Question: After tapering off Effexor XR 37.5 mg very slowly I began a trial of Trileptal. At a dose of 300-450 mgs it was difficult to wake up, and I felt mentally impaired during the day and I am getting regular headaches. I am still taking 100mgs of Lamictal.

Dizziness and irritability (I assume from the discontinuation of effexor) became difficult to deal with at work, so I took 5mgs of Celexa, knowing that it has a longer half life and would make the "comedown" smoother. Within hours most of the dizziness was gone as was the impairment from the Trileptal. Mood was significantly better and I even felt a little overstimulated.

I have since read that Trileptal can increase Celexa levels in the blood to dangerous levels regarding cardiovascular problems. Is 5mgs of Celexa a problem? I am also taking Prilosec which does something similar in combination with Celexa

Another question: I've heard of people taking much less than the recommended 1200 mgs of trileptal effectively. Does it make sense for me to keep increasing the Trileptal if I'm already feeling tired and impaired on it? Some drugs have a lower side effect profile at higher doses and I'm not sure if Trileptal is one.

I am also weaning off the Lamictal as I find it doesn't mix well with Celexa. And the side effects of having two anti-seizure meds are compounded.

Thank you

Thanks for getting back to me so quick Dr. S

Not exactly sure where I'm headed honestly. I've experienced some level of depression, anxiety, and distraction/concentration issues since I can remember; There is a strong possibility of BP II or borderline (or both, hard to tell). I've never been able to do more than 6 months without some kind of med

Effexor was my last ditch before trying something second-line or hosptializing myself and stripping all meds away, start fresh, and do intensive therapy. That said I'm very high-functioning (medicated) just super sensitive to emotional/cognitive side effects.

Effexor made lifted me out of the suicidal rumination hole, but made me feel extremely cold and distant. Concentration/distraction and ability to study was much better than Celexa (old treatment). Sleep problems and the coldness made me decide to switch. Mr. doctor and I saw two approaches: replace or increase the Lamictal (for either the BPII or BPD) or go with an MAOI, which I favored due to the lower Side effect profile in terms of mental/emotional blunting.

I decided the Trileptal would be the less "drastic" measure as I can no longer tolerate higher doses of Lamictal. I described my experience to date in the first email. I am trying to ride out the effexor discontinuation and evaluate the trileptal.

The effexor with the Trileptal seemed to result in deep depression so I held off taking the trileptal until the effexor was done. I'm torn between using the trileptal to help with the anxiety and social reactivity, along with something for the depression (if necessary) and just washing out and trying Parnate (first choice) or Nardil (second choice).

Strangely my mood and motivation felt great when I went down on my effexor to half or quarter dose, but concentration/distraction became very hard as did regulating my excitability. Mood-wise I would have loved to stay where I was at.