Medicated and not doing well
DEAR DR PHELPS, I WAS DIAGNOSED SEVEN MONTHS AGO WITH BIPOLAR II DEPRESSION. I AM CURRENTLY TAKING 2400 MG NEURONTIN. I HAVE EXPERIENCED SOME IMPROVEMENT BUT STILL HAVE DAYS WHERE I BECOME AGITATED WITH MY HUSBAND AND CHILDRED AND FEEL BADLY WHEN THIS HAPPENS. MIGHT IT BE HELPFUL TO CHANGE MEDS OR AUGMENT THE MEDICATION I'M CURRENTLY TAKEN? I HAVE ALSO USED ATIVAN TO HELP WITH MY ANXIETY AT TIMES. I AM FRUSTURATED THAT I AM NOT FEELING AS WELL AS I THOUGHT I WOULD AFTER SEVEN MONTHS OF THERAPY AND MEDICINE. ANY ADVICE WOULD BE HELPFUL TO ME . I LOOK FORWARD TO YOUR RESPONSE!
Dear Ms. R -
Here are some general principles: first, people with BPII can get better to the point where they do not have active symptoms. There is even some evidence to suggest that continued symptoms may mean more trouble with even more symptoms later. So it is worth it from your treatment's point of view, as well as from your point of view, to shoot for zero symptoms. In many cases, though, that's not easy and you can go through an awful lot of medications, and end up taking a lot of them together, trying to reach that goal. So, at any stage along the way you can choose to say: "that's good enough for me, for now" and stick with what you have.
It doesn't sound like you're there now! Take a look at the general guidelines for treatment on my site where you can see the references from which these guidelines derive. A good overview, if a little technical, is the Consensus Guidelines for Treatment published this year. You'll see that Neurontin is not high on the list as a starting place or as "monotherapy".
Finally, I use a person's need for Ativan (generic: lorazepam) as a marker for whether we have enough mood stabilizer going. That is, when people are doing well, they won't need it; and if they do end up needing it again, it's time to look at increasing one of the mood stabilizers or adding another, especially if they start to need it all the time.
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