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Re: anti-hypomanites?

Posted by JohnX2 on March 10, 2002, at 1:30:48

In reply to Re: Nardil » JohnX2, posted by JonW on March 9, 2002, at 22:11:00


Hi Jon,

(sorry I keep posting, that's what us hypomanics do).

When I first met my latest pdoc, he introduced me to this new
concept for bipolar of not using any ADs. I always used to believe
that most people used a mood stabilizer + an AD. But I've
learned since then that there is a pretty big division of school
of thought.

So when I was mildly depressed and seeing my pdoc I was really
pissed that he wouldn't add an AD and I thought he
was such an anti-hypomanite. His feeling was that he needed to
wipe out every sympom of hypomania, see where I was then (hopefully
the depression would be gone), and if things were still in a low,
then we would "sneak an anti-depressant into the back door".
My doctors main concern is giving an AD would cause one to
cycle back into severe depression. He felt for me that if
my mixed symptoms would go away the chances of an AD destabilizing
me would be low.

It seems like your pdoc is in the same school and maybe was
really scared that an AD would make you really depressed.
Anyways I'm actually shocked to see so many different med
combos of mood stabilizers. Were you exhibiting symptoms
of hypomania that your doctor was concerned about as you went
through all these trials?

I certainly see your frustration. As you dose in an anti-depressant
you want to be stabilized enough so that the AD doesn't cycle
you back into dispair (well, you already know this). But you are
just testing the AD add-ons after a long run of mood
stabilizers......

I was major depression symptom free for about 1 year on Lamictal but
still a bit low at times and wanted to test anti-depressants, but
my psychiatrist pushed back as I still had mixed hypomanic symptoms
like agitation. When I quit the klonopin I went severly manic and
this had bad conequences at my job (I almost got fired) and I
crashed into 2 major depressions (what an aweful feeling to go
back into that state). So I understand what my doctor was concerned
about.

What are you thinking?

take care,
John


> I've been on several combinations of mood stabilizers and have just added ADs because I couldn't take it anymore. Be that decision a good one or a bad one.
>
> I think it would be easiest for me to first list all of my recent cocktails:
>
> lamictal
> lamictal + depakote
> depakote + geodon
> depakote + geodon + gabatril
> depakote + trileptal + geodon
> depakote + trileptal
> trileptal + geodon
> trileptal + seroquel
> depakote + trileptal + zyprexa
> depakote + trileptal + zyprexa + neurontin
> depakote + trileptal + zyprexa + neurontin + (ritalin, dexedrine, aricept)
> depakote + trileptal + zyprexa + lithium
> depakote + trileptal + zyprexa + neurontin + zoloft
>
> I've also been on nearly all of these with Klonopin. Lamictal gave me horrible memory problems, and made me more emotional -- neurontin has this same effect on my emotions. Lithium makes me depressed and fast! I suppose wellbutrin has been the least rocky AD, but it makes me extremely irritable and probably the worst headache I've ever had. I wouldn't mind the highs of the ADs except I'm irritable along with the "high" and it never lasts.
>
> Jon
>
> >
> > Hi JonW,
> >
> >
> > What mood stabilizers have you tried besides Depakote?
> >
> > Have you been able to get onto an anti-depressant without
> > getting such a wild manic response?
> >
> > Has your pdoc talked about taking more
> > mood stabilizers like lithium, lamictal, more depakote?
> >
> > My pdoc's opinion is that most bipolars should be treated
> > with more mood stabilizers and as few ads as possible.
> >
> > Has your physician ever started you solely on a mood stabilizer,
> > before adding on ADs?
> >
> > I'm just wondering what the strategy is to avoid the pattern of
> > cycling. I had the same snag, and Lamictal was the only medicine
> > that helped me without causing a big cycle (Lamictal of the
> > mood stabilizers has a good anti-depressant action). Lithium
> > is good at snaggig the bad mania.
> >
> > Even now that I have good Lamictal and Topamax
> > some Serzone dosing makes me hypomanic. I might add
> > some Lithium soon.
> >
> > sorry for all the questions.
> >
> > best wishes,
> >
> > -John
> >
> > > Hi Elizabeth,
> > >
> > > Thanks for the informative post! I've read other post of yours and have found them useful as well.
> > >
> > > As for my symptoms... Well, I suppose I'm a mut when it comes to that but I'll try to paint a picture. I have very bad social phobia -- I used to be afraid of just going out to my mailbox. I also have this general physiological anxiety that never goes away -- neurontin helps somewhat. If I had to pick out the depression it might be considered double depression by some but its far worse than dysthymia most of the time. My mood cycles every couple of days, but sometimes within the same day. I can be cheered up by driving in my car or watching a sitcom. I definitely crave sweets,etc. I feel better at night and horrible in the morning, have difficult time getting out of bed in the morning.
> > >
> > > What makes my doctor think I am bipolar? Nearly every AD made me "high" the first couple of days and then irritable agitated depressed. When "high" I could just lay on my back and smell the air as it never smelled so good and the sights never looked so good. I would drive 90mph and yell at the top of my lungs! I cycle more frequently when on ADs -- although life is subjectively better. Parnate (I only took it for 2 days) in particular made me sooo high and overconfident I aced a job interview (plus) but I verbally assaulted others (big minus) because I was very agitated. I'm very impulsive at times. As a child I reacted with violent temper tantrums to being told "no". I absolutely love pissing off authority -- I may do it under the guise of some principal, of course. I had suicidal thoughts as early as age 9. I've been hospitalized twice -- both in the last 6 months.
> > >
> > > Sorry for this being so long... Well, if you or anyone else has any ideas or avenues I might want to pursue please let me know.
> > >
> > > Thanks,
> > > Jon
> > >
> > >
> > >
> > > > Nardil is a great anti-anxiety drug. I've seen it do wonders for people with social phobia and other kinds of interpersonal sensitivity. MAOIs are also known to be effective for atypical depression -- more so than SSRIs like Zoloft.
> > > >
> > > > Atypical depression isn't the same as bipolar II disorder, but depression in bipolar disorders can have "atypical" features: excessive eating and sleeping, feelings of heaviness, interpersonal sensitivity (esp. rejection sensitivity), ability to be cheered up temporarily. The more of these characteristics apply to your depression, the more likely it is that the diagnosis of atypical depression is accurate. Nardil is good at relieving the hpersensitivity that is seen in atypical depression and social phobia.
> > > >
> > > > I also think that MAOIs are the antidepressants that are most helpful in ADHD, although doctors shy away from giving them to children. Parnate may be better than Nardil for ADD since Parnate seems to share more characteristics of the stimulants. On the other hand, as John says, Nardil seems to be better for anxiety symptoms. MAOIs often relieve lethargy, whereas SSRIs can make it worse; Parnate may be the better choice for this symptom.
> > > >
> > > > MAOIs can be used in combination with stimulants, but you have to be cautious. Some people (like me) can't get away with it because they have hypertensive reactions even on low doses of stimulants, but many people can do it safely. You need to be able to monitor your blood pressure if you're going to try it. As I said, I think that if you try an MAOI, you may find that it helps with the ADD by itself.
> > > >
> > > > MAOIs can trigger cycling in bipolar disorder, so if that diagnosis is correct, you should be cautious (this is true of any antidepressant, including Zoloft). Can I ask what symptoms led to the diagnosis of bipolar II? IMO, this has become a bit of a "wastebasket" diagnosis, used for all kinds of unidentified conditions that probably are not all the same thing. I agree with John that doctors may be inclined to misinterpret ADD symptoms (especially in adults) as hypomania.
> > > >
> > > > Just some opinions, for whatever they're worth.
> > > >
> > > > -elizabeth


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poster:JohnX2 thread:97093
URL: http://www.dr-bob.org/babble/20020307/msgs/97284.html