Yeah, I just had a chat with a friend of mine that suffers from Bipolar disorder, who's going through some extreme Venlafaxine -discontinuation symptoms.
Her Bipolar Disorder is a bit unusual in that she is extremely rarely manic, and has very long and pronounced depressive symptoms, to such a degree that her BD was misdiagnosed as MDD for a number of years - naturally resulting in a highly limited treatment-response - SSRI's are useless on their own, for BD.
She finally received the correct diagnosis and her situation has subsequently improved dramatically.
She still has the occasional drop into BD-depression however (still no noticeable mania of any kind, none of us that know her, or even SHE can notice manic behaviour - she can notice the emotional shifting however, but not in any external way - she never seems unusually happy, she just drifts much faster into depression than the majority).
Her Dr. has treated her with Venlafaxine in order to bring her out of the BD-depression, and since Venlafaxine is an SNDRI, it has worked fairly well.
However, since NDRI-effect is a dangerous thing for a BD-sufferer while not in depression, she has decided to phase Venlafaxine out, now that the depressive-state has been cured.
(should be noted that because of her treatment with Abilify, the depressive period was much milder than normal)
Venlafaxine is infamous for it's discontinuation-symptoms however, and she is now suffering from extreme nausea, vomiting, headache and brain-zaps.
So, once she has finally been able to go off Venlafaxine, she needs something different to replace it.
What do you guys think about her going on low-dose Methylphenidate XR -formulations during her depressive periods? And then simply increasing her dose of Abilify to compensate. Her regular dose is 5 mg of Abilify - works fairly well - would a temporary increase to 7 mg be sufficient to keep any potential mania in check, while on 10 mg Ritalin LA?
She does not have any history of substance-abuse, and her manic episodes are extremely rare.
There is some evidence that for certain BD-groups, concomittant stimulant-therapy is tolerated:
Adjunctive stimulant use in patients with bipolar disorder: treatment of residual depression and sedation.
http://www.ncbi.nlm....pubmed/15383134
Naturalistic long-term use of methylphenidate in bipolar disorder.http://www.ncbi.nlm....pubmed/16974196
