I read your book twice and found it very helpful. I hope you can help with this question -- I just turned 60 and my doctor, whom I do trust, has indicated that my increasing depression is common and expected as I age and that the manic phases, to the extent I have any [the seraquel has eliminated them so far] will not be the "highs" I am used to but limited to irritability, tension, wakefulness etc. I counted on the highs to put badly-needed energy back into my life that I could use to get me through the downs. Do you have any suggestions for me?


Dear Ms. D. --
As you know, no answer to this question is simple, and I do not mean to imply that with the following comment. As much as it may sound simple, it is not.

In my view, as you probably saw in the book, the key to the whole process of treatment is to stop the cycling. That way, you will not need the Highs to put the energy back in to cope with the Downs. If you are not having highs now, that's a good thing: for most people, they lead to downs -- so that one of the ways to prevent the latter is to prevent the high phases as well.

But let us assume that what you are describing means that there is still some degree of depression causing trouble at this point. Now we have a very different challenge: if cycling is no longer occurring, but depression is still present, how can one lift mood to operate without destabilizing the whole thing again? As you also saw in the book, antidepressants carry much more risk of this destabilizing effect than numerous other antidepressant alternatives. Having the list of those alternatives is so important, to avoid turning to antidepressants, I have laid them out on a webpage specifically for this purpose: Nine Antidepressants That Are Not Antidepressants.

So first one tries to ensure that cycling is completely controlled; and then if a significant degree of depression remains, one turns to that list first. When most of the practical alternatives from the list have been tried, then some of the antidepressants less likely to induce cycling might also be considered. At the moment, many mood specialists think that bupropion (Wellbutrin) is one of the best in that respect.

I hope something in there proves useful.

Dr. Phelps



Published January, 2008