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Re: Where to go from here? Dinah

Posted by Ron Hill on April 24, 2003, at 2:59:45

In reply to Re: Where to go from here? Ron and Ritch, posted by Dinah on April 23, 2003, at 10:10:41

Dinah,

I wrote most of this post on Wednesday afternoon but I had to lay it aside until now before I had time to finish it up. However, by now Ritch has posted back to you and I like his response better than mine. Im gonna send mine anyway, though, cause I spent a bunch of time on it and I hate throwing work product away.

Have you ever tried Lamictal?

Did you watch Dr. Bowden's recent presentation on Grand Rounds?

Have you read the relevant portions of the following documents?

http://www.psych.org/clin_res/bipolar_revisebook_index.cfm

http://www.psychguides.com/gl-treatment_of_bp2000.html


I wonder if the dysphoric mood states would abate if you targeted the rapid cycling with your medication.

> Luvox helped with my OCD and with my tendency to get overstimulated. It may have spaced the meltdowns farther apart but didn't make them less intense. And oddly I was less able to control my self injury urges on Luvox. So the meltdowns caused more physical harm. I'm not even sure I'm characterizing them correctly as dysphoric hypomanias. They may be the week long tempertantrums of someone with the nervous system of an overtired two year old.

Yeah, Im all too familiar with the mood state to which youre referring. However, it sounds like you have a much more severe case than I have. SSRIs always did a good job in taking away my dysphoric mood states, but they all (and yes I tried almost all of them) eventually adversely effected my dopamine pathways and, as a result, they left me completely unmotivated, apathetic, and emotionally blunted.

As you probably know, for about three months Ive been enjoying success using Enada NADH to treat the atypical depressive side of my BP II disorder (I also take 600 mg/day of Lithobid). I have been taking one 2.5 mg tablet every four days. I like it a lot but it can make me irritable on the day that I take it (i.e.; Day One in the dosing sequence). This irritability is above and beyond my normal periodic foul mood that was apparently included free of charge in my bipolar disorder mood package menu.

Enada NADH increases dopamine and Ive recently come to believe that the irritability is due to my getting the serotonin-to-dopamine balance slanted too much in favor of dopamine. If the teeter totter tilts too far toward the serotonin, then low motivation and apathy results. If it leans the other way, irritability raises its growly head (GRRRRRR!).

So a couple days ago I set out to fix the problem. Ive added a low dose (25 mg max on any given day) of 5-HTP for use PRN. (As an aside, I also added TMG a couple days ago and Im also keeping it, but for reasons unrelated to the topic at hand (the growls)).

Its only been a couple of days so far, and who knows what it will do long-term, but so far it works great. From what Ive read, I want to minimize the dose and only take it on the days that I need it so that it retains its effectiveness. I cut 50 mg 5-HTP tablets into pieces, and then I place a piece under my tongue as if it were a sublingual tablet. Within thirty minutes or an hour my irritability is gone.

I say all this to ask, have you ever tried 5-HTP during your meltdown periods?

> That's why I liked Risperdal. It was slightly energizing, worked directly on the symptoms of the meltdown, and since I only took it as needed, didn't affect me the rest of the time.
>
> Perhaps I should just accept the very slight risk of movement disorders.

Yeah, perhaps. Tough decision. How much do you take on the days that you do take it?

-- Ron


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poster:Ron Hill thread:221270
URL: http://www.dr-bob.org/babble/20030423/msgs/221927.html