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Dr. K
Dr. K, Psychiatrist
Category: Mental Health
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Experience:  15 years clinical experience in all areas of psychiatry. Holistic and practical approach.
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Several years ago I was diagnosed as being bipolar, but my

Resolved Question:

Several years ago I was diagnosed as being bipolar, but my symptoms seem much elmore similar to cyclothymia. I know they are similar, but cyclothymia is not as extreme. I'm being treated with depakote and wellbutrin. Is there a better option? I believe the wellbutrin is causing insomnia and an irregular heart beat.
Submitted: 5 years ago.
Category: Mental Health
Expert:  Dr. K replied 5 years ago.
Cyclothymia is rarer than bipolar, so there is much less research on it. The good news is that the same general treatment principles work.

There are no medications which are always better or worse. Any particular medication will be better or worse for you; there are no tests we can do to determine the best medication for you. Despite all our science, there is a trial & error approach.

Lithium & depakote are usually the top 2 mood stabilizers. Any traditional antidepressant has the risk of increasing mania or cycling moods. Wellbutrin is the least likely to do this. Lamictal has been a great medication for those with bipolar depression, but it doesn't sound like it worked for you.

One option is to try either a different version or lower dose of wellbutrin. Wellbutrin comes in at 3 main versions: 1) regular, or immediate release, 2) SR (sustained release), and 3) XL (extended release). The 1st 2 versions work best if taken twice/day and the XL only needs to be taken once/day. Sometimes the side effects are less on the XL version because the blood levels are a bit smoother (less peaks & valleys). On the other hand, sometimes insomnia is less on one of the other 2 versions b/c the blood level at night goes down more.

Other medicines you can try include topamax & trileptal. Those are my top 2 other choices.

Don't forget that it's important to treat any mood symptoms holistically.

This would include 1) psychotherapy with a live therapist, and 2) learning some formal relaxation therapy.

The last 2 treatments I mentioned are proven by sophisticated studies using brain scans (CT, MRI, EEG, pet scans) to improve brain function.

Also, by formal relaxation therapy I mean yoga, meditation, or similar methods. Having relaxing hobbies is also important, but not quite the same as formal relaxation therapy.

And remember you can't separate emotional health from physical health, so exercise & nutrition are vital.

There are also several self-help books you can read which can help including: 1) "The Seven Spiritual Laws of Success" by Deepak Chopra, 2) "The Feeling Good Handbook" by David D. Burns, 3) "The Relaxation & Stress Reduction Workbook" by XXXXX XXXXX, & 4) "The Depression Workbook: A Guide for Living with Depression and Manic Depression" by Mary Ellen Copeland and Matthew McKay.

I hope this helps. Let me know if you need more feedback. Good luck & take care.
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