Expert: Ivan Goldberg, M.D. - 3/31/2007

Question
Dear Dr. Ivan,

I was an ultra-rapid cycler who is now stable on aripiprazole, duloxetine, lamotrigine, T3 and modafinil. I am still left with such fatigue that I sleep 3 hours more a day than I used to.I also seem to be quite unmotivated which may be related to the fatigue; my mood is very good and stable. I have tried raising and lowering the meds to no avail and have also tried Wellbutrin.

My questions are: do you have any experience with Xyrem and if so, do you think it may help with my fatigue? Have you had any experience with the selegilene patch being activating for patients? I am going to try Concerta for the fatigue. Do you have any other ideas?

Thank you for your input!

Miriam

Answer
Hi Miriam . . .

I have no experience with Xyrem and cannot comment on its usefulness.

When it comes to controlling fatigue in people being treated for Bipolar Disorder I have had success with modafinil up to 600 mg/day, dextroamphetamine, and methylphenidate.

I am not very impressed with selegiline patches in general. Anything then can do, selegiline tablets can do do and for a LOT less $$$.

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%