Posted by joebob on July 18, 2003, at 19:20:55
In reply to Re: depakote prior to lexapro........for jrbecker » joebob, posted by jrbecker on July 18, 2003, at 13:55:18
i started the depakote as a precursor to ssri, lexapro...as i said it does calm me, but it makes me a little dumber/slower, too
i'm a little concerned about upping the depakote due to side effects, and i still use ethananol
i am using the lithium orotate form as noted in my post, am not willing to use the carbonate form
i have intended to start the lex at 2.5mg and see from there....funny you should mention the zoloft, i have some samples standing by...and i have been looking at the remeron info
i did start w/celaxa some 2 or 3 years ago and it was fine at the time, but now is another time with greater stressors.
serzone is one thing i have yet to consider
tried psychotherapy, have done therapy for others myself and am not of great hope in my case....have lots of therapists around when i need them.......there's nothing left for us to talk about
i agree with you about the neuro doc and am considering the whole matter as we speak :)
i have been told by dr.i.g. that he is not impressed by neurontin as a 'mood stabilzier', but i started the depakote as a precursor to the ssri, as a way of cooling off the basil ganglia ( i think), and the neurontin was supposed to be ok for that purposefunny you should mention b12...if you are really patient and tough you should be able to find an old article by HL Newbold re: hydroxycobalamin for depression.......... a classic...it appeared in the Lancet maybe 10 or 15 years ago....and if you can find a first edition copy of his first book at your local library, you will learn a lot...i found it here in santa monica, but you must find the first edition to get the real deal, later additions were edited for mass consumption...as i recall it was called 'mega nutrients for your nerves', but you will have to search his biblio and remember, only the first edition
as i said in the earlier post i only use Kirunal for fish oil due to my review of the research and my relationship by e-mail with the now deceased david horrobin, m.d.....i go to the worlds largest health food expo and have heard all the cr*p about fish oils from all the big shots, not impressed, which all goes to say the wrong fish oils will give you not good results and some extra side effects
gotta go, want to take my wife out for a rare chance to have a date and consider/worry about the future............she has the no-depression 5htt gene, obviously i have the other
best,
joebob
> First advice: whatever you do, add or subtract one med at a time. It's really hard to find out what you're responding to if you change up too many things at once.
>
> It sounds like you're in a more comfortable spot now that you're on the depakote. I would think that if you can tolerate it, then you should consider bumping it up (750mg - 1500mg). This will not only help your mood stabilize, but it will also definitely help your anxiety. Thirdly, at a certain higher dosage an appetitive effect will kick in. Give this a little bit of time to figure out before you jump into an antidepressant regimen again. As for depakote (as well as lithium) being a neuroprotectant, that's definitely the case. All the more reason why you should try to stay on one, even if it's just a low dose. For more info, see
>
> http://www.psycheducation.org/bipolar/frameset.html
>
> One more strategy might be to add in a low dose of lithium to the depakote. It all rests on what drug and what dosage you can tolerate.
>
> Next up. Now that you're ready, I would consider another trial of an antidepressant. Lexapro is as good as anywhere to start within the SSRI class. Why Lex? It has a very minor side effect profile. At the same time, it can be very potent. Even the starting dose for some people can be very over-powering. And based on what you've said, it might exacerbate three of your symptoms: apathy, anxiety, and lack of appetite. But you don't know that for certain. Everybody reacts differently. Some gain weight on it, have their anxiety reduced, and it has no effect on their motivation.
>
> *Note: on any of the ADs, perhaps it is prudent to start below the normal therapeutic dose, taking into account your hypomania last time. For instance, ask your doc about trying just 5mg for a few weeks on Lex.
>
> If after a month (remember, give it at least 4-6 weeks to see not only the mood response, but also the lowering of the side effects), you don't feel like you're having a great response with the Lex, I think you come to a fork in the road. Do you A) want to consider another SSRI, or B) go for another AD class.
>
> If you and your doc choose A), I think you should take a look at Zoloft. It has a slight appetitatve effect, and it won't make you too apathetic. It also might help you quit the smokes (we'll get to that).One more option in the class, I would try celexa -- very different from Lexapro. Most people find it a lot "softer."
>
> If you choose B) I think you should talk to your doc about Serzone or Remeron. Either one will help you sleep (you can then ax the trazadone) and it will be a lot better for your anxiety than most of the SSRIs are. Both have been shown to be more effective in treatment-resistant depression than the SSRIs. Plus, they will help your appetite. Lastly, I would try Wellbutrin/Zyban again, but only if you feel very stabilized -- it can induce irritability.
>
> OK, as for the valium, it's fine if you're using it only occassionally. But if you're using it all too frequently, I would consider a regular benzo (ativan, klonopin) instead. BUT, my guess is that once you up the depakote and are on an AD you like, you won't need it. So try to cut the downers out all together as soon as you can. That won't help the motivation.
>
> As for the smokes. Well, hey, I've been there. I smoked on and off for years. It's a great antidepressant in itself. Here's the catch though, it can actually induce depression in most people -- there are studies to back this up. This happens because the HPA axis is being overstimulated and the nicotine is actually exaccerbating the stress-response. This just shows you the delicate interplay between anxiety and depression. So not to be a PSA, but the smokes ain't helping. When (and only when)you're at a very comfortable point down the line, consider quitting. You'll miss the euphoric hits you get a few times a day, but I promise you that your anxiety and depression will recede noticeably.
>
> As for the alternative therapies you've been trying. I'm all for it, and I'm big fan of non-traditional therapies myself. I will say this though: the meds have the highest percentage of working in most people. Don't overload yourself in relying too much on them or taking too much of them right now (some supplements will counteract your meds). Stick to this as the cornerstone of your treatment plan first. Then you can go back to adding back in the homeopathic supplements later. By the way, if you were to start anywhere on this, I would recommend a multi-vitamin, some folate and B12, and possibly some fish oil (some like it, some don't).
>
> As for psychotherapy, have you considered it? It helps, even if you chalk it up to placebo. There are lots of reasons why it works for me, but probably the biggest is that it makes me vocalize what I plan to do about my own problems. For instance, in dealing with my own lack of motivation, by talking out what I want to do (or should be doing) I take ownership for action in making it happen. Or perhaps just talking through your problems might be beneficial.
>
> Lastly, if you don't feel like your neuro doc is the best fit for you -- go shopping for a new one. Don't settle on someone who can just write your scripts. Take the time to find someone who is patient (and has enough people-skills) to explain your options in psychopharm therapy. This is no doubt part of your current problem.
>
> Tell me your thoughts on this.
>
> > i doubt the paise is much undeserved....you have a knack for this sort of thing and may be a 'healer' in disguise.....we live in the republic of santa monica so i have a somewhat 'california' perspective
> >
> > i started the depakote 10 days ago, after hearing the advice to pre-treat hot type brains prior to ssri implementation, re: notable brain activity expert
> >
> > i will start the lex on tuesday after the 2 weeks pre dosing on the dep
> >
> > i do not have a formal diagnosis of bipolar II as far as i know, my neurologist is not too communicative, very busy etc.
> >
> > she gave me trazadone for sleep...i take 100 mg an hour before bed and it is great...she also gave me valium for anxiety, which i use occasionally as needed
> >
> > i started the dep at 250mg and over the last 2 days went to 500mg.........i do think the dep has done something to mellow me out a little, but am concerned about long term use and may try to taper off after the lex kicks in fully....as an interesting side note, a dear friend of mine, who is a neuropsychologist and naturopath told me that depakote may get some sort of approval as a brain protective med, this info from a pharm rep who is a natural type like both of us, and who specializes in depakote representaion.....he trusts her to tell it straight, btw he is also the one who gave me the pre-dosing tip after a professional seminar, a very knowledgable guy and knows me very well.....btw, you can also use neurontin as a pretreatment for ssris, and one more (i don't have the notes at hand)...
> >
> > it does seem the depakote is causing some weird/intense dreams & recall, which i normally don't have....i do have some constipation, and i can tell when i'm typing that i make more mistakes and am slower
> >
> > i tried a very small dose of lexapro some months ago and on the 3rd day or so i had some hypomania (?), i.e. racing thoughts, agitation, anxiety...so i stopped
> >
> > have been under external stressors for 3 years, and at the time it all started i started smoking which i think is what mostly kills my appetite, and raises my dopamine levels or so i hear..i have lost weight due to simply not eating, just smoking and drinking beer....i am hoping that if the lex does its job i will regain some appetite but still need to address the smoking, zyban didn't work for me for smoking
> >
> > i have been using kirunal fairly regularly on the advice of david horrobin, but as the stressors keep increasing on me i need stronger help, but i do like the kirunal and am giving it on occasion to my 5 year old son, as i suspect he has a 50% chance of having the wrong 5htt gene
> >
> > see: http://weeksmd.com/articles/psychiatry/Depression_and_Schizophrenia__Essential_Fatty_Acids.pdf
> >
> > and:
> > http://www.fincastle.com/sp_products.html
> >
> > i have also gone back to chewing some lithium orotate a couple of times a day....i have used it over the years and think of it as a useful supplement for lots of people, not just bipolars....i still have some bottles hans neiper gave me
> >
> > see:
> > http://www.mwt.net/~drbrewer/cancer.htm
> >
> > my motivation has been mostly tied up by emotional paralysis ie, anxiety, confusion, fear of making an expensive mistake, etc
> >
> > i would say in closing that the biggest help to me over the last couple of years has been classical homeopathy, as is definitely true for my wife and child, but right now i need more help and made the difficult decision to try the meds to get up and running again.........in the future i may try the joan larson approach but for now am not up to it, need a simpler fix......i am sure she is on to something and know i am a high histamine type
> >
> > see:
> > http://www.healthrecovery.com/Biochemical_Restoration.html
> >
> > i hope there is something useful for you and others in this long post......
> >
> > thank you for your kind attention
> >
> > > joebob, thanks for the praise, much of it is undeserved.
> > >
> > > so you've recently started lexapro? how many weeks have you been on the depakote?
> > >
> > > So your dx is BP II, considering your mixed-state, or is this just med-induced? Please explain your episodes of hypomania, are they dysphoric (anxious, agitated in nature) or are they more or less euphoric experiences, but slightly out of control?
> > >
> > > How is your mood [specifically] being treated thus far? Are you happy with the Lex and it's just the side effects you're having a problem with, or is your depression still lingering (not anxiety)?
> > >
> > > Oppositely, is your anxiety [not your mood] worse on Lexapro than off of it?
> > >
> > > What's your motivation been like before the meds. Is this just apathy from the meds, or just part of your symptoms, or if both, then to what extent can you attribute them to either.
> > >
> > > Once again, how has your appetite been prior to your meds? Lex for many kills appetite.
> > >
> > > What's our sleep like -- too much, too little, presently and, also what's it like when you're off meds?
> > >
> > > What's your general consensus on the depakote and how much are you taking?
> > >
> > >
> >
> >
>
>
poster:joebob
thread:223661
URL: http://www.dr-bob.org/babble/20030718/msgs/243316.html