Posted by HOK on May 2, 2003, at 14:26:08
In reply to Re: Help: Ron, Scott, Mitch...recently dx Bipolar II » HOK, posted by Ron Hill on April 30, 2003, at 14:58:46
Ron,
thanks so much for the very thorough response. I am in such eager anticipation of what my doc has to say next week in the first session since being given the Bipolar II dx. It sounds like I'm going to be entering a few rounds of med experimentation, but I'm definitely hopeful of finding something that works without making me into an invalid.
As for the selegiline, unfortunately, my doc said that I should discontinue it until we have a chance to explore adding in a mood stabilizer first. He said I could most likely add it back in later. I'm really unsure if it was having any negative effects on me since I blame a lot of my irritability on the Lexapro I've been taking.
Anyways, once I get on Lithium or a mood stabilizer, I hope I can hit you up for some answers on what to expect. I'm sure I'll have a lot of questions! Take care,
HK
> HK,
>
> Sorry to take a couple days to respond. Looks like you’ve already got some good feedback. I’ll merely add my two cents to the thread.
>
> > Ok, so my doc and I have finally come to the realization that my atypical depression is most likely a variant of bipolar II disorder. He said he wants to ask his colleagues about how to proceed with treatment now that a mood stabilizer might be in order. This news is sort of a double-edged sword. On the one hand it brings with it a lot more treatment options to consider, but on the other, makes me see treatment as a lot more hit or miss from here on out.
>
> It’s my opinion that the first step in solving a problem is to clearly define the problem. In other words, getting the dx nailed down (as best one can) is of upmost importance. For example, I was initially misdiagnosed as ADHD and spoon fed a bunch of Ritalin and SSRIs. Because of this wrong medication (resulting from a misdiagnosis from an inept pdoc), I was pushed into a full blown mania causing me to lose my engineering career, spend beyond my means, and generally speaking, act kind of weird. The wrong medication can be way worse than no medication. Getting the dx correct is very important.
>
> > Considering my symptoms are depressed and very atypical by nature without the aid of an antidepressant, and my hypomanic states (if they are indeed that) are manifested by showing 1) anxiety 2) irritability/agitation 3) sleep porblems 4) occasional anger, I'd like to hear any and all suggestions on where to start.
>
> I’d say continue to do your homework. Please check out the following links if you haven’t already done so:
>
> Watch Dr. Bowden’s presentation on Grand Rounds:
>
> http://psychiatry.uchicago.edu/grounds/030303/
>
> Read the relevant portions of the American Psychiatric Association 2002 Guidelines on treatment options for bipolar disorder:
>
> http://www.psych.org/clin_res/bipolar_revisebook_index.cfm
>
> Dr. Phelps specializes in bipolar disorder: His web site has good information but the site is not very user friendly. You’ll have to click around to find all the good information on the site:
>
> http://www.psycheducation.com/
>
> >I can only assume my doc is going to probably start me on lithium or depakote, probably the latter. He knows that I have tried Lamictal in the past with limited success (it caused some irritability, moderate cognitive dysfunction, and only a mild mood lift). So, my questions to you guys are...
> >
> > 1) Should I go ahead with a trial of Lithium or Depakote? Some of the info I've been reading up on so far seems to indicate Depakote as a better option for Bipolar II. However, on the other hand, I'm aware that only Lithium and Lamictal seemed to provide any antidepressant effect, and considering my natural mood state is almost always atypically depressive in nature, then what options does this lead one to consider? In other words, I'm quite fearful of mood stabilizers that might lead to more lethargy, hypersomnia, and anhedonia than I currently feel in my natural mood state.
>
> HK, you might have to use trial-and-error procedures to determine which mood stabilizer is best for you. For me, Depakote caused me to gain 30 pounds, gave me a rash, and made me more depressed. I’ve been on a low dosage of Lithobid for almost four years and it works well for me. YMMV.
>
> If you try lithium, I’d recommend using a slow release product and start at a low dosage. The side effects are much less (or non-existent) in the lower dosage range. I take 600 mg/day which correlates to a blood level of 0.4mEq/l (in my case). Perhaps you could initially shoot for a blood level in the range of 0.4 – 0.6 mEq/l. As you probably know, the current thinking is that lithium has some neuroprotective properties, particularlly in the lower dosage ranges.
>
>
> 2) Should I stick with a low dose of my antipressant [Lexapro] as a maintenance dose, or should I ditch it altogether? I've been reading up on the kindling debate and whether one should augment at all with an AD. The hardest thing for me to guage right now is whether antidepressants are causing me more harm that good (e.g., manifesting mixed states, agitation, increased cycling, etc.). What I do know, however, is that when I tried Lamictal for a few months monotherapeutically, I was not at all satisfied with it as an antidepresant. And frankly, I didn't believe it functioned as a great mood stabilizer as well since it caused a lot of agitation, irritability and anxiety.
>
> The debate over whether or not bipolar patients should take antidepressants, and more specifically SSRIs, is controversial. Some (like Colin) seem to tolerate SSRIs while others (such as myself) do not.
>
> In my case mood stabilization was relatively easy using Lithobid, but the treatment of depressive side proved to be much more problematic. I tried most of the SSRIs in conjunction with Lithobid (also in conjunction with Depakote prior to starting Lithobid). The pattern was roughly the same for all of them. They all almost immediately induced hypomania which lasted any where from a few days to a couple of weeks, followed by brief period of good AD effectiveness, but then, in the end, all of the SSRIs interfered with my dopaminergic pathways and left me unmotivated, anergic, anhedonic, and severely emotionally blunted.
>
> Please take time to read about the AD Controversy on Dr. Phelp’s web site. Here’s the link:
>
> http://www.psycheducation.org/bipolar/controversy.htm
>
> I’m currently treating the depressive side of my BP II disorder with OTC supplements and, so far, it’s working. If the supplement approach poops out, then I will have to go back to the drawing board. I have made a list of medications to try if this were to occur. Here is my list presented in order of preference:
>
> Medications to Possibly Try:
>
> Add-on another Moodstabilizer:
> Tripetal
> Neurontin
>
> Dopaminergic Medications:
> Selegiline (low dose)
> Provigil
> Mirapex
>
> MAOIs:
> Parnate
> Nardil
> Selegiline
>
> Benzodiapines:
> Long acting (e.g.; Klonopin) daily or short acting PRN
>
> Atypical Antipsychotic (low dosage):
> Zyprexa
> Respridol (sp?)
>
> > Any advice here guys, I'm quite nervous but also optimistic about new treatments to consider, but I just hope that I can find one that helps my depression just as much as it helps stabilizes my mood. Any personal accounts of similar circumstances would be greatly appreciated. Thanks.
>
> Best wishes HK. Hey, what ever happened with your trial of sublingual deprenyl?
>
> -- Ron
>
poster:HOK
thread:222897
URL: http://www.dr-bob.org/babble/20030429/msgs/223860.html