Posted by med_empowered on August 2, 2005, at 3:15:06
In reply to second opinion, posted by cockeyed on August 1, 2005, at 23:33:58
hey. I'm kind of in a similar boat..I've been dx'd as BP II, BP I, BP NOS, and (once, by an incompetent dufus) schizophrenic. What really sucks about bipolar treatment, as I think you've noticed, is that shrinks seem to mostly care about mania--I think the energy and the craziness that go along with it scares them, so they really focus on that to the exclusion on adequately treating the depressive symptoms, which are more frequent and, for me at least, more severe. I've been on all kinds of meds (stimulants, anti-depressants, benzos, sleeping pills, anti-psychotics, mood-stabilizers, etc.) and I gotta say-- getting balanced on meds is tough. Right now I dont take anything, and I'm in the midst of a pretty rough depressive patch (atypical: I respond to whats going on around me, which gives me a temporary break). NOW...it sounds like when you feel "normal" you seem kind of "hypomanic". "Hypomania" is a symptom of bipolar disorder, but its really not a big problem for most people; usually its mania, which often includes psychosis, spending sprees, promiscuity, and other problems that really is a problem. Hypomania can be pretty pleasant, actually...in my own experience, I have a tendency to become kind of anxious while hypomanic; if you're taking Tranxene or other anti-anxiety meds, that will help a lot. The bad news is that its much, much harder to adequately treat the depressed phase of bipolar illness. The treatment for depression in BP II is pretty much taken out of the treatment for BP I; you can increase the mood-stabilizer dosage, add a mood-stabilizer, add an antidepressant, rarely add a stimulant, or do electroshock. I think we may have similar issues...I tend to be get seriously depressed, move up a bit, then move down. From my own experience, I can only say that your medication should reflect your *current* mood (this is why its good to see your doc often if you have these kinds of issues; meds sometimes need constant updating). I kind of think in your case a good place to start with the meds would be to taper or at least reduce the 40mgs of Prozac you're taking; of all the SSRIs, Prozac probably has the *worst* reputation when it comes to making people crazy. And...any antidepressant without a mood-stabilizer (or possibly with a mood-stabilizer) can make the "cycling"--movement up or down the mood chart-- considerably faster and more intense for those with bipolar disorder. I think you mentioned gabitril or gabapentin...these meds are OK, sometimes, but they're really not very good mood-stabilizers for most people. I personally prefer mood-stabilizers that don't require blood tests--the idea of some med ruining my liver or pancreas is just a bit too much for me to take. So, I'd recommend Trileptal--a modified version of Tegretol--as a 1st line candidate. Basically, Trileptal is like other mood-stabilizers in the sense that its mostly "anti-manic"--its good at bringing the mood down a bit and preventing manic craziness, but it isn't all that great at fixing the depressed phase of bipolar disorder...at best, it slices off the worst of the depression; in the worst case scenario, it can just dampen your mood without having any real anti-depressant effects. The other main option would be Lamictal. Lamictal seems good at treating and preventing the depression that you find in bipolar disorders, but it really isn't so good at treating or preventing mania. Some people get hypomanic while taking Lamictal, so some docs only RX it mixed with Depakote or Lithium. Based on your history and your desire to treat the downs more aggressively than the ups, it would seem that using Lamictal might be a good idea. But..Lamictal can cause a possibly fatal skin reaction in some people, so beware of that...your doc will adjust your dose gradually, and the med is usually stopped at any sign of a rash. There's also Tegretol (similar to Trileptal, but with blood tests and toxicity problems), Depakote, and Lithium. Depakote can be useful if you have problems with panic disorder or excessive anxiety, tend to "cycle" rapidly, or have a problem with psychosis when you move up or down in terms of mood. It also can cause hair loss, cognitive problems, weight gain, and hormonal weirdness; because of the possibility of damage to the liver and pancreas, you'll need to do blood tests. Lithium is the classic bipolar remedy...it can cause tremor, cognitive problems, hair loss, acne/skin problems, and weight gain, among other things. It has an anti-suicide effect, but I wouldn't call it an antidepressant per se..its really best used as an anti-manic agent. Like with Depakote, periodic blood tests are a must...you'll also need to watch fluid intake and avoid dehydration. Then...there are the antipsychotics. Atypicals are now being used not just to treat acute mood episodes or control psychotic episodes, but also for maintenance. I personally dont really like antipsychotics, but some people love them, so its a personal thing. Abilify is the newest and the one I like the most. You can take anywhere from 5mgs-30mgs daily, usually as one dose at night. It tends to be pretty much non-drowsy; mixed with antidepressants, it can be "activating," mildly stimulating, and very effective against depression. Its also pretty weight neutral; odds are you won't gain or lose weight on abilify. The downsides are start up anxiety, plus the usual problems with antipsycohtics--akathisia, tremor, possible tardive dyskinesia. Geodon is a less-frequently used antipsychotic...its more or less weight neutral, but it does tend to be sedating (its a 2X daily med) and it has induced mania when mixed with antidepressants. Then there's seroquel...great for sleep, also a 2X daily med..can cause weight gain, diabetes, etc....can have antidepressant effects, but they seem much less pronounced than the other atypicals. Zyprexa is the reigning champ of the atypicals; it can cause diabetes and weight gain, but it can also zap some depressive episodes (especially when mixed with antidepressants--hence Symbyax, the zyprexa+prozac combo) and is pretty good at controlling mood long-term. Risperdal and clozapine are also options, but I think those are best used when other options fail. Treatment of bipolar disorder or severe depressive disorders usually involves a mood-stabilizer + WHATEVER. Antidepressant, benzos, stimulants, etc. are all possible add-ons, depending on what exactly your problems are. Good luck!
poster:med_empowered
thread:536587
URL: http://www.dr-bob.org/babble/20050728/msgs/536617.html