Do These Meds Lose Effectiveness
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Q:  Do These Meds Lose Effectiveness

Hi.  I am BP II.  I take Lamictal (150mg), Keppra (750mg), Topamax (50mg), and Folic Acid (2mg).  He also gave me Seroquel to take only as needed only for a short time, I suppose for sleep and irritability or anxiety (he worries about those drugs causing movement disorders so he doesn't give them very long). I have begun seeing a psychologist as well, acknowledging that although I do likely have a biological problem, I think I could benefit some therapy.  We'll see. 

I recently went to my university health clinic and got some kind of run of the mill blood and urine tests done, including thyroid.  I thought it wouldn't hurt to have it sent to my psychiatrist and see what he says.  I am also wondering if I should be tested for that genetic problem where your system retains too much iron which can cause depression and fatigue.  I admit I am obsessing about medical problems, but it is out of desperation.

What do you think about my prescriptions?  I feel rather fatigued in the day time, possibly from the Topamax, but I think it helps me sleep (and I am not taking the Seroquel by the way). 

Also, do these medications continue to work long term, or do they lose effectiveness like some antidepressants?


Dear Mark -- 
Interesting combination:  three of the most recently discovered medications for bipolar disorder (Keppra is perhaps not even quite yet discovered, in terms of published data on it's effectiveness).  The Topomax is a good candidate for the daytime fatigue.  I don't know about Keppra, haven't used that one yet; I'm watching the data for a while yet.  

Your doc' is clearly  a "modern" type, and I admire the concern he added about Seroquel even though the movement disorder problem is more typically associated with the old generation antipsychotics.  My personal preference is to start with more well known agents, although maybe you've had all those in the past (here's a list of mood stablilizers).  

Do these medications lose effectiveness?  Well, some people see symptoms return while taking them.  Is that the medication losing effectiveness, or the bipolar disorder somehow changing over time?  In general I think the latter is a better model, because usually what we end up doing is using more medications over time; ie. it's not like just switching to an equivalent dose of a similar agent (to the extent that we know what that is) will usually work.  Rather, we end up adding another, then later trying to taper the first one, and then discovering that both are necessary to maintaining stability -- commonly, at least.  

Dr. Phelps

Published March, 2003


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