can simplify things for you, at least.

BP sucks, especially with anxiety.  Hang in there, and keep learning all you can.

--ncc--

[Glen]

Mood disorders trump psychotic disorders trump anxiety disorders.

Treat the mood disorder first. Lithium might be a good choice .Try a low dose first. Also consider adding some choline. Of course check with your doctor.