I saw my psychiatrist this morning, bringing to him my concerns about mood, behavior and weight. There's no doubt that I'm showing behavioral changes that indicate a drop into depression. A couple of weekends ago I just blew off paying the bills, with the result that by the time I did sit down to pay them, a couple were going to be paid late. I should be changing the dressing on Mom's stomach twice a day, but it's only getting done once every couple of days. And although I felt good this past Sunday and made a lot of headway with housework, I've hardly done a lick since - not even keeping up with the clutter of everyday living.
And of course, there's the weight gain - up to 200 pounds. My cholesterol is too high, and so are my triglycerides and blood sugar (which is borderline pre-diabetic).
Dr. Meyer told me something I wish I'd known a long time ago: in his experience, the sedative properties of Seroquel (quetiapine) are better at a dosage of about 150 milligrams than at higher doses. Here I've been kicking up the dose every time it seemed like I wasn't sleeping well enough, thinking I'd developed a tolerance to the drug ... until now I'm taking 400 mg every evening. And the higher dose is much more likely to cause weight gain. He agreed that I need to lower my dose of Seroquel or get off it.
I asked him about switching to Geodon (ziprasidone). He replied that the #1 drug in his opinion for bipolar depression is Lamictal (lamotrigine). The main concern about Lamictal, he said, is the chance of a serious rash or Stevens-Johnson Syndrome (which, in clinical trials, occurred in about 1.3 in 1,000 adults with bipolar disorder), but the key in avoiding rash problems is to increase the dose very slowly. If I decided to try Lamictal and a rash did appear, he told me, I should stop taking Lamictal immediately, call him, and get the rash evaluated by my family doctor or a dermatologist. And although anxiety was found to be a very rare side effect of Lamictal therapy in clinical trials, Dr. Meyer said he has had a few patients who did experience anxiety when initiating Lamictal treatment, and it usually goes away after three or four days.
We discussed the pros and cons of possible medication changes, and in the end we decided on the following:
- Begin lowering the dose of Seroquel in 50 milligram increments per week.
- If side effects such as sleep problems or anxiety appear, wait until they go away before taking the Seroquel dosage down any further.
- If depression gets worse, start taking 25 milligrams of Lamictal in the mornings.
- If anxiety appears after starting Lamictal, take 25 to 50 milligrams of my total Seroquel dosage in the morning with the Lamictal, and the rest of the Seroquel at night.
