When I was last hospitalized in November, I got to see the best psychiatrist ever. I have bad rapid cycling and I’m prone to mixed episodes (the 3 times I was hospitalized were for mixed episodes). She told me rather than being on the mood stabilizer, antipsychotic, anti-anxiety combo I was typically on (at the time I was on Lamictal, Risperdal, and Klonopin) I needed to be on TWO mood stabilizers rather than the one mood stabilizer and one antipsychotic. I forget her exact words, but the gist is that if my biggest problems were my rapidly changing moods, and mixed states, then taking multiple mood stabilizers needed to be the center focus of my treatment. At least two, though she has occasionally prescribed three. I am still on Lamictal (it was upped to 200 mg twice a day) ended the Risperdal (which helped with nothing anyhow), added Trileptal (300 mg twice a day, which still needs to be upped to 600 mg twice a day) and she spread out my Klonopin so that I was still taking 2 mg, but .5 mg in the morning, .5 mg midday, and 1 mg at night.

I have had a harder time staying on a good sleep and day schedule lately, which has made me more inconsistent with my meds and my mental state isn’t as great. But when I was on a good schedule, the Lamictal and Trileptal together, along with the Klonopin spread out throughout the day, was the best I had felt in years. It has made me really buy into this multiple mood stabilizer idea. Even when I’m not consistent with the meds, I have not been in a mixed state and have not had any rapid cycling within the same day. At worst had a “bad day” and felt better for several more days. This is huge for me because I typically cycle several times in the same day.

As much as I hate to admit it, because Depakote (another mood stabilizer) caused me to gain nearly 40 pounds in 8 months and I will never take it again, the combo of Lamictal and Depakote was the only thing that effectively treated my first major manic/mixed episode I had about 5 years ago and significantly reduced my rapid cycling. I did not have much improvement when I took Lithium and Lamictal together, but I personally seem to respond better to two anti-epileptic mood stabilizers at the same time. I rarely have psychotic features (I’ve occasionally had some visual, shadow-like, hallucinations when severely manic) and have found antipsychotics were only good for helping me sleep, they never added anything positive to my moods, and often made me feel like a zombie.

I have been on Lamictal forever, I think since I was first diagnosed about 10 years ago (I had Bipolar 2 diagnosis at the time because it was before I had any true manic or mixed episodes) and I wonder if somehow it’s not as effective for me as it used to be since I have taken it so long. This is the highest dose I’ve ever been on. But the Lamictal and Trileptal combination has worked so well for my mixed episode and rapid cycling, I’m hoping my new psychiatric provider I see next month won’t change it, just increase the Trileptal dose as the other psychiatrist recommended. I believe Trileptal is chemically almost identical to Tegretol, just without the bad side effects, so it seems to becoming a popular mood stabilizer even though it’s an “off label” treatment for bipolar disorder.

Multiple mood stabilizers, and for me two anti-epileptic mood stabilizers, has been the best for my rapid cycling and mixed states. The way the psychiatrist described it to me, it made so much logical sense why multiple mood stabilizers would be best for these two issues. I hope that helps!