Hello,
Currently, I am taking Klonopin at night for anxiety. Would Tryptophan be a good way to taper off, perhaps adding it as I reduce the Klonopin? Also, since I haven't been responding properly to SSRIs, my doctor has suggested that I may need to go the bipolar route, perhaps starting with Lamictal. This kind of scares me, because I've never thought of myself as bipolar, and the people I've known/seen who are seem far worse off than I, with terrible reactions to the conventional treatments such as Lithium and Depakote. Zoloft used to work for me years ago, but recently, only a little bit seemed to cause "mixed episodes." Anyway, if I do explore Lamictal, would Tryptophan be OK to take with Lamictal, as it is not an SSRI? And what are the risks of taking a medication such as this if you aren't truly bipolar? As a 42 year-old man, hair-loss is an issue for me, and I know that that can be one of the  side-effects. Would Propecia counteract this problem? Or are there "natural" treatments for bipolar? In my case, it's anxiety that results in insomnia that seems to send me spiraling into depression.
Thanks


Hello Dale --

Couple of thoughts:
1. You will find of interest (I hope) my essay about mood swings without mania, which explains the "mood spectrum" concept that many mood experts operate from nowadays. Start from that link and take the full story for patients and families option. Read, at minimum, the page on Diagnosis.

2. Can a person take tryptophan with Lamictal? To my knowledge, this is not a recognized problem. Of course, we started using a lot more Lamictal after tryptophan was pulled off the market by the FDA, so the opportunity to observe problems, if there are going to be any, has probably been somewhat limited. But you are probably referring to the known interaction with serotonergic antidepressants, and that problem at least is not relevant here (the mechanism of action of lamotrigine is not clear, but seems to be associated with its effect on glutamate, different neurotransmitter, or its effect on sodium channels, part of the nerve conduction system -- not serotonin).

3. Your experience on Zoloft, where it worked pretty well at one time, but then more recently does something quite different, and quite negative, is unfortunately very common. This has been called a "bipolar soft sign", as you will read about in that essay above.

4. Hair loss is an extremely uncommon side effect on Lamictal (of course, anyone who has had it is going to think that it is not so uncommon, but when you look at a hundred or more people who take Lamictal, and perhaps one of them has a problem with hair loss, which has been my experience, or maybe less, it seems quite uncommon indeed). Some people have found that approaches which work for hair loss when using Depakote, also worked for hair loss when using lamotrigine.

5. The two treatments that I recommend most often, statistically, are Lamictal and "dark therapy", the latter a non-medication approach (natural, or close to it, I think one would say) that has suggestive evidence for its efficacy and illustrates the importance of having regular rhythms of sleep and activity -- even if one does not do "dark therapy" as such. So, the answer is yes, there are "natural" treatments for bipolar disorder, though only in the most extreme cases of success with such treatments would one be able to consider using those approaches alone without medications.

Dr. Phelps



Published December, 2007