Asking for a med increase

[marcia]

I have bipolar I disorder, "classic" euphoric type (most of the time). I took Depakote for several years, which controlled the manic symptoms well, but unfortunately flattened my moods and personality more than I liked. Back in November I stupidly discontinued the Depakote (AMA), which resulted in a moderately severe manic episode within two weeks of discontinuation (I am also taking Wellbutrin and Celexa). Four weeks ago, my doctor suggested we try Neurontin and initiated treatment @ 600 mg/day. The Neurontin (or nature) ended the manic episode, but since that time I seem to have entered a rapid-cycling phase that I can't get out of. A week ago, my doctor increased the dose to 1200 mg/day, but I'm still experiencing very obnoxious manic symptoms alternating with tearful--not suicidal--depression. I'm trying hard to control my behavior, but not having as much success as I'd like. The questions are these: Should the increased Neurontin have had a more stabilizing effect by now? Is it reasonable to contact my doctor to discuss another increase so soon after the first one? Or, if not, how long should I wait? At what point or dose level would you consider the Neurontin ineffective for treating my disorder, assuming the rapid cycling continues?

I apologize for the length of this question, but I wanted to provide as much relevent information as possible. Thank you for taking the time to read this and respond.

Sincerely,

marcia

[HFHS.MD-AJ]

Marcia,

Research studying treatment of rapid cycling bipolar I disorder with the anticonvulsant Neurontin (Gabapentin) is still ongoing. At the present time, Neurontin is not FDA-approved for treatment of bipolar disorder. Depakote is a more well accepted treatment for rapid cycling, and is FDA-approved for the treatment of bipolar disorder. The development of rapid cycling in bipolar I disorder is more likely in female patients, and has been associated with the use of antidepressants and hypothyroidism.

Neurontin is usually prescribed in doses of 900 to 1800 mg per day, given in three divided doses, with a maximum daily dose of 2400 mg. There is limited data with regards to how long it takes Neurontin to achieve clinical efficacy, unlike Depakote which can produce resolution of manic symptoms within days.

I am not aware of any relationship between obsessive thoughts and bipolar disorder or Neurontin. Please discuss your concerns further with your treating physician/psychiatrist.

[marcia (addendum)]

One more piece of information (sorry). I'm also experiencing a lot of obsessive thoughts, which my therapist agrees is not typical for me. I'm wondering if this can possibly be a side-effect of the Neurontin, or if it's a symptom of bipolar I've never experienced before?

Okay, that's the end of my questions for today. I promise.

Thank you.

marcia